Alcohol Reduction Interventions Research Articles

Prevalence of hepatitis coinfection and substance use among antiretroviral therapy clinic clients with hazardous alcohol use in Vietnam.

The confluence of injection drug use (IDU), alcohol consumption, and viral hepatitis increases morbidity among persons living with HIV (PWH). We present a secondary analysis of a randomized controlled trial of alcohol reduction interventions in Thai Nguyen, Vietnam conducted between 2016-2018. We assessed hepatitis B (HBV) and hepatitis C (HCV) coinfection among PWH reporting hazardous alcohol consumption and examined differences in IDU and alcohol use by coinfection status. Participants were ≥18 years old, living with HIV, and reported hazardous alcohol consumption per the WHO Alcohol Use Disorders Identification Test Consumption (AUDIT-C; score ≥4 for men, score ≥3 for women). At enrollment, participants were tested for hepatitis coinfection with HBV surface antigen tests and rapid serological HCV tests. Demographic information, IDU, and recent alcohol consumption were assessed via behavioral survey and 30-day timeline follow back. Fishers Exact and Kruskal-Wallis tests were used for statistical testing. Hepatitis coinfection was common among the 440 enrolled PWH: HCV: n = 355 (81%); HBV: n = 5 (1%); HBV and HCV: n = 37 (8%). Only 10% (n = 43) of participants had no hepatitis coinfection. Among those who tested positive for HBV, 36% had previously been diagnosed with HBV; among those who tested seropositive for HCV, 18% had previously received an HCV diagnosis. History of IDU was higher among those with hepatitis coinfection (HBV or HCV coinfection: 88%; HBV and HCV coinfections: 97%) than those without hepatitis coinfection (7%; p<0.01). Median days of alcohol consumption in the last 30 days was higher among those with coinfection (HBV or HCV coinfection: 20 (Interquartile Range (IQR): 10-30); HBV and HCV coinfections: 22 (IQR: 13-28) than those without hepatitis coinfection (10; IQR: 6-21; p<0.01). The syndemic conditions of HIV, hepatitis, IDU, and alcohol use are deeply entangled and challenging to parse out. Integrated health services are warranted to reduce the risk of liver-related morbidity.

A self-efficacy enhancement alcohol reduction intervention for men on-remand in prison: the APPRAISE feasibility pilot RCT.

As many as 70% of remand prisoners have admitted to being under the influence of alcohol when committing the crime leading to their imprisonment. Providing support and advice regarding alcohol consumption can be effective in some groups of people. There is little evidence regarding this for men on remand in prison. To pilot the study measures and evaluation methods to assess the feasibility of conducting a future definitive multicentre, pragmatic, parallel group, randomised controlled trial. A two-arm, parallel group, individually randomised pilot study of a self-efficacy-enhancing psychosocial alcohol intervention to reduce levels of alcohol consumption for males on remand in prison and on liberation. Two purposively selected prisons in Scotland and England. Adult men on remand in prison with an Alcohol Use Disorders Identification Test score of ≥8. The APPRAISE intervention delivery comprised four steps: Step 1: 1×40-minute face-to-face session, delivered by a trained practitioner from Change Grow Live in prison. Steps 2, 3 and 4: 20-minute sessions conducted by phone, on or as close as possible to days 3, 7 and 21 post liberation. Control: assessment, screening and referral onto further alcohol support options. Recruitment and retention rates, completion of follow-ups, outcome measures at 12 months and interventions delivered. The primary outcome for the pilot study was alcohol consumed in the 28 days prior to Time Point 2, assessed using the extended Alcohol Use Disorders Identification Test-C. Of 182 men on remand approached across two study sites, 132 were randomised (90 in England; 42 in Scotland) with 46 randomised to intervention and 44 to care as usual in England and 22 randomised to intervention and 20 to care as usual in Scotland. A total of 53 in-prison interventions were delivered. One day-3 post-liberation intervention was delivered, no day-7 and one day-21. At 12 months, of 132 randomised, 18 (13%) were followed up, 53 (40%) were not liberated; 47 (36%) were uncontactable and 14 (11%) had been released but could not be located. Data completeness was 96% at baseline and 8% at 12 months. The process evaluation reported good acceptability of the intervention with investment in time, capacity and space to support implementation identified. The economic study produced guidance on how to assess costs associated with implementing the APPRAISE intervention which could be applied more broadly. No adverse events or side effects were noted. A future definitive trial would be possible, but only if follow-up mechanisms can be addressed as well as full access to recidivism and health data. Collaboration with the probation service in future could offer the opportunity to develop a robust process and system to optimise follow-up post liberation. Dedicated resources to support the intervention delivery both in and out of the prison setting are recommended. Coronavirus disease discovered in 2019 impacted recruitment and follow-up, with access to prisons restricted. We were unable to deliver the post-liberation element of the intervention. We did not include probation services or other agencies in the trial. This trial is registered as Current Controlled Trials ISRCTN36066. This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: 17/44/11) and is published in full in Public Health Research; Vol. 12, No. 11. See the NIHR Funding and Awards website for further award information.

