Drinking motives and alcohol intervention for patients with HIV

For individuals with HIV, heavy drinking can interfere with medication adherence and impair liver function. Yet, many individuals with HIV drink heavily. A recent alcohol intervention trial[1] indicated that motivational interviewing (MI) enhanced with HealthCall (consisting of self-monitoring and discussion of drinking data collected through self-monitoring) was effective at reducing drinking in HIV patients. Also using this data, Elliott et al.[2, 3] showed that patients' drinking motives at baseline were associated with both past-year and end-of-treatment drinking. However, it remains unknown: (a) whether motivational interventions also decreased drinking motives, and (b) whether the predictive validity of motives extended to end-of-study (i.e., 12-months post-baseline).

The sample consisted of 254 HIV-infected patients with past-month heavy drinking (78% male; 94.5% minority), participating in a randomized trial of brief alcohol interventions[1]. Participants completed one of three conditions: (a) a DVD educational control; (b) MI only; (c) MI+HealthCall. Patients reported motives, drinking, and alcohol dependence symptoms at baseline, end-of-treatment, and end-of-study.

The intervention conditions evidenced few differences in motives at end-of-treatment (MI+HealthCall evidenced higher drinking due to social pressure, p<0.05), and no differences at end-of-study. However, baseline motives remained predictive of drinking at end-of-study (drinking to cope with negative affect associated with more past-month drinks and dependence symptoms, ps<0.05; drinking due to social pressure with fewer drinks, p<0.01).

Although MI+HealthCall reduces drinking, it does not reduce drinking motives. Individuals participating in MI+HealthCall were more likely to transition to drinking due to social pressure, an indicator of lower-risk drinking[2]. However, motives (particularly drinking to cope) were predictive of alcohol consumption and dependence up to a year later, suggesting their importance in understanding and predicting drinking. Further work should increase attention to drinking motives in alcohol interventions for HIV patients.