Ultra-brief intervention for problem drinkers Steps to a full intervention trial John Cunningham

What I’m interested in How do people change their behaviour? What tools do clinicians use to motivate this change? Can these tools be applied in different settings to help motivate people who do not come to treatment? How do we demonstrate that these tools are effective?

United Kingdom Final Report For Jim How do you compare to males your age from the United Kingdom? The highlighted slice of the pie chart below is where your drinking fits compared to other males in your age range from the United Kingdom.                                                                                                                                                                                                                                                                                                                                                                                                                                                   Average drinks per week for males aged 20-24 from the United Kingdom. This chart just contains people who drank in the last year. 3

Mailing pamphlets to households Study 1 Mailing pamphlets to households

Randomization by postal walk Household received pamphlet

One-month follow-up - Total drinks in last week

Alberta study: Mailing pamphlets to households

Alberta study: Mailing pamphlets to households Problem drinkers identified on a general population telephone survey Said they were interested in self-help materials Randomly assigned to be sent or not sent ‘Evaluate Your Drinking’ Pamphlet

Six-month follow-up % drinking 5+ drinks/drinking day

Full intervention trial Study 3 Full intervention trial

Why is it needed? Because I am a skeptic Set up implementation to mimic public health initiative Recruit people who are not interested in help seeking Examine mechanisms of change Is it the normative feedback or just receiving a pamphlet?

Study Design 12,200 weekly drinkers to be contacted in RDD telephone survey Identify problem drinkers (AUDIT > 8) Estimated sample, N = 2,440 Recruit for 3- and 6-month follow-ups Estimated sample, N = 1,830 Randomly assign to be sent intervention pamphlet, control pamphlet, or nothing

Explanation provided to participants: “The Centre for Addiction and Mental Health is in the process of mailing a safe-drinking pamphlet to some households in Toronto. I do not know if this pamphlet is being sent to your household, but if you do see it, the six-month follow-up survey will ask about your impressions of the materials.”

Study Results? Predict impact of intervention pamphlet Will it work? Who knows.

References Cunningham, J. A., Wild, T. C., Bondy, S. J., & Lin, E. (2001). Impact of normative feedback on problem drinkers: A small-area population study. Journal of Studies on Alcohol, 62, 228-233. Wild, T. C., Cunningham, J. A., & Roberts, A. B. (2007). Controlled study of brief personalized assessment-feedback for drinkers interested in self-help. Addiction, 102(2), 241-250. Cunningham, J. A., Neighbors, C., Wild, C., & Humphreys, K. (2008). Ultra-brief intervention for problem drinkers: research protocol. BMC Public Health, 8, 298.

Collaborators and Funding Keith Humphreys, Clayton Neighbors, Cameron Wild Sources of Funding: Centre for Addiction and Mental Health National Institute on Alcohol Abuse and Alcoholism Contact: John_Cunningham@camh.net