This study has several important limitations. First, the study sample reflects VA primary care patients with frequent binge drinking who were willing to enroll in a trial in which they would be offered alcohol-related services, limiting generalizability. The prevalence of AUD based on DSM-IV and DSM-5 is likely to be markedly lower in general primary care populations, and may differ in younger and non-research populations. It is also possible that those patients meeting criteria for DSM-IV AUD alone (1 DSM-IV abuse criterion or 2 DSM-IV criteria including legal consequences) were less likely to participate in a research study on alcohol and therefore were not represented in our sample. For example, this could disproportionately impact racial minorities who may be more likely to have legal consequences of drinking [32], but less likely to participate in trials. The recruited sample was also 90% men, who tend have higher rates of AUD than women, and the sample had a relatively high prevalence of mental health symptoms and drug use disorders.
