INTRODUCTION:Many countries around the world including Australia, New Zealand, England and the United States of America face increasing alcohol use and alcohol-related harms amongst the ageing population. Despite alcohol being linked to diseases such as cancer and dementia, many conventional alcohol harm reduction campaigns don't resonate with older audiences. This qualitative study aimed to investigate what features of alcohol harm reduction campaigns appeal to a middle-aged and older audience. METHODS:In-depth interviews were conducted with 45 Australian participants aged 54-74 years (mean age 62 years, 62% female, 42% drinking beyond national guidelines). Data analysis followed an inductive thematic approach. RESULTS:Participants reflected on the construction of their own drinking identities, provided feedback on six pre-existing alcohol harm reduction campaigns, and expressed their preferences for future campaigns. Some participants felt defensive or conflicted about whether alcohol harm reduction campaigns would be appropriate or effective with their demographic. Despite this, participants broadly endorsed campaigns that employed a more positive tone, provided practical advice, and were delivered by a relatable messenger. DISCUSSION AND CONCLUSION:Findings suggest the use of motivational messaging, as delivered by a non-authoritarian and gender-matched messenger, for future campaigns with this demographic may reduce expressed resistance to health messaging. This large qualitative study generated rich, novel, and nuanced accounts of older adults' perspectives on alcohol harm reduction campaigns.

Introduction Despite the significant harms associated with methamphetamine use both in Australia and globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many barriers to help-seeking; however, their utility for treatment of methamphetamine use disorder is not well understood. This study explored the experiences and perceived impacts of a standalone, telephone-delivered cognitive and behavioural intervention, Ready2Change, for individuals with methamphetamine use disorder.Methods In-depth semi-structured telephone interviews were conducted and analysed using Framework Analysis.Results Twenty-seven participants (mean age = 42.0 years, standard deviation = 10.7, range 27-63) completed an interview. Four major themes arose: (i) Therapeutic connection experienced via telephone; (ii) Telephone format promoting comfort; (iii) Accessing treatment anywhere, anytime; and (iv) Treatment gains via telephone.Discussion and Conclusions Evidence of therapeutic relationships was found in participant accounts of experiencing non-judgemental support from counsellors. However, some participants reported in-person treatment would create a stronger therapeutic relationship. Many participants described a sense of comfort the telephone format afforded them, permitting anonymity and facilitating openness. Participants reported the telephone modality to be highly accessible and convenient, particularly for those with multiple commitments. Participants reported various benefits, including greater insight regarding their methamphetamine use and reduced methamphetamine use. Contrastingly, some participants felt their use was too severe and complex to be treated via telephone. Telephone-delivered interventions represent a potentially valuable initial step in the treatment trajectory for people with methamphetamine use disorder.

Purpose: People who use methamphetamine can experience significant barriers to access treatment, care, and support. This study aimed to explore the experiences of access to care using a conceptual model, for this population. Patients and Methods: This descriptive qualitative study was embedded within an Australian telephone-delivered intervention trial for methamphetamine use problems. Twenty-seven participants were interviewed about their experiences of access to care (prior to enrolment in the trial). Interview transcripts were analysed using framework analysis, and data mapped to a patient-centred access to care framework. Results: Three themes were identified: (1) the "problem" of methamphetamine use; (2) beliefs about treatment; and, (3) the impact of stigma. These themes were aligned to relevant determinants of access to care. Access to care was experienced through participant perceptions about the need for care, the ability to engage in the care process, and the acceptability of service providers. Conclusion: Stigma and beliefs about problematic use, and knowledge of treatment options dominated participants' experiences of access. Clear information about available treatment options, particularly to address fears of engaging in treatment that is viewed as stigmatising, are important considerations for policy makers and service providers.

