Almost half of active-duty military members in the United States — 47 percent — were binge-drinkers in 2008, up from 35 percent a decade earlier. Rates of heavy drinking also rose during that period, according to a 2012 by the Institute of Medicine. But many in the military avoid seeking help for alcohol abuse, fearing disciplinary action or other repercussions, and few soldiers are referred for evaluation or treatment.

“If you’re in the military and you seek substance abuse treatment, your commanding officer is notified and it goes on your medical record and your military record. That’s a huge barrier,” said , director of the at the 91̽�� School of Social Work.

Not surprisingly, there is little research on what type of treatment is most effective for active-duty military members. To shed new insight on that question and remove obstacles to seeking treatment, Walker and a team of researchers tested a telephone-based intervention geared specifically to military members struggling with alcohol abuse — with promising results.

The , published online Oct. 13 in October in the , found that participants in the telephone intervention significantly reduced their drinking over time, had lower rates of alcohol dependence and were more likely to seek treatment.

The trial involved 242 military members at Joint Base Lewis-McChord in western Washington, who were recruited through advertisements and informational booths at military events. All met the criteria for alcohol use disorder, though none were enrolled in treatment programs.

Participants had an initial interview by phone to assess their daily and monthly alcohol consumption. They were also asked a series of questions about the consequences of their drinking — for example, whether it had impacted their physical training or interfered with their ability to fulfill their duties.

Then participants were randomized to a treatment or control group. The control group received educational information about alcohol and other drug use, while the treatment group got a one-hour personalized intervention session over the phone that used “motivational interviewing,” a goal-oriented approach intended to help people make positive behavioral changes.

“The intervention really connects their behavior with their values and goals and wants for themselves,” Walker said. “It’s a safe place to talk confidentially and freely with someone on the other end who is compassionate and non-judgmental.”

The counselors also asked participants about their alcohol consumption versus that of their peers, to gauge whether excessive drinking was in part spurred by normative perceptions about alcohol use in the military.

“The army has a culture of drinking, so there’s a heightened sense among soldiers that their peers are drinking more than they actually are,” said , project director for the study and a 91̽��doctoral student in social work.

“When those perceptions are corrected, it can have a strong effect, as heavy-drinking soldiers often reduce their intake to more typical levels.”

Follow-up interviews were conducted three and six months after the sessions and showed significant decreases in both drinking rates and alcohol dependence. Intervention group participants went from drinking 32 drinks weekly on average to 14 drinks weekly after six months, and their rates of alcohol dependence dropped from 83 to 22 percent. Alcohol dependence also decreased in the control group, from 83 to 35 percent.

“Those are pretty dramatic reductions in drinking, particularly for one session with a counselor,” Walker said. “That was really encouraging.”

Participants increasingly sought treatment over time; by the six-month follow-up, nearly one-third of soldiers in both groups had made some move toward seeking treatment, such as discussing substance abuse concerns with an army chaplain or making an appointment for treatment intake. While the intervention led to more dramatic decreases in drinking, providing educational information may be enough to prompt some to take a first step toward making a change, the researchers said.

Walker and Walton attribute the intervention’s success to its convenience and confidentiality. Participants could enroll without fear of their superiors finding out — recruitment materials made it clear that military command was not involved — and could schedule the phone calls at their convenience.

“Some did the session on their lunch breaks or in the garage while their family was in the house,” Walker said. “They didn’t have to walk into a building that says ‘army substance abuse program.’ It was private and a low-burden intervention.”

And though the military offers substance abuse programs, Walker said, many soldiers avoid seeking help and are not referred to treatment until their problems reach a crisis point.

“People who get into army substance abuse programs are often mandated to go or have gotten into trouble,” she said. “That leaves out a huge proportion of the population who are struggling and not doing well.”

That reality and the protracted conflicts in Iraq and Afghanistan, Walker said, have intensified the need for additional options to help soldiers grappling with substance abuse and other problems. Telephone-based counseling, she said, is a cost-effective way to encourage military members to seek help confidentially, without the barriers of more traditional approaches.

