A single, 45-minute “motivational interview” with two 20-minute follow-up phone calls may help people with HIV who report unhealthy drinking reduce their alcohol intake. This approach may be particularly effective for those drinkers who are unmotivated or ambivalent about changing, say researchers at UC San Francisco and Kaiser Permanente.
Among participants in the researchers’ study who initially did not feel it was important to reduce alcohol use, motivational interviews resulted in a drop from 41% to 9% in the number of people who reported at least one day of unhealthy drinking in the previous month – defined as 5 or more drinks in a day for men and 4 or more for women.
The study was published June 11, 2019, in the Journal of General Internal Medicine.
Motivational interviewing is used to address behavioral aspects of managing chronic health conditions such as diabetes, high blood pressure and asthma, and addictions. For this study, a psychologist used open-ended questions to determine the patient’s goals for HIV care and overall health, as well as reflective listening, which emphasized the patient’s reasons to cut down, while acknowledging positive aspects of drinking, such as stress relief. The psychologist also voiced support of the patient’s efforts and successes in self-care, such as showing up for doctors’ visits and taking medication as directed.
Alcohol impedes adherence to HIV meds
“For patients in treatment for HIV, excessive alcohol use can be especially harmful,” said lead author Derek Satre, PhD, of the UCSF Department of Psychiatry and Kaiser Permanente Northern California Division of Research. “Drinking can impact medication adherence, which leads to reduced effectiveness and increased antiretroviral resistance. Alcohol use can also contribute to conditions such as liver disease that affect the progression of HIV infection.”
In the study, which is one of the largest to date of people with HIV, 614 primary-care patients at Kaiser Permanente Northern California who reported any problem alcohol use in the past year were divided into 3 groups.
“These are important findings since we found that you can reduce unhealthy alcohol use and related issues in a health care system that already does a lot in this area.”
Michael Silverberg, PhD, Kaiser Permanente Division of Research and the study’s senior author
One group participated in the motivational interview. The second received emailed feedback from a psychologist, via a patient portal, with content tailored to demographics and level of alcohol use. The email included drinking cutoffs, risks of exceeding those cutoffs, and recommendations to limit intake or quit, as well as listings for addiction treatment services. The third group received treatment as usual, which included physician advice to quit or reduce drinking; those with significant alcohol use were given referrals to specialty services. Patients who still reported unhealthy drinking 6 months later were offered additional motivational interviewing calls or emailed feedback.
The researchers found that all 3 treatment approaches were helpful in getting participants to reduce their number of unhealthy drinking days. There were no significant differences among the 3 groups. At the start of the study, participants in the usual-care group reported an average of 3.5 unhealthy drinking days, versus 1.4 unhealthy drinking days 1 year later. This compares with 2.2 unhealthy drinking days at the start of the study for the emailed feedback group and 1.3 a year later; and 3.4 and 1.6, respectively, for the motivational interview group.