Aims:To examine pre-pandemic predictors of parent substance use during COVID-19 in Australia, where some of the longest periods of public health restrictions in the world occurred. Methods:We used data from the Australian Temperament Project Generation 3 Study on 560 parents (59% female) who completed COVID-19 specific surveys (2020/2021), including assessment of alcohol, tobacco, and illicit substance use. Comprehensive pre-pandemic assessments were conducted during the postpartum period when offspring turned 1-year of age (2012-2018), including 33 indicators spanning parent and child factors (individual, relational, and contextual). Results:During the pandemic, 39% of parents reported drinking alcohol 3-to-4 days per week or more, 12% used tobacco, and 6% used illicit substances. In Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, a variety of pre-pandemic predictors [k] were identified across alcohol (AUC = 0.72, k = 2; OR = 0.92-2.03), tobacco (AUC = 0.96, k = 10; OR = 0.61-4.21), and illicit substance use (AUC = 0.78, k = 2; OR = 1.44-1.60). The strongest predictors were pre-pandemic use of the same substance (OR = 1.60-4.21). While few other predictors were identified for alcohol and illicit substance use, several family characteristics predicted tobacco use. Conclusions:Results indicated that parents engaging in alcohol, tobacco and illicit drug use in our cohort reported strong continuity of use from before, to during the COVID-19 pandemic in Australia. This highlights the importance of public health initiatives that provide accessible substance use support and treatment options to parents during periods of public health emergencies. Further, enriched population interventions targeted across socioeconomic and family contexts may be important in identifying risk, particularly for tobacco use.

Background: Alcohol harms changed significantly during COVID-19, but did not affect the population equally. Vulnerable groups including people with pre-existing mental health or suicidal behaviors may be at greater risk of alcohol-related harms, yet limited public health data are able to assess these. Methods: The present study utilised a novel, statewide surveillance system to examine ambulance attendances for alcohol intoxication over a four-year period prior to, and during the strictest lockdowns in Victoria, Australia. Results: While there was an overall reduction in alcohol-related attendances during lockdown (n = 15,064) compared to the 2018-19 period (n = 16,989), alcohol- intoxication attendances involving mental health symptoms increased by 40 % in Melbourne (IRR: 1.40 [1.30-1.51], p < 0.001), and by 25 % in regional Victoria (IRR: 1.25 [1.07-1.44], p = 0.005).There was also a 7 % increase in alcohol-intoxication attendances with co- morbid suicidal behaviors in Melbourne (IRR: 1.07 95%CI [1.02-1.13], p = 0.006), and a 21 % increase in regional Victoria (IRR: 1.21 [1.08-1.35], p = 0.001). Conclusions: These findings suggest that extra services and supports for individuals with co-morbid alcohol- related harms are required to ensure their clinical care needs are being met.

There are increasing concerns that digital interventions in healthcare settings could be better designed for scalable and sustained use. Implementation science is the scientific study of how to embed evidence-based interventions in practice. Calls to integrate implementation science and Human-Centred Design methods have focused on integrating design methods within implementation science processes. By contrast, we present a novel approach to integrating implementation science within Human-Centred Design for digital health interventions. Our approach leverages the socio-technical Nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework within the distinct phases of the Double Diamond process. To illustrate our proposal we demonstrate its application in the redesign of a brief health promotion intervention to reduce the risk of alcohol-attributable breast cancer in women attending routine mammography. We discuss reflections on the approach and implications for future research that targets implementation within design.

INTRODUCTION:Helplines are often the first contact with the alcohol and other drug (AOD) treatment system. We examined call data from an AOD helpline in Victoria, Australia, to explore the association between COVID-19 lockdown measures and frequency of calls. METHODS:This was a retrospective analysis of AOD helpline data collected between January 2018 and September 2020, for alcohol, methamphetamine and cannabis use concerns. Linear and logistic regression analyses examined differences in pre-COVID-19 (January 2018 to March 2020) and during COVID-19 (March 2020 to September 2020) caller characteristics, and interrupted time-series analyses examined changes in frequency of calls relative to lockdown measures. RESULTS:There were 14,340 calls for alcohol (n = 10,196, 71.10%), methamphetamine (n = 2522, 17.59%) and cannabis (n = 1622, 11.31%). Relative to pre-COVID-19, during COVID-19 there was an increase in the rate of change over time in number of alcohol calls (b = 0.39), increase in first-time alcohol callers (OR = 1.29), and reduction in first-time methamphetamine callers (OR = 0.80). During COVID-19, alcohol callers had lower Socio-Economic Indicators for Areas scores (b = -3.06) and cannabis callers were younger (b = -2.07). During COVID-19, there were reductions in alcohol calls involving counselling/support (OR = 0.87) and information provision (OR = 0.87), cannabis calls involving information provision (OR = 0.71) and methamphetamine calls involving referral (OR = 0.80). DISCUSSION AND CONCLUSIONS:In the first 6 months of the pandemic, frequency of alcohol-related calls increased over time, and first-time alcohol-related callers increased. The number of calls for cannabis and methamphetamine remained stable. Results suggest the helpline was not used to its full capacity, suggesting a role for further promotion during times of crises.

