Brief Intervention for Substance Use is Not Associated with Reductions in Aggression or Sexual HIV Risk Behaviors

Aggression and risk-taking behaviors often arise from intoxication. The authors hypothesized that a brief intervention (BI) targeting substance use in young South Africans would also be associated with reductions in aggression (physical and verbal) and sexual HIV risk behaviors (e.g., transactional sex, multiple partners). The trial enrolled 403 participants with substance use recruited from a community health center for primary care in Capetown, South Africa, who were randomized to receive nurse practitioner-delivered BI plus a list of resources, or the list plus usual care.

  • At baseline, 52% of participants reported risky alcohol use,* while 20% reported illicit use of cannabis, 0.3% cocaine, 9% methamphetamine, and 1.4% sedatives. Most participants denied engaging in aggressive activities (61%), and had 1 or 2 sexual HIV risk behaviors (70%).
  • The BI was associated with decreases in alcohol consumption but not other substances.
  • The BI group did not experience a reduction in aggression or sexual HIV risk behaviors compared with the control group.
  • Participants who reduced their substance use were less likely to report engaging in aggressive activities at follow-up. This was true for both the intervention and control groups, in the full sample and the subsets that reported risky substance use and risky alcohol use. This effect was not seen for HIV sexual risk behaviors.

* Defined as medium or high risk use on the Alcohol, Smoking and Substance Involvement Screening Test.


Since the majority of individuals did not report engaging aggressive activities at baseline, future studies might benefit from a more sensitive instrument to detect lower levels of aggression, or focus on individuals engaged in more frequent aggressive activities. Lack of impact of substance use reduction on sexual HIV risk behaviors may also be related to low levels of risk-taking at baseline. Furthermore, HIV sexual risk-taking behaviors are often multifactorial, and may not be as directly related to intoxication as aggression.

Jessica S. Merlin, MD, MBA


Ward CL, Mertens JR, Bresick GF, et al. Screening and brief intervention for substance misuse: does it reduce aggression and HIV-related risk behaviours? Alcohol Alcohol.2015 ;50(3):302–309.

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