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Drinker's Check-up

Drinker's Check-up (DCU) is a computer-based brief intervention designed to help problem drinkers reduce their alcohol use and alcohol-related consequences. The program targets individuals along the continuum of problem drinking from hazardous use (e.g., binge-drinking college students) to alcohol dependence (e.g., individuals presenting for specialized alcohol treatment). DCU is based on the principles of brief motivational interviewing and is sensitive to the individual's readiness to change. DCU's core elements are characterized by the acronym FRAMES: Feedback is personalized, Responsibility for changing is left with the individual, Advice to change is given, a Menu of options for changing is offered, information is provided in an Empathetic style, and Self-efficacy is emphasized. The program consists of integrated assessment, feedback, and decisionmaking modules. Following the completion of the assessment and feedback modules, users are prompted to review information and exit the program, complete a second decisional balance exercise, or negotiate goals and develop a plan for change, depending on the individual's reported readiness to change. DCU is available as a Windows program for use by health care providers, therapists, and treatment programs and as a Web application for use by the general public. The Windows version includes a companion Follow-up DCU (FDCU) program for conducting follow-up data collection and evaluating treatment outcomes. DCU can be used as a stand-alone intervention or as a precursor to more intensive alcohol treatment.

Descriptive Information

Areas of Interest Substance abuse treatment
Outcomes Review Date: February 2008
1: Alcohol use
2: Alcohol-related consequences
3: Symptoms of alcohol dependence
4: Motivation for change
Outcome Categories Alcohol
Treatment/recovery
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Hispanic or Latino
White
Race/ethnicity unspecified
Settings No settings were identified by the applicant.
Geographic Locations Urban
Suburban
Implementation History Drinker's Check-up, available since 2003, is currently being used by 22 rural health clinics in New Mexico. Approximately 65 copies of the program have been distributed to other substance abuse treatment providers throughout the country. As of 2007, approximately 2,200 individuals from the United States and other countries, including Australia, Belgium, Canada, India, New Zealand, Singapore, Switzerland, the United Kingdom, and Yugoslavia, have used the online version of DCU.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: February 2008

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Hester, R. K., Squires, D. D., & Delaney, H. D. (2005). The Drinker's Check-up: 12-month outcomes of a controlled clinical trial of a stand-alone software program for problem drinkers. Journal of Substance Abuse Treatment, 28(2), 159-169.  Pub Med icon

Supplementary Materials

Squires, D. D., & Hester, R. K. (2002). Computer-based brief intervention for drinkers: The increasing role for computers in the assessment and treatment of addictive behaviors. Behavior Therapist, 25(3), 59-65.

Squires, D. D., & Hester, R. K. (2004). Using technical innovations in clinical practice: The Drinker's Check-Up software program. Journal of Clinical Psychology, 60(2), 159-169.  Pub Med icon

Outcomes

Outcome 1: Alcohol use
Description of Measures Self-reported 30-day alcohol use data were collected using a self-administered version of the Brief Drinker's Profile and a face-to-face structured retrospective interview. Measures included average drinks per day, average drinks per drinking day, and estimated average peak blood alcohol concentration (BAC), which was based on quantity and rate of consumption, body weight, and gender. Self-report was corroborated by significant others.
Key Findings A study compared an immediate treatment group with a delayed treatment group that received the intervention 4 weeks later. All participants reported significantly reduced drinking levels from baseline to 4 weeks (p < .05) and from 8 weeks to 12 months (p < .05) across all three drinking measures. The reductions in average drinks per day (p < .01), average drinks per drinking day (p = .01), and estimated average peak BAC (p < .05) from baseline to 4 weeks were significantly greater for participants in the immediate treatment group than for those who had not yet received the intervention. From baseline to 4 weeks, the mean effect size averaged over the three drinking variables was large (Cohen's d = 0.93) for the immediate group and small (Cohen's d = 0.21) for the delayed group.