OBJECTIVES:To assess the effectiveness of a brief alcohol intervention for improving awareness of alcohol as a breast cancer risk factor, improving alcohol literacy, and reducing alcohol consumption by women attending routine breast screening. DESIGN:Single-site, double-blinded randomised controlled trial. SETTING:Maroondah BreastScreen (Eastern Health, Melbourne), part of the national breast cancer screening program. PARTICIPANTS:Women aged 40 years or more, with or without a history of breast cancer and reporting any alcohol consumption, who attended the clinic for routine mammography during 5 February - 27 August 2021. INTERVENTION:Active arm: animation including brief alcohol intervention (four minutes) and lifestyle health promotion (three minutes). CONTROL ARM:lifestyle health promotion only. MAJOR OUTCOME MEASURE:Change in proportion of women who identified alcohol use as a clear risk factor for breast cancer (scaled response measure). RESULTS:The mean age of the 557 participants was 60.3 years (standard deviation, 7.7 years; range, 40-87 years); 455 had recently consumed alcohol (82%). The proportions of participants aware that alcohol use increased the risk of breast cancer were larger at four weeks than at baseline for both the active intervention (65% v 20%; odds ratio [OR], 41; 95% confidence interval [CI], 18-97) and control arms of the study (38% v 20%; OR, 4.9; 95% CI, 2.8-8.8), but the change over time was greater for the active intervention arm (arm × time: P < 0.001). Alcohol literacy also increased to a greater extent in the active than the control arm, but alcohol consumption did not significantly change in either arm. CONCLUSION:A tailored brief alcohol intervention for women attending breast screening was effective for improving awareness of the increased breast cancer risk associated with alcohol use and alcohol literacy more broadly. Such interventions are particularly important given the rising prevalence of risky drinking among middle-aged and older women and evidence that even very light alcohol consumption increases breast cancer risk. REGISTRATION:ClinicalTrials.gov, NCT04715516 (prospective; 20 January 2021).

Background Alerts about changes in unregulated drug markets may be useful for supporting health and community workers to anticipate, prevent, and respond to unexpected adverse drug events. This study aimed to establish factors influencing the successful design and implementation of drug alerts for use in clinical and community service settings in Victoria, Australia. Methods An iterative mixed methods design was used to co-produce drug alert prototypes with practitioners and managers working across various alcohol and other drug services and emergency medicine settings. A quantitative needs-analysis survey ( n = 184) informed five qualitative co-design workshops ( n = 31). Alert prototypes were drafted based on findings and tested for utility and acceptability. Applicable constructs from the Consolidated Framework for Implementation Research helped to conceptualise factors that impact successful alert system design. Results Timely and reliable alerts about unexpected drug market changes were important to nearly all workers (98%) yet many reported insufficient access to this kind of information (64%). Workers considered themselves ‘conduits’ for information-sharing and valued alerts for increasing exposure to drug market intelligence; facilitating communication about potential threats and trends; and improving capacity for effective responding to drug-related harm. Alerts should be ‘shareable’ across a range of clinical and community settings and audiences. To maximise engagement and impact, alerts must command attention, be easily recognisable, be available on multiple platforms (electronic and printable formats) in varying levels of detail, and be disseminated via appropriate notification mechanisms to meet the needs of diverse stakeholder groups. Three drug alert prototypes (SMS prompt, summary flyer, and a detailed poster) were endorsed by workers as useful for supporting their work responding to unexpected drug-related harms. Discussion Alerts informed by coordinated early warning networks that offer close to real-time detection of unexpected substances can provide rapid, evidence-based drug market intelligence to inform preventive and responsive action to drug-related harm. The success of alert systems requires adequate planning and resourcing to support design, implementation, and evaluation, which includes consultation with all relevant audiences to understand how to maximise engagement with information, recommendations, and advice. Our findings about factors impacting successful alert design have utility to inform the development of local early warning systems.

