Description of the Drinker's Check-up

Assessment Module. When drinkers begin the DCU, they are first asked to complete the Alcohol Use Disorders Identification Test (AUDIT). This allows users to screen themselves and make an informed decision as to whether it might be worth their time to complete the program. Based on Project MATCH data, the program then provides feedback on whether they scored low, medium, high, or very high in terms of their risk and experienced alcohol-related consequences. Individuals whose scores suggest mild problems or higher (8+) on the AUDIT are advised that they might benefit from using the program and are invited to proceed. Registration requires the user's first name, a password, age, gender, weight and height. The latter are used to calculate peak blood alcohol concentrations in the Feedback Module. Because the entire program (Assessment, Feedback, and Decision Making) will take one to two hours to complete, the user has the option of exiting the program at any time and returning at a later point. In practice, however, all clients went through the program from start to finish in one session.

Once registered, users complete an initial decisional balance exercise. A decisional balance is often used as a way to acknowledge ambivalence among those with alcohol problems. This exercise compares the "good things and the not-so-good things" (Miller & Rollnick, 2002) of drinking. Acknowledging that there are things about drinking that the individual likes (the "good things") makes it easier for them to consider and explore the consequences of their drinking (the "not so good things"). In this exercise, users can choose from lists of positive and negative things about drinking or type in their own. When they submit the information, it is saved and brought up later in the Decision Making Module.

A list of assessment questionnaires is also presented. These include the Brief Drinker Profile (BDP), the Drinker Inventory of Consequences, the Severity of Alcohol Dependence Questionnaire, Community Sample (SADQ-C), and Stages of Change Readiness and Treatment Eagerness Survey (SOCRATES). When the program is used as an adjunct to treatment, the health care provider can recommend that a client complete a particular instrument (or combination of instruments) which then show up on the main page highlighted in red. In the web application all questionnaires are highlighted. Once an assessment instrument has been completed, a check mark appears on the screen next to it. By clicking on the check mark, the user can receive immediate feedback for that instrument, or they can wait until they complete all applicable assessments and enter the Feedback Module, which is what most people did.

Feedback Module. The Feedback Module has the most potential for generating resistance and defensiveness in users because they often receive information that is discrepant from their own views of their drinking. Minimizing participants' resistance requires a delicate balance between empathy and confrontation. The program accomplishes this balance by providing a number of automatic links to different forms where it can respond to the most common reactions (I don't understand this sentence). Here is an example of the program's response to a user whose quantity/frequency feedback was higher than he expected

"It can be surprising and (for some) discouraging to see that they fall higher on the alcohol use scale than they expected. Some people think there might be a mistake in the way results are calculated. (Feel free to review your answers in the BDP questionnaire.) Remember that you are being compared to other men for the entire U.S. adult population. Also, it is not uncommon for people to socialize with others who drink the same as -(or more) than they do. Think about which, if any, of these reactions apply to you."

The program also anticipates discrepancies between feedback from different instruments (e.g., heavy drinking compared to the general population but low levels of problems relative to individuals in treatment) and provides links to appropriate responses. In structuring the feedback process, the program offers users a "Guided Tour" option that will literally "walk" them through feedback specific to each of the assessments they completed.

Decision Making Module. Once the user has completed the Feedback Module, they begin the Decision Making Module. This module starts with a "Readiness Ruler." The Readiness Ruler is presented as a slide bar with a pointer that can be clicked and dragged along a continuum from "Not at all Ready" to "Really Ready to Change." The program then branches depending on where the individual indicates he or she is in considering change. If the individual is "Not at all Ready" and has taken all the assessment instruments, then he or she is given the options of printing their feedback summary or of viewing the Project MATCH pamphlet Alcohol and You before exiting the program. If the individual is "Unsure," the program proceeds with a second, more detailed Decisional Balance exercise. If the individual is "Really Ready to Change" the program skips this second decisional balance exercise and proceeds directly to negotiating goals of change and helping the user develop a change plan.

The Decisional Balance Exercise. This is a computerized version of what is used in Guided Self-Change. It asks the user to consider the importance of various aspects of the feedback he or she has received and to rank orderits importance. These reasons for changing are compared to what the user likes about his or her drinking (the "good things" from the initial decisional balance exercise). This results in a two-column form that contrasts the reasons for changing with the reasons for not changing. The user is asked to consider whether the reasons for changing outweigh the reasons for not changing. Once completed, the program again asks the individual to decide whether he or she is ready to change. If the individual is still undecided, the program respectfully asks the user to consider what he or she has learned in the program and to talk about it with close family members and his or her therapist, if appropriate. It also asks the user to consider a series of questions found to be related to long-term sobriety (Fletcher, 2001). In the event that the user is not working in conjunction with apsychotherapist, the program also invites the individual to return and reconsider after having given the matter some thought. If the individual still decides not to change, he or she is offered the exit option. If, however, the decision to change is made, the program then proceeds with negotiating goals of change.

Negotiating Goals of Change. Consistent with the FRAMES components of brief motivational interventions, the DCU offers individuals a menu of options for how they are going to change their drinking and how they can accomplish that goal. Although abstinence is the safest way to avoid alcohol problems, it is often a goal rejected by individuals with less severe alcohol-related problems. If the individual chooses moderation as a goal of change, the program offers to take him or her through a section that defines moderate drinking, contraindications to it, and an offer to take the Michigan Alcoholism Screening Test (MAST) to determine their long-term chances of success with moderation. We included the MAST because of its ability to predict success with moderate drinking 2 to 8 years after training (Miller, Leckman, Delaney, & Tinkcom, 1992).
Developing Alternatives and a Plan of Change. Once users have chosen a goal, the program offers to help them determine how they will achieve and maintain those changes. This section begins with a variation of Miller's New Roads exercise (Miller & Pechacek, 1987) and then proceeds to the Change Plan worksheet used in Project MATCH. At the end of the program, users are presented with a link to our web site (www.behaviortherapy.com) that provides resources to help them achieve their goals. In addition to listing therapists who work with clients seeking to moderate their drinking, we also link to Moderation Management, Self Management and Recovery Training (SMART), and to other self-help materials. Lastly, once the user has completed the program a summary of worksheets and feedback from all completed assessments automatically prints so that they have a hard-copy reference.