Participants

Between August 2016 and August 2018, we assessed 1609 patients receiving care in three primary care clinics and two Women’s Health Clinics in one VHA healthcare system for eligibility. Some patients were referred directly to the study by primary care staff and others were invited by mail after being identified based on past 3-month positive alcohol screens via administrative data. A total of 1417 (88.1%) were excluded from randomization, with 175 participants not meeting inclusion criteria and 1242 participants declining to participate. In total, 192 patients were enrolled and randomized to the Relational Agent + TAU intervention arm (n=95) or TAU arm (n=97). Fifteen were excluded from analyses due to mistakes in eligibility found after randomization, resulting in a final analytic sample of 178 patients (Fig. ​(Fig.11).

CONSORT diagram.

Eligibility criteria were as follows¹: a positive Alcohol Use Disorders Identification Test-C screening (AUDIT-C; ≥ 3 for women and 4 for men¹³ in the last 3 months),² drinking above the NIAAA guidelines within the past 30 days (i.e., > 3/7 standard drinks per day/week for women, > 4/14 drinks per day/week for men),^30,3 current stable phone number and address for follow-up, and⁴ willingness to provide contact information for at least one “locator” (i.e., a person who always knows their whereabouts for follow-up). Exclusion included receipt of substance use treatment in the past 30 days or participation in the usability and feedback part of the study.