Background Drug alerts designed for health and community workforces have potential to avert acute harms associated with unpredictable illicit drug markets, by preparing workers to respond to unusual drug-related events, and distribute information to service users. However, the design of such alerts is complicated by diverse needs of individuals, and broader socio-political contexts. Here, we discuss the tensions that arose in the process of co-designing drug alert templates with health and community workers.Methods We conducted five in-depth digital co-design workshops with 31 workers employed in alcohol and other drug and urgent care settings. Our approach to analysis was informed by Iterative Categorisation and reflexive thematic analysis methods.Results We identified five key tensions. First, there is a need to provide comprehensive information to meet the information needs of a diverse group of workers with varying knowledge levels, while also designing alerts to be clear, concise, and relevant to the work of individuals. Second, it is important that alerts do not create "information overload'; however, it is also important that information should be available to those who want it. Third, alert design and dissemination must be perceived to be credible, to avoid "alert scepticism'; however, credibility is challenging to develop in a broader context of criminalisation, stigmatisation, and sensationalism. Fourth, alerts must be carefully designed to achieve "intended effects' and avoid unintended effects, while acknowledging that it is impossible to control all potential effects. Finally, while alerts may be intended for an audience of health and community workers, people who use drugs are the end-users and must be kept front of mind in the design process.Conclusions The co-design process revealed complexities in designing drug alerts, particularly in the context of stigmatised illicit drug use, workforce diversity, and dissemination strategies. This study has highlighted the value of developing these important risk communication tools with their target audiences to ensure that they are relevant, useful, and impactful. The findings have informed the development of our drug alert prototypes and provide local context to complement existing best-practice risk-communications literature.

BACKGROUND AND AIMS:Alcohol is a major modifiable risk factor for female breast cancer, with breast cancer risk now associated with substantially lower consumption levels than those previously deemed safe. This study sought to measure risky drinking among women attending breast screening services in Australia according to new national alcohol guidelines and to compare daily, weekly and recent (past 12 months) consumption to Australian gender and age population norms.DESIGN, SETTING AND PARTICIPANTS:This study was a retrospective analysis of cross-sectional data from the Lifepool Project (collected October 2011-January 2016) in Victoria, Australia, comprising a convenience sample of women attending breast screening services aged 40+ years.MEASUREMENTS:Typical and heavy alcohol consumption patterns over the previous 12 months (frequency, quantity), socio-demographic (e.g. age, education) and health-related (e.g. menopause status, breast cancer history) characteristics. Primary outcomes were the proportion of women drinking at a level exceeding new guidelines for weekly and daily alcohol consumption.FINDINGS:Of 49 240 women, mean age was 59.94 years (standard deviation = 7.14, range = 40-94 years). Most women had consumed alcohol during the past 12 months [41 628, 85.48%, 95% confidence interval (CI) = 85.16, 85.79]. One in five women (8464, 18.34%, 95% CI = 17.99, 18.69) were drinking at a level exceeding new national guidelines for weekly consumption (i.e. greater than 10 standard drinks per week), and one in six (7446, 15.60%, 95% CI = 15.28, 15.93) were exceeding new guidelines for consumption on a single day (i.e. greater than four standard drinks on any 1 day, more than once per month). The proportion of women in this sample drinking daily (4.21-11.19%), weekly (34.73-50.71%) and in the past 12 months (74.96-90.81%) was significantly greater among nearly all age groups (by decade), compared with Australian gender and age norms [drinking daily (3.4-9.1%), weekly (27.1-37.6%) and in the past 12 months (64.4-81.9%)].CONCLUSIONS:There appears to be a high prevalence of risky alcohol consumption among a large convenience sample of breast screening service clients in Australia using new national alcohol guidelines introduced in December 2020.

