Presented by Alexander J. Cowell Brief Intervention Costs in Two Populations in the United States: College Students and US Air Force Personnel Presented by Alexander J. Cowell Presented at INEBRIA, Gateshead, UK October 9, 2009

Acknowledgments PI for both is Dr. Janice Brown Air Force College Many colleagues and collaborators at RTI and US Air Force Yuta Masuda and Brendan Wedehase Funding from Department of Defense W81XWH-04-1-0072 College Many colleagues and collaborators at RTI and study site National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health R01 AA014374-02 10/15/2017

Background Intervene with risky drinkers Both populations have problem drinkers Young adults aged 18 to 25 are the age group with the highest rates of heavy alcohol use Air Force population: In 2005, 10.3% of Air Force personnel in the sample reported heavy drinking over the past 30 days (Bray and Hourani, 2007) College population: In 2001, 44% of college students in the sample reported binge drinking (Wechsler et al., 2002) Little known about cost of MI for these groups AF drinking: Bray, RM, and LL Hourani. 2007. "Substance use trends among active duty military personnel: findings from the United States Department of Defense Health Related Behavior Surveys, 1980-2005." Addiction 102, no. 7: 1092-1101. CINAHL Plus with Full Text, EBSCOhost (accessed October 1, 2009). The drinking level and classification was created with an algorithm consisting of eight items that inquired about the frequency of drinking and amount of each type of beverage (beer, wine or hard liquor) and classified respondents into drinking categories ranging from abstainer to heavy drinker. College drinking: WECHSLER, H., LEE, J.E., KUO, M., SEIBRING, M., NELSON, T.F., AND LEE, H. Trends in college binge drinking during a period of increased prevention efforts: Findings from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001. J. Amer. Coll. Hlth 50: 203-217, 2002b. 10/15/2017

Methods: Treatment Groups Air Force 4 bases 3 study arms Treatment as Usual (TAU) A full day of alcohol education and information sessions 6-10 hour session Group MI (GMI) MI in a group of 3 – 5 2-2.5 hour session Individual MI (IMI) Usual MI 0.5-1.5 hour session College 1 university campus 4 study arms Assessment Only No treatment Feedback Feedback report based on participant drinking habits MI Only MI with Feedback 10/15/2017

Methods: Main Study Eligibility Outcomes Preliminary screening Air Force: referral College: at recruitment AUDIT or other screening Exclude dependents Include risky drinkers Outcomes Survey Number of drinking days in past 30 days Number of heavy episodic drinking days in past 30 days Average drinks per drinking day 10/15/2017

Methods: Economic Evaluation Cost Perspective Air Force and client College Cost = P * Q Price From various records Quantity Detailed records of activities Log kept by interventionists 10/15/2017

RESULTS Air Force 10/15/2017

Startup Costs (€2009) 10/15/2017

Time per Intervention (minutes) 10/15/2017

Cost per Client of Providing the Intervention (€2009) 10/15/2017

Cost per Client of Client’s Time and Expenses (€2009) 10/15/2017

Total Cost (€2009) 10/15/2017

RESULTS College 10/15/2017

Trainee Time 10/15/2017

Startup Costs (€2009) 10/15/2017

Time per Intervention (minutes) 10/15/2017

Cost per Intervention (€2009) P-value for FB vs MI is 0.7428 10/15/2017

Cost per Intervention Sensitivity Analysis (€2009) 10/15/2017

Comparing the Two Studies 10/15/2017

Comparison of Start-up Costs 10/15/2017

Comparison of MI Cost Average length of MI Air Force MI: 80 minutes College MI: 33 minutes 10/15/2017

Discussion and Conclusion Similar start-up costs Different implementation costs Next Step: Cost-Effectiveness Evidence for both studies of improvement in outcome Air Force Outcome study has low n and high attrition If value of client time is included, TAU is not likely to be cost-effective College Outcome study has high n and low attrition Sensitivity of conclusions to assumptions made in “feedback only” arm may well affect cost-effectiveness conclusions 10/15/2017