Background: Educating physicians and other health care professionals about the identification and treatment of patients who drink more than recommended limits is an ongoing challenge.Methods: An educational randomized controlled trial was conducted to test the ability of a standalone training simulation to improve the clinical skills of health care professionals in alcohol screening and intervention. The "virtual reality simulation" combined video, voice recognition, and nonbranching logic to create an interactive environment that allowed trainees to encounter complex social cues and realistic interpersonal exchanges. The simulation included 707 questions and statements and 1207 simulated patient responses.Results: A sample of 102 health care professionals (10 physicians; 30 physician assistants or nurse practitioners; 36 medical students; 26 pharmacy, physican assistant, or nurse practitioner students) were randomly assigned to a no training group (n ‫؍‬ 51) or a computer-based virtual reality intervention (n ‫؍‬ 51). Professionals in both groups had similar pretest standardized patient alcohol screening skill scores: 53.2 (experimental) vs 54.4 (controls), 52.2 vs 53.7 alcohol brief intervention skills, and 42.9 vs 43.5 alcohol referral skills. After repeated practice with the simulation there were significant increases in the scores of the experimental group at 6 months after randomization compared with the control group for the screening (67.7 vs 58.1; P < .001) and brief intervention (58.3 vs 51.6; P < .04) scenarios.Conclusions: The technology tested in this trial is the first virtual reality simulation to demonstrate an increase in the alcohol screening and brief intervention skills of health care professionals.

Objective: The aim of this study was to test the effi cacy of brief physician advice in reducing alcohol use and related harm in college students. Method: The College Health Intervention Projects (CHIPs) is a randomized, controlled clinical trial with 12-month followup conducted in fi ve college health clinics in Wisconsin; Washington state; and Vancouver, Canada. Of the 12,900 students screened for highrisk drinking, 484 men and 502 women met inclusion criteria and were randomized into a control (n = 493) or intervention (n = 493) group. Ninety-six percent of students participated in the follow-up procedures. The intervention consisted of two 15-minute counseling visits and two follow-up phone calls, and used motivational interviewing, contracting, diary cards, and take-home exercises. Results: No signifi cant differences were found between groups at baseline on alcohol use, age, socioeconomic or smoking status, rates of depression, or measures of alcohol-related harm. At 12 months, the experimental subjects reduced their 28-day drinking totals by 27.2%, and the control group reduced their totals by 21%. A mixed effects repeated measures model found a statistical difference in favor of the brief-intervention group (β = 4.7, SE = 2.0, p = .018) in 28-day drinking totals. The total Rutgers Alcohol Problem Index score was also signifi cantly different during the 12-month follow-up period (β = 0.8, SE = 0.4, p = .033). There was no difference on the other outcome measures of interest, such as frequency of excessive heavy drinking, health care utilization, injuries, drunk driving, depression, or tobacco use. Conclusions: The study supports resource allocation and implementation of alcohol screening and brief physician advice in primary care-based college health clinics. (J. Stud. Alcohol Drugs, 71, 23-31, 2010)

BACKGROUND High-risk alcohol use in persons 18 to 30 years of age is a critical public health problem. It is the number 1 cause of death in this population. This article reports the results of a subanalysis of young adults (aged 18 to 30 years) who participated in Project TrEAT (Trial of Early Alcohol Treatment) conducted in the offi ces of 64 primary care physicians located in 10 counties in southern Wisconsin.METHODS Project TrEAT was a randomized clinical trial designed to test the efficacy of a brief intervention protocol to reduce alcohol use, improve health status, and decrease health care utilization. A total of 226 young adults were randomly assigned to either a usual care or brief intervention group. RESULTSThere were no signifi cant differences between the 2 groups at baseline on a number of potential confounders. During the 4-year follow-up period, there were signifi cant reductions in number of persons drinking more than 3 drinks per day, average 7-day alcohol use, number of persons drinking 6 or more drinks per occasion, and number of binge drinking episodes in the previous 30 days (P <.01 to P <.001). There were also signifi cant differences (P <.05) in emergency department visits (103 vs 177), motor vehicle crashes (9 vs 20), total motor vehicle events (114 vs 149), and arrests for controlled substance or liquor violation (0 vs 8).CONCLUSION In this 4-year subanalysis of young adults who participated in Project TrEAT, we found long-term reductions in high-risk drinking behaviors and consequences. The fi ndings of this study support more widespread implementation of brief interventions in primary care settings.

Brief primary care interventions structured around patient workbooks have been shown to be effective in modifying hazardous drinking behavior. However, the critical ingredients of such interventions are not well understood, possibly contributing to their under-utilization. Seventeen campus-based clinicians trained in a brief, workbook-based alcohol intervention participated in a qualitative study to identify the most promising clinician-patient interaction components within this shared approach, utilizing a focus group with the clinicians and ranking of the 24 workbook ingredients. Based on the clinicians' collective experience, consensus emerged around the perceived strength of five main components: (1) providing a summary of the patient's drinking level, (2) discussing drinking likes and dislikes, (3) discussing life goals, (4) encouraging a riskreduction agreement, and (5) asking patients to track their drinking (on cards provided for this purpose). This is the first paper to examine primary care physician perspectives on potentially critical components of effective brief alcohol intervention. (150 words)