This study reports outcomes from a preliminary study of an online, peer-led support group intervention for family members of people experiencing addiction. A mixed-methods design, comprising within-subjects analysis of intervention data and semi-structured interviews, was used. Seventy-eight participants received the intervention. Participants completed baseline and exit surveys: (i) General Self-Efficacy Scale, (ii) Personal Well-being Index, and (iii) Social Connectedness Scale; and at exit: (i) Client Satisfaction Questionnaire, (ii) Group Sessions Rating Scale, and (iii) Perceived Personal Benefits Scale. Eleven participants were interviewed. There was a significant improvement in mean general self-efficacy for the 23 participants who completed baseline and exit surveys. Most were satisfied with the intervention and reported it to be beneficial. Three themes were identified through a conventional content analysis of interviews: connection with others who share experiences, expertise of facilitators, and accessing support when in crisis. Online peer-led support groups may provide an opportunity for affected family members to share and learn coping strategies.

Aims: Despite the magnitude of alcohol use problems globally, treatment uptake remains low. This study sought to determine the proportion of people presenting to telephone-delivered alcohol treatment who are first-time help-seekers, and explored perceived barriers to help-seeking to understand the barriers this format of treatment may help to address. Methods: Secondary analysis of baseline data from a randomized controlled trial of a telephone-delivered intervention for alcohol use problems. Latent class analysis (LCA) identified participant profiles according to self-reported barriers to alcohol treatment. Results: Participants' (344) mean age was 39.86 years (SD= 11.36, 18-73 years); 51.45% were male. Despite high alcohol problem severity (Alcohol Use Disorder Identification Test: mean = 21.54, SD =6.30; 63.37% probable dependence), multiple barriers to accessing treatment were endorsed (mean = 5.64, SD =2.41), and fewer than one-third (29.36%) had previously accessed treatment. LCA revealed a two-class model: a low problem recognition' class (43.32%) endorsed readiness-for-change and attitudinal barriers; a 'complex barriers' class (56.68%) endorsed stigma, structural, attitudinal and readiness-to-change barriers, with complex barrier class membership predicted by female sex (adjusted OR = 0.45, 95% CI 0.28, 0.72) and higher psychological distress (adjusted OR =1.13, 95% CI 1.08, 1.18). Conclusion: The majority of people accessing this telephone-delivered intervention were new to treatment, yet had high alcohol problem severity. Two distinct profiles emerged, for which telephone interventions may overcome barriers to care and tailored approaches should be explored (e.g. increasing problem awareness, reducing psychological distress). Public health strategies to address stigma, and raise awareness about the low levels of drinking that constitute problem alcohol use, are needed to increase help-seeking.

BACKGROUND:Alcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach.OBJECTIVE:This study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her); to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service; and to examine the implementation strategy through process evaluation.METHODS:This was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11).RESULTS:This research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023.CONCLUSIONS:This study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services.TRIAL REGISTRATION:ClinicalTrials.gov NCT04715516; https://clinicaltrials.gov/ct2/show/NCT04715516.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID):RR1-10.2196/44867.

