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 especially 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 percent to 9 percent in the number of people who reported at least one day of unhealthy drinking in the previous month – defined as five or more drinks in a day for men and four of more for women.
The study publishes 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, as well as 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 patients’ 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 first 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 studies 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 three groups.
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 information on 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, and for those with significant alcohol use, referrals to specialty services. Patients who still reported unhealthy drinking six months later were offered additional motivational interviewing calls or emailed feedback.
The patients, whose average age was 49, were predominantly male (97 percent) and taking antiretroviral therapy (97 percent). Some 63 percent were white, 14 percent were Hispanic and 9 percent were black. Roughly 25 percent met the criteria for alcohol dependence, which includes alcohol tolerance, withdrawal symptoms, increased drinking over longer periods, and reduction in social, recreational and occupational pursuits.
The researchers found that all three treatment approaches were helpful in getting participants to reduce their number of unhealthy drinking days. There were no significant differences between the three 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 one 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.
Motivational Interview May Speak to Resistant Drinkers
However, when the researchers looked at the 334 participants who said they placed low importance in reducing their drinking, motivational interviewing was found to have more impact.
The intent is to enhance motivation, so it may speak to those patients who might not indicate that they are ready to cut back, or are ambivalent, but are willing to engage in a discussion about drinking.
At study enrollment, 41 percent of the motivational interview group reported at least one day of unhealthy drinking in the previous month. One year later, it had dropped to 9 percent. This compares favorably with 37 percent and 17 percent respectively in the emailed feedback group, and 38 percent and 24 percent respectively in the usual care group.
The results suggest that motivational interviewing can be an effective tool for people with HIV who were unmotivated or ambivalent about cutting back on their drinking, said Satre, who is also affiliated with the UCSF Weill Institute for Neurosciences.
“The intent is to enhance motivation, so it may speak to those patients who might not indicate that they are ready to cut back, or are ambivalent, but are willing to engage in a discussion about drinking,” Satre said. “In this study, motivational interviewing was delivered by a psychologist, but it is a skill that any health care provider can be trained to use.”
The study is part of ongoing research by Satre and senior author Michael Silverberg, PhD, an epidemiologist at Kaiser Permanente’s Division of Research, that examines the impact of unhealthy drinking and alcohol treatment on people with HIV.
“These are important findings,” said Silverberg, “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.
Co-authors: Paul Volberding, MD, of UCSF; Constance Weisner, DrPH, MSW, of UCSF and Kaiser Permanente Division of Research; Amy Liebowitz, PsyD, Wendy Leyden, MPH, Jennifer O. Lam, PhD, Hannah Jang, PhD, Stacy Sterling, DrPH, of Kaiser Permanente’s Division of Research; Sheryl Catz, PhD, of UC Davis; Bradley Hare, MD, of Kaiser Permanente San Francisco Medical Center; Kendall Bryant, PhD, of the National Institute on Alcohol Abuse and Alcoholism; and Michael Horberg, MD, of Kaiser Permanente Mid-Atlantic States.
Funding: The study was funded by the National Institute on Alcohol Abuse and Alcoholism.
Disclosures: The authors report no conflicts of interest.
UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals – UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – as well as Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. UCSF faculty also provide all physician care at the public Zuckerberg San Francisco General Hospital and Trauma Center, and the SF VA Medical Center. The UCSF Fresno Medical Education Program is a major branch of the University of California, San Francisco’s School of Medicine.