Telehealth Treatment of Veterans With Alcohol Misuse at Risk for Cardiovascular Disease (CDA 19-035)

Inclusion Criteria

Inclusion Criteria: * Enrolled in 1 of 3 primary care clinics associated with the Durham VAHCS, as evidenced by at least one outpatient PCP visit recorded in Managerial Cost Accounting (MCA) system. * Diagnosis of hypertension, hyperlipidemia, and/or diabetes mellitus in EHR (ICD-10 codes I10, E78.xx, and E11.xxxx) for at least one year. * Uncontrolled BP (indicated by average outpatient past year systolic BP of \>140/100mmHg). \> 1 measurement required. * Currently prescribed at least one oral medication for hypertension, hyperlipidemia, and/or diabetes mellitus as evidenced by at least one pharmacy refill within the previous year. * Most recent EHR AUDIT-C 5 (suggestive of alcohol misuse). * Self-reported access to any SMS text-capable phone. * Appropriate medication regimen for CVD prevention, screened by research coordinator and reviewed by Matt Crowley, MD (Mentor). Exclusion Criteria: * Current enrollment in another trial for CVD risk reduction or medication adherence specifically. * Current participation in other alcohol misuse treatment programming. * EHR AUDIT-C suggestive of severe alcohol dependence requiring medical treatment, defined as 10-12 for both men and women. * Any recent or impending procedures that would warrant inpatient hospital stays or considerable changes to current medications (e.g., any changes other than altered doses). * Current palliative care or care through a nursing/hospice home. * History of clinically significant alcohol withdrawal symptoms, as evidenced by a score 10 on the CIWA. * Contraindicated medication regimen for CVD prevention, screened by research coordinator and reviewed by Matt Crowley, MD (Mentor).