Background Australia has one of the highest rates of methamphetamine (MA) use in the world; however, uptake of in-person psychological treatment remains extremely low due to numerous individual (e.g. stigma, shame) and structural (e.g. service accessibility, geographical location) barriers to accessing care. Telephone-delivered interventions are ideally placed to overcome many of the known barriers to treatment access and delivery. This randomised controlled trial (RCT) will examine the efficacy of a standalone, structured telephone-delivered intervention to reduce MA problem severity and related harms. Methods This study is a double-blind, parallel-group RCT. We will recruit 196 ± 8 individuals with mild to moderate MA use disorder from across Australia. After eligibility and baseline assessments, participants will be randomly allocated to receive either the Ready2Change-Methamphetamine (R2C-M) intervention ( n = 98 ± 4; four to six telephone-delivered intervention sessions, R2C-M workbooks and MA information booklet) or control ( n = 98 ± 4; four to six ≤5-min telephone check-ins and MA information booklet including information on accessing further support). Telephone follow-up assessments will occur at 6 weeks and 3, 6 and 12 months post-randomisation. The primary outcome is change in MA problem severity (Drug Use Disorders Identification Test, DUDIT) at 3 months post-randomisation. Secondary outcomes are as follows: MA problem severity (DUDIT) at 6 and 12 months post-randomisation, amount of methamphetamine used, methamphetamine use days, methamphetamine use disorder criteria met, cravings, psychological functioning, psychotic-like experiences, quality of life and other drug use days (at some or all timepoints of 6 weeks and 3, 6 and 12 months post-randomisation). Mixed-methods program evaluation will be performed and cost-effectiveness will be examined. Discussion This study will be the first RCT internationally to assess the efficacy of a telephone-delivered intervention for MA use disorder and related harms. The proposed intervention is expected to provide an effective, low-cost, scalable treatment for individuals otherwise unlikely to seek care, preventing future harms and reducing health service and community costs. Trial registration ClinicalTrials.gov NCT04713124 . Pre-registered on 19 January 2021.

ImportanceDespite the magnitude of alcohol use problems globally, treatment uptake remains low. Telephone-delivered interventions have potential to overcome many structural and individual barriers to help seeking, yet their effectiveness as a stand-alone treatment for problem alcohol use has not been established.ObjectiveTo examine the effectiveness of the Ready2Change telephone-delivered intervention in reducing alcohol problem severity up to 3 months among a general population sample.Design, Setting, and ParticipantsThis double-blind, randomized clinical trial recruited participants with an Alcohol Use Disorders Identification Test (AUDIT) score of greater than 6 (for female participants) and 7 (for male participants) from across Australia during the period of May 25, 2018, to October 2, 2019. Telephone assessments occurred at baseline and 3 months after baseline (84.9% retention). Data collection was finalized September 2020.InterventionsThe telephone-based cognitive and behavioral intervention comprised 4 to 6 telephone sessions with a psychologist. The active control condition comprised four 5-minute telephone check-ins from a researcher and alcohol and stress management pamphlets.Main Outcomes and MeasuresThe primary outcome was change in alcohol problem severity, measured with the AUDIT total score. Drinking patterns were measured with the Timeline Followback (TLFB) instrument.ResultsThis study included a total of 344 participants (mean [SD] age, 39.9 [11.4] years; range, 18-73 years; 177 male participants [51.5%]); 173 participants (50.3%) composed the intervention group, and 171 participants (49.7%) composed the active control group. Less than one-third of participants (101 [29.4%]) had previously sought alcohol treatment, despite a high mean (SD) baseline AUDIT score of 21.5 (6.3) and 218 (63.4%) scoring in the probable dependence range. For the primary intention-to-treat analyses, there was a significant decrease in AUDIT total score from baseline to 3 months in both groups (intervention group decrease, 8.22; 95% CI, 7.11-9.32; P < .001; control group decrease, 7.13; 95% CI, 6.10-8.17; P < .001), but change over time was not different between groups (difference, 1.08; 95% CI, -0.43 to 2.59; P = .16). In secondary analyses, the intervention group showed a significantly greater reduction in the AUDIT hazardous use domain relative to the control group at 3 months (difference, 0.58; 95% CI, 0.02-1.14; P = .04). A greater reduction in AUDIT total score was observed for the intervention group relative to the control group when adjusting for exposure to 2 or more sessions (difference, 3.40; 95% CI, 0.36-6.44; P = .03) but not 1 or more sessions (per-protocol analysis).Conclusions and RelevanceBased on the primary outcome, AUDIT total score, this randomized clinical trial did not find superior effectiveness of this telephone-based cognitive and behavioral intervention compared with active control. However, the intervention was effective in reducing hazardous alcohol use and reduced alcohol problem severity when 2 or more sessions were delivered. Trial outcomes demonstrate the potential benefits of this highly scalable and accessible model of alcohol treatment.Trial RegistrationANZCTR Identifier: ACTRN12618000828224.