“This intervention has the potential to be used for soldiers and military personnel worldwide. It would really help fill the gap in service provision that is currently available to soldiers.”

Co-authors are Clayton Neighbors, professor of psychology at the University of Houston ; , a 91̽��professor of psychiatry and behavioral sciences; Lyungai Mbilinyi, research social scientist at RTI International; Jolee Darnell, program manager of the Army Substance Abuse Program; Lindsey Rodriguez, an assistant professor at the University of South Florida, St. Petersburg; and , professor emeritus at the 91̽��School of Social Work. The study was funded by the U.S. Department of Defense.

For more information or a copy of the study, contact Walker at ddwalker@uw.edu or 206-543-7511.

The , an organization in the 91̽��School of Social Work, is recruiting people 18 and older for a free marijuana and tobacco treatment trial. The study is aimed at adults who are regularly using both substances, want to quit marijuana and are willing to consider kicking the tobacco habit as well.

This group tends to struggle when it comes to quitting marijuana. Rates of tobacco use are high among regular cannabis users — between 40 and 90 percent, depending on the study and the population — and people who seek treatment for marijuana use who are also smokers tend to have poorer outcomes and higher relapse rates, principal investigator said.

“We have some indication that people coming into treatment using both tobacco and pot don’t do as well in treatment as folks who only use marijuana, so how do we better help them?” said Walker, director of the Innovative Programs Research Group. “If we also focus on tobacco smoking while they’re trying to quit using marijuana, will that improve outcomes?”

Trial participants will be randomly divided into two groups, one to receive treatment for tobacco concurrently with marijuana treatment for 12 weeks, and the other to be treated for marijuana first for 12 weeks, followed by another 12 weeks of tobacco treatment. Participants must come to an office in the University District twice weekly and have their urine tested for THC and other drugs.

Each marijuana-negative sample is rewarded with a Visa cash card, with the amount increasing for each consecutive marijuana-free sample. Participants who are successfully able to quit marijuana and provide negative samples can earn up to $435.

The trial uses a mix of and therapy. After an intake screening assessment with a researcher and a brief counseling session, the treatment is delivered primarily via computer. Participants complete weekly interactive sessions on a computer that are intended to increase motivation and teach skills to help meet their goals. The approach was developed by , a professor of psychiatry at Dartmouth College, who is conducting the trial in partnership with the UW.

Walker worked on a with Budney that tested the computerized treatment with an in-person version and found there was little difference in outcomes between the two approaches. Web-based treatments are less costly and more convenient, she said, and can provide access in settings where counselors may not be as available.

“It opens up a wide array of places where you can try to intervene with people — primary care settings, juvenile justice or other places where you can capture people in waiting rooms,” she said. “You can have them working on a computer, getting assessed and getting feedback, and if needed, getting referrals for additional treatment.”

The Innovative Programs Research Group, which focuses on providing early interventions for youth and adults struggling with behavioral issues, conducted a separate 2010 trial for people who wanted to quit marijuana and recruited more than 70 participants within weeks.

“Our phone was ringing off the hook,” said Lauren Matthews, project director for the current trial.

But that was before Washington and Colorado in 2012 became the first two states in the nation to legalize and regulate recreational marijuana use. Matthews said participants in the earlier trial seemed primarily motivated by the feeling that their pot use was out of control, rather than the drug’s illicit status.

As legalize marijuana, Walker said there is concern that cannabis is increasingly perceived as harmless. Some marijuana users are easily able to quit, she said, but others struggle and may experience withdrawal symptoms such as sleeplessness, irritability and loss of appetite. According to the , almost 4.2 million people in the U.S. abused or were dependent on marijuana in 2014, and studies suggest that 9 percent of users will become dependent at some point.

“There’s a segment of the population that has a really tough time quitting or cutting down, and even with treatment, quitting appears just as hard as with other substances including alcohol,” Walker said.

People interested in participating in the study, which is funded by the National Institute on Drug Abuse, can contact Matthews at uwmatts@uw.edu or 206-616-3235.