Brief Interventions in the Emergency Department for Alcohol and HIV/Sexual Risk
Condition: Alcohol Consumption; Unsafe Sex
MeSH terms: Emergencies; Alcohol Drinking
Study type: Interventional

Summary: 
      This brief alcohol and sexual risk taking intervention has the potential to influence the
      public health by reducing alcohol use and sexual risk taking behavior in individuals who are
      seeking treatment in an Emergency Department.
    

Detailed description: 
      Linkages between alcohol use and HIV/sexual risk behaviors have been observed in multiple
      groups and each behavior has been successfully treated individually. Indeed, some studies
      suggest these behaviors can be successfully treated together. The Emergency Department (ED)
      provides a venue through which many patients with multiple risks are treated. Yet, to date no
      study has addressed these behaviors together in an ED, where admission may represent an
      opportunistic moment when patients are particularly willing to discuss these risky behaviors.
      Motivational Interviewing (MI) has demonstrated promise with alcohol risk in the ED in
      several of our previous studies, and has shown promise with sexual risk populations as well.
      Accordingly, this study (N=302) will address whether a one session multiple risk MI can more
      effectively decrease and maintain reduction in alcohol use, alcohol related problems, and
      sexual risk taking following discharge from the ED than Brief Advice (BA). Baseline, MI
      Session 1 and BA will be administered in the ED. Follow-ups will be conducted at 3, 6 and 9
      months. This project will allow us to address the next phase of our program of research that
      has been designed to develop easily disseminable treatments for high-risk populations in
      medical settings. This study will also address potential mediators (motivation to change risk
      taking, self-efficacy) of MI effects. We will also examine whether reductions in sexual risk
      associated with MI compared to BA are accounted for by reduced drinking. A tertiary aim will
      examine the moderating effect of co-occurring substance use on outcomes. The
      cost-effectiveness of the interventions will also be addressed. Thus, this study will address
      two significant Public Health problems and provide significant information about MI
      mechanisms that may be relevant to the treatment community.
    

Intervention name(s): Brief Motivational Intervention (BMI); Brief Advice
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The BMI incorporates open-ended exploration, personalized feedback, and discussion about patients' alcohol use and sexual behaviors and the consequences of these behaviors. Using the central principles described by Miller and Rollnick (2002), the goal of the session, conducted in the hospital as soon as possible, is to explore the patient's alcohol use and sexual behaviors and to help patients consider what they might want to change. Also included is a presentation of personalized feedback, and for patients who are interested in change, a focus on establishing goals for reduced drinking and sexual risk abstinence. Collaboratively the counselor and patient develop a plan for the future, identify goals for behavior change, explore barriers to changes, and provide strategic advice.; Patients in the Brief Advice (BA) condition will receive intervention consistent with standard medical practice when alcohol problems or sex-risk behaviors are indicated. Project staff will offer BA about level of alcohol/drug and sexual behaviors and drug problems risk, and will provide a list of treatment resources (including options for HIV testing) in the local area. Patients will be told they show signs of risk associated with alcohol use in that they scored above a cut-score for our alcohol screen, and that they reported recently engaging in sexually risky behaviors. The staff person will advise patients that reducing their alcohol use, and illicit drug use when relevant, and using condoms is advised. BA will take approximately 5 minutes.
Other intervention name(s): BMI; BA
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Brief; Alcohol; Intervention; Sex; Risk