Reaching Veterans Online for Research and Outreach Efforts

A Brief Online Alcohol Intervention to Increase Access to Care for Veterans

About half of recent American veterans and service members struggling with posttraumatic stress disorder (PTSD), alcohol misuse, and depression do not seek care due to barriers such as limited availability of services or negative beliefs about how helpful treatment would be. Young adult veterans are particularly difficult to engage in care, making them an important focus of this study.

Objective

This study created and tested a brief, single-session, Internet-delivered intervention to reduce problem drinking among veterans. We recruited participants on social media using methods meant to attract hazardous drinkers who are not specifically searching for care.

We designed the intervention to reach a wide range of veterans with unmet treatment needs to help them reduce drinking, prevent alcohol-related consequences, and facilitate treatment initiation. The overarching goal of this project was to help alleviate personal, familial, and societal costs resulting from alcohol misuse in this population.

To meet the main study objective, this study addressed two questions central to improving veteran behavioral health:

1. How do we reach veterans in need of alcohol use care that are not currently receiving it?
2. Once we reach these veterans in need, can we deliver a brief, evidence-based, online program to reduce their alcohol use and related consequences?

Procedures

This study was conducted in two phases, with the goal of developing and testing a very brief online program to reduce heavy alcohol use among young adult veterans in the United States.

In the first phase, we examined how Facebook could be used to reach veterans in the community. Although veterans are an at-risk group for heavy drinking and mental health problems, few seek care. We demonstrated that targeted Facebook advertisements can be used to reach out to veterans and offer them an alcohol reduction program that they likely would not have received otherwise. Using Facebook outreach alone, we recruited a sample of over 1,000 veterans aged 19 to 34 for our study. Approximately 70 percent of these veterans screened positive for possible PTSD, depression, or hazardous alcohol use, yet less than half reported receiving any mental health or substance use care in the past year.

In the second phase, we developed and pilot tested a single-session personalized normative feedback (PNF) intervention for young adult veterans recruited on Facebook to increase the reach of an empirically-based brief alcohol intervention to this population. We developed methods to successfully recruit 784 heavy drinking veterans (seventy-nine percent had not sought substance use care before) and provide them with a brief intervention rooted in strong empirical evidence targeting other tight-knit groups (e.g., college students).

The PNF intervention targeted veterans who greatly overestimate how much their peers drink. These misperceptions influence how much veterans themselves drink.

Young adult male veterans say that they drink 15 drinks per week, and think that others drink 23 drinks per week.

The actual number of drinks per week that others drink are 10.

In the PNF intervention:

• Veterans learned their peers drank far less than they thought. Correcting perceptions leads to less drinking.
• Veterans also learned peers drink less than they themselves do, which serves as a reality check that their drinking may be a problem.

In the month after receiving the brief online PNF intervention, veterans drank approximately eight fewer drinks per week, binge drank approximately three fewer days, and decreased their experience of alcohol-related consequences by approximately 50 percent. These reductions were all significantly different than the control group.

The use of Facebook to reach veterans outside of treatment settings is a novel and innovative contribution of this project. We hope to continue these research efforts by testing the long-term effects of the intervention and examining how this approach can be used to help veterans with heavy drinking and mental health problems, perhaps by increasing their engagement in both in-person and online treatment approaches.

See our Featured Research page for our published research work detailing findings from the study.

Learn More About Phase 1

Funding

This study was funded by grant R34 AA022400 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) awarded to Eric R. Pedersen. The project was housed within RAND Health Care for purposes of project oversight and quality assurance.