Average drinking levels for both the immediate and delayed treatment groups declined by 50% from baseline to 12-month follow-up. Reductions in drinking levels were associated with a large effect size for the immediate (Cohen's d = 1.05) and delayed (Cohen's d = 0.93) treatment groups.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 2: Alcohol-related consequences
Description of Measures Alcohol-related consequences were assessed using the Drinker's Inventory of Consequences. This 50-item self-report scale evaluates alcohol-related consequences during the past 3 months in areas of interpersonal and intrapersonal functioning, physical health, social responsibility, and impulse control.
Key Findings A study compared an immediate treatment group with a delayed treatment group that received the intervention 4 weeks later. Participants in both the immediate and delayed treatment groups had a significant reduction in reported alcohol-related consequences from baseline to 12-month follow-up (p < .001 for both groups).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 3: Symptoms of alcohol dependence
Description of Measures Symptoms of alcohol dependence were assessed using the Severity of Alcohol Dependence Questionnaire. This 22-item self-report scale evaluates the symptoms of physical withdrawal, affective withdrawal, withdrawal relief drinking, alcohol consumption, and the speed of onset of withdrawal symptoms.
Key Findings A study compared an immediate treatment group with a delayed treatment group that received the intervention 4 weeks later. Participants in both the immediate and delayed treatment groups had a significant reduction in reported symptoms of alcohol dependence from baseline to 12-month follow-up (p < .001 and p < .05, respectively).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.7 (0.0-4.0 scale)
Outcome 4: Motivation for change
Description of Measures Motivation for change was assessed using the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). This 19-item self-report scale comprises three subscales representing recognition of a problem, ambivalence about change, and taking steps to change.
Key Findings A study compared an immediate treatment group with a delayed treatment group that received the intervention 4 weeks later. From baseline to 12-month follow-up, participants in both the immediate and delayed treatment groups had significantly decreased ambivalence about reducing alcohol use (p < .001 and p < .05, respectively). Only the immediate treatment group had significantly increased motivation to take steps to change (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 2.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult) 		52% Male
48% Female 		79% White
13% Hispanic or Latino
5% American Indian or Alaska Native
3% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Alcohol use 3.8 2.8 4.0 2.0 2.0 2.5 2.8
2: Alcohol-related consequences 3.5 3.5 4.0 2.0 1.5 2.5 2.8
3: Symptoms of alcohol dependence 3.0 3.0 4.0 2.0 1.5 2.5 2.7
4: Motivation for change 3.0 3.0 4.0 2.0 1.5 2.5 2.7

Study Strengths

Investigators used widely recognized instruments with established reliability and validity to measure key outcomes. The intervention was delivered through a stand-alone computer program, maximizing fidelity. While each participant used the program, a researcher was present in the room to answer questions, which further enhanced fidelity. Measures of program fidelity included the amount of time taken to complete the program and the amount of time the therapist interacted with the participant.

Study Weaknesses

Because the delayed treatment group received the intervention only 4 weeks after the immediate treatment group, only outcomes assessed during this limited timeframe can be attributed to the intervention with some certainty. Without the use of a lasting control group, potential confounding variables cannot be addressed. Attrition was high, and the reliance on list-wise deletion to handle missing data was not optimal. Statistical analyses could have been strengthened by an intent-to-treat approach.
Readiness for Dissemination
Review Date: February 2008

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Drinker's Check-up Web version, http://www.drinkerscheckup.com/

Hester, R. K. (2004). Drinker's Check-up & Follow-up Drinker's Check-up [CD-ROM]. Albuquerque, NM: Behavior Therapy Associates.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
3.5 4.0 4.0 3.8

Dissemination Strengths

Program materials are offered in an online and offline computer format for individuals and organizations. Instructions for installing the software are provided. The self-directed nature of the program makes additional training unnecessary. The program format ensures fidelity, and outcome measurement tools are provided to support quality assurance.

Dissemination Weaknesses

Implementation of this program requires that users be computer literate.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Drinker's Check-up on CD-ROM $500 Yes (either CD-ROM or Internet version is required)
Drinker's Check-up, Internet version Free Yes (either CD-ROM or Internet version is required)
1-day training workshop $3,000 plus travel expenses No
Technical assistance $175 per hour No
Replications

No replications were identified by the developer.
Contact Information

To learn more about implementation or research, contact:
Reid K. Hester, Ph.D.
(505) 345-6100
reidhester@behaviortherapy.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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