Motivational Interviewing Might Reduce Drinking or Drug Use in Some Patients With HIV

Brief clinician advice can reduce self-reported drinking. But more complex patients such as those with HIV infection may require a more intensive intervention. Investigators at a large US health system enrolled in a randomized trial 614 adults with HIV infection who reported drinking ≥3 (≥4 for men) standard drinks on any one day in the past 12 months. Participants were assigned to one of three interventions (all received usual care), the latter two adapted for HIV infection: 1) usual care (in-clinic electronic medical record-prompted screening followed by clinician brief advice to quit or cut down, or a referral for specialty treatment); 2) usual care plus one 45-minute in-person and two 20-minute phone motivational interviewing sessions delivered by research clinicians; or 3) electronically mailed personalized feedback and recommendations for treatment or online resources from the patient’s clinician. The latter two addressed drugs, too. Follow-up was 95% at 12 months.

  • At follow-up, there were no differences in the number of participants drinking ≥4 (≥5 for men) standard drinks in the past month.
  • In a secondary analysis, other drug use was lower in the motivational interviewing group (12%) than in the other two groups (22-23%).
  • Among a sizeable subgroup who reported low importance of reducing drinking (score 1–3 on a 1–10 scale), motivational interviewing was associated with less heavy drinking (9% versus 17% for email and 24% for usual care).

Comments: Overall, this was a null trial regarding effects of emailed feedback or motivational interviewing over brief advice. Secondary and subgroup analyses, however, generate the hypotheses that motivational interviewing might be more efficacious for reducing drug use, and for those who assign lower importance to reducing drinking (the latter being a group consistent with that for whom motivational interviewing was developed).

Richard Saitz, MD, MPH

Reference: Satre DD, Leibowitz AS, Leyden W, et al. Interventions to reduce unhealthy alcohol use among primary care patients with HIV: the health and motivation randomized clinical trial. J Gen Intern Med. 2019 [Epub ahead of print]. doi: 10.1007/s11606-019-05065-9.

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