Eight drinks over a 30-day period would not qualify as high-risk alcohol use for many people, but that level represents problematic use for HIV-positive patients, possibly compromising the effectiveness of antiviral medications and leading to risky sexual practices. A study being launched at the University of Houston will evaluate whether accurate and personalized alcohol use information delivered to HIV patients can increase their motivation to reduce drinking.
Funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the study will evaluate the effect of one interactive, computer-based intervention lasting around 30 minutes, by reviewing patient outcomes one and three months post-intervention. The interactive program will help patients gain a more accurate picture of drinking patterns in others who carry similar health risks.
“By giving them personalized feedback, we may help them understand their personal relative risk related to drinking,” says Michael Zvolensky, who directs the university's Anxiety and Health Research Laboratory/Substance Use Treatment Clinic. “We also offer them concrete strategies for reducing use.”
The marginalized HIV population often fails to access accurate health information, so these individuals are particularly susceptible to embracing behavior change strategies that don't work. The idea behind the concept to be studied in this latest research, Zvolensky tells Addiction Professional, involves borrowing from motivational enhancement theory in sharing relevant information about risk behaviors as a tool for motivating patient change.
Zvolensky, who says the research team has been piloting this intervention for about a year, offered a description of how the study will unfold. Adult HIV patients ages 18 to 50 will be randomized to a group receiving the personalized intervention or a control group receiving standard education about health behaviors but not in a personalized fashion.
All of the HIV patients will meet criteria for problematic drinking, with a minimum of eight drinks consumed in the past 30 days. The patients will also be assessed at baseline for factors such as mental health issues and HIV medication compliance.
The computer program for the intervention group, developed in-house by university researchers, will be delivered to patients at their HIV clinic. The patients will wear headphones and will respond to prompts from the computer voice; they are required to engage in the “conversation” or the program doesn't move forward.
They will be asked questions about the levels of high-risk behaviors they believe others are engaging in, Zvolensky says. Accurate answers will be validated by the computer voice, while answers that reflect the common belief that others are being more high-risk than they actually are (which then justifies patients' own high-risk actions) will be met with educational information in a non-confrontational way. “This is not a scare tactic,” Zvolensky says.
Given the motivational aspect of the program, he says, some of the key outcomes that will be evaluated will include whether participation increases patient self-efficacy for change and motivation to reduce drinking. The researchers also will examine actual drinking behaviors, as well as sexual risk practices and adherence to HIV medications.
The researchers will be able to tease out the active components of the intervention to determine what most influences patient behavior, Zvolensky says.