Internet Applications for Screening and Brief Interventions for Alcohol in Primary Care Settings – Implementation and Sustainability

Abstract

Screening and brief interventions head the list of effective evidence-based interventions for the prevention and treatment of alcohol use disorders in healthcare settings. However, healthcare professionals have been reluctant to engage with this kind of activity both because of the sensitive nature of the subject and because delivery is potentially time-consuming. Digital technologies for behavioral change are becoming increasingly widespread and their low delivery costs make them highly attractive. Internet and mobile technologies have been shown to be effective for the treatment of depression, anxiety, and smoking cessation in healthcare settings, and have the potential to add substantial value to the delivery of brief intervention for alcohol. Online alcohol questionnaires have been shown to elicit reliable responses on alcohol consumption and compared with conventional prevention techniques, digital alcohol interventions delivered in various settings have been found to be as effective in preventing alcohol-related harms. The last decade has seen the emergence of a range of approaches to the implementation in health care settings of referral to Internet-based applications for screening and brief interventions (eSBI) for alcohol. Research in this area is in its infancy, but there is a small body of evidence providing early indications about implementation and sustainability, and a number of studies are currently underway. This paper examines some of the evidence emerging from these and other studies and assesses the implications for the future of eSBI delivery in primary care settings.

Predictive validity of clinical AUDIT-C alcohol screening scores and changes in scores for three objective alcohol-related outcomes in a Veterans Affairs population

“…Efforts are under way to improve the quality of alcohol‐related primary care, including implementing preventive screening and brief intervention as well as engaging patients in care for alcohol use disorders (AUD) . As these efforts proceed, health systems need practical, valid approaches to measuring changes in patients’ drinking over time in response to interventions .…”

Improved Designs for Cluster Randomized Trials

“…There is increasing interest in the use of digital technologies to deliver behavioral and mental health interventions, owing to their low delivery costs and tailorability (11,19,57). Strategies such as fractional factorial designs should be more widely considered for such studies because the technology can easily facilitate control over the combination of intervention components delivered.…”

Quality of Smartphone Apps Related to Alcohol Use Disorder

“…Such a result is of interest in a field under development such as e-mental health apps, highlighting the importance of a more interdisciplinary and integrative approach to e-health apps, as well as user involvement in such developments [4,69,71]. …”

“…Assessment feedback was the most commonly developed feature of the self-help options on the apps, likely because of the simplicity of developing this feature and possibly because of its plausibility as a brief intervention study [4,69]. …”

“…Personal and treatment-related barriers, including perceived stigma, contribute to this phenomenon [3]. Internet-based treatments and smartphone apps were suggested as a possible way to improve treatment access among people with AUDs and substance use disorders [4,5]. A number of studies reported that a large proportion of people with mental and substance use disorders appear to be ready to use the Internet and smartphone apps for health purposes [6,7,8,9,10,11].…”