Integrated Stepped Therapy Improves Outcomes for Individuals With HIV and Unhealthy Alcohol Use

Unhealthy alcohol use can be particularly harmful for people with HIV. Integrated stepped treatment (ISAT) is an evidenced-based strategy to collocate tailored care for unhealthy alcohol use into HIV clinics. Contingency management (CM) added to ISAT may also reduce alcohol use. This randomized controlled trial assessed the effectiveness of an ISAT+CM intervention (i.e., management by an addiction physician, motivational enhancement therapy, and CM) compared with treatment as usual (TAU; a health handout and referral to substance use treatment for participants meeting criteria for alcohol use disorder [AUD]). The primary outcome was self-reported abstinence from alcohol consumption in the past 21 days at week 24.

• Participants (N=120) had HIV and unhealthy alcohol use and were mostly male (96 percent) and Black (83 percent); the majority had severe AUD. Of these participants, 83 percent provided data at week 24.
• At week 24, the rates of abstinence in the ISAT+CM group were higher than in the TAU group (posterior mean proportion,* 9.4 percent versus 0.3 percent, respectively).
• In adjusted analyses, the odds of abstinence among participants in the ISAT+CM group were 14 times higher than in the TAU group.
• Individuals in the ISAT+CM group were more likely to receive naltrexone for AUD than those receiving TAU (25 percent versus 5 percent, respectively).

* Defined as “the adjusted proportion of participants reporting abstinence at week 24.”

Comments: This study adds evidence of the feasibility and acceptability of integrated treatment for unhealthy alcohol use in outpatient care, and importantly supports the addition of CM as an effective treatment option. However, these treatments only work if they are offered to patients; efforts to expand access to evidence-based substance use treatment are needed.

Melissa B. Weimer, DO, MCR

Reference: Edelman EJ, Dziura J, Deng Y, et al. Integrated stepped alcohol treatment with contingency management for unhealthy alcohol use among people with HIV: a randomized controlled trial. J Acquir Immune Defic Syndr. 2025;98(1):72–81.