The effectiveness of reduction in alcohol consumption achieved by the provision of non-alcoholic beverages associates with Alcohol Use Disorders Identification Test scores: a secondary analysis of a randomized controlled trial

BackgroundThe Alcohol Use Disorders Identification Test (AUDIT) is commonly used in clinical settings to assess the severity of alcohol-related problems, with the effectiveness of alcohol reduction interventions varying across this spectrum. In a recent study, we demonstrated that a 12-week intervention involving the provision of free non-alcoholic beverages reduced alcohol consumption among heavy drinkers for up to 8 weeks post-intervention. However, it remains unclear whether this effect was consistent across different AUDIT score ranges. Therefore, this secondary analysis aimed to examine whether the severity of alcohol-related problems, as indicated by AUDIT scores, influences the effectiveness of non-alcoholic beverage provision in reducing alcohol consumption.MethodsThis was a single-center, open-label, randomized, parallel-group study. Participants were Japanese individuals who frequently consumed large quantities of alcohol (at least 40 g/day for men and 20 g/day for women) but were not diagnosed with alcohol dependence. Participants were randomly assigned to either an intervention or control group. The intervention group received free non-alcoholic beverages once every 4 weeks over a 12-week period (24 bottles of 350 mL per case, up to three cases per session, for a total of three sessions). Alcohol and non-alcoholic beverage consumption over the previous 4 weeks was tracked using a drinking diary. For this secondary analysis, participants were categorized into four groups based on their AUDIT scores (group 1: ≤ 7 points, group 2: 8–11 points, group 3: 12–14 points, and group 4: ≥ 15 points), and changes in alcohol consumption were compared across these groups in both the intervention and control participants.ResultsThe provision of non-alcoholic beverages significantly increased non-alcoholic beverage consumption in all groups. However, alcohol consumption was significantly reduced in the intervention groups compared to controls only in groups 1–3. The reduction in alcohol consumption was less pronounced in groups 3 and 4 compared to group 1 (both, p < 0.05). Importantly, the provision of non-alcoholic beverages did not lead to an increase in alcohol consumption, even among individuals with higher AUDIT scores.ConclusionsThese findings suggest that individuals with higher AUDIT scores may experience a reduced benefit from a 12-week non-alcoholic beverage intervention in terms of alcohol consumption reduction. Nevertheless, this intervention appears to be a safe and effective strategy for reducing alcohol consumption in heavy drinkers who do not have alcohol dependence.Trial registrationUMIN UMIN000047949. Registered 4 June 2022.

Alcohol Interventions on Online Grocery Shopping Platforms

Introduction &amp; BackgroundThere is opportunity to engage light to moderate drinkers in alcohol reduction interventions as a preventative measure. In the space of online grocery shopping there is an added challenge in intervention development in the form of deceptive patterns, which influence consumer behaviour in unhealthy ways including automating behaviour and encouraging overconsumption. Objectives &amp; ApproachThe objectives of this study are to: 1) identify deceptive patterns in the online grocery shopping context, 2) develop interventions which support healthier decision making in this context, 3) apply those interventions to appropriate product categories. The method utilised in the first objective is heuristic analysis which was conducted across eleven major online grocery shopping platforms. The interventions were then developed using the Rapid Iterative Testing and Evaluation (RITE) method, which involved interviewing participants and iterating upon the inventions after every interview. Each interview was analysed using content analysis. When incorporating the interventions into the online grocery shopping environment, interviews were conducted to gain insight into drinking and purchasing habits of consumers. These final interviews were then analysed with inductive thematic analysis. Relevance to Digