Substance use and drinking outcomes in Personalized Cognitive Counseling randomized trial for episodic substance-using men who have sex with men?,??
Introduction
Alcohol and substance use are prevalent among men who have sex with men (MSM). Based on National HIV Behavioral Surveillance (NHBS) data, 42% of MSM used substances recreationally in the past year (Sanchez et al., 2006). Moreover, National Household Survey on Drug Abuse (NHSDA) data show that MSM have higher lifetime prevalence of substance use and higher prevalence of “dysfunctional” use (i.e., having any symptoms of drug dependence) relative to other men in the United States (Cochran et al., 2004). NHBS data also suggest that among MSM, heavy episodic drinking (“binge-drinking”), defined as having five or more drinks on a single occasion, exceed rates reported for the general population (Finlayson et al., 2011, Centers for Disease Control and Prevention, 2012).
It is important to note, however, that most alcohol and/or substance-using MSM (SUMSM) do not meet criteria for dependence (Colfax et al., 2004, Santos et al., 2011); only 5.7% of MSM have drug dependence syndrome in NHSDA (Cochran et al., 2004). Nevertheless, alcohol and/or substance use have important public health implications in their own right: 4.8% of the global burden of disease and 2.9 million deaths attributed to alcohol and drug use in 2010 (Lim et al., 2012). Moreover, use of alcohol/substances are independently associated with HIV-related sexual risk behaviors, as well as HIV seroconversion among MSM (Drumright et al., 2006, Koblin et al., 2006, Ostrow et al., 2009, Sander et al., 2013, Vosburgh et al., 2012). This may be compounded by the limited number of evidence-based behavioral interventions for non-dependent substance users; none of which are efficacious among MSM (Centers for Disease Control and Prevention, 2013). Although brief behavioral interventions, such as motivational interviewing have shown promise in addressing substance and alcohol abuse in the general population (Baker et al., 2001, Baker et al., 2005, Daeppen et al., 2011, Smedslund et al., 2011), efficacy of brief interventions is less compelling among MSM (Colfax et al., 2010, Morgenstern et al., 2009). Given the high prevalence of non-dependent substance use patterns among MSM, there is a great need to develop brief interventions that may be more suitable to this population than traditional intensive treatment programs for abuse/dependence.
We previously reported that the evidence-based Personalized Cognitive Counseling (PCC) intervention (Dilley et al., 2007), adapted for episodic SUMSM (Knight et al., 2013), was associated with significant reductions in number of unprotected anal intercourse (UAI) events with most recent non-primary partners among a subgroup of non-dependent participants (Coffin et al., 2014), compared to rapid HIV testing only. As a secondary data analysis, we sought to evaluate whether PCC added to rapid HIV testing had collateral effects on alcohol/substance use outcomes among episodic SUMSM.
Section snippets
Study design
This is a secondary data analysis testing the efficacy of PCC in reducing alcohol and substance use outcomes. The study, Project ECHO, was conducted in San Francisco, CA from May, 2010 to May, 2012 (clinicaltrials.gov = NCT01279044; trial ended when target enrollment accrued and planned 6-month follow-up completed). Study procedures were approved by the institutional review board for the University of California, San Francisco.
Study methods have been reported elsewhere (Coffin et al., 2014).
Results
The study recruited a diverse sample of 326 SUMSM (47% white, 26% Latino/Hispanic, 11% Asian/Pacific Islander, 10% black/African American, and 6% mixed/other race). Mean age was 33.6 years, and 71% attended some/finished college. Participant baseline characteristics in the two arms were similar (see Supplementary Table).
Discussion
We observed significant intervention effects for several substance use outcomes. Specifically, abstinence from alcohol, marijuana, and EDD significantly increased while frequency of alcohol intoxication, as well as UAI events while intoxicated with methamphetamine significantly decreased among men receiving PCC, compared to controls. These intervention effects occurred among episodic SUMSM not seeking treatment to stop or reduce their substance use, but interested in participating in a study to
Role of funding source
Nothing declared.
Author contributors
Agree with the manuscript’s results and conclusions: all co-authors Designed the experiments/the study: G.C., M.D., T.M., G.M.S., J.D., E.V., J.H. Analyzed the data: G.M.S., E.V. Collected data/did experiments for the study: T.M., E.D. Enrolled patients: E.D., T.M. Managed the project: G.C., P.C., M.D., T.M. Acquired funding: G.C., M.D., T.M. Interpreted data: G.M.S., E.V., P.C., M.D., T.M., E.D., J.D., J.H., J.R., M.C. Wrote the report: G.M.S., P.C., J.H., T.M. Revised the report: G.M.S.,
Conflict of interest
No conflict declared.
Acknowledgements
We acknowledge all of the study participants who volunteered for this project, Project ECHO facilitators and staff (Erin Antunez, Reggie Gage, Alic Shook, Rand Dadasovich, Shannon Huffaker, Deirdre Santos and Kelly R. Knight), the recruitment coordinator, John Farley, and field recruitment team.
Supported by the Centers for Disease Control and Prevention under cooperative agreement UR6PS000684 to Public Health Foundation Enterprises, City of Industry, CA.
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Supplementary material can be found by accessing the online version of this paper at http://dx.doi.org and by entering http://dx.doi.org/10.1016/j.drugalcdep.2014.02.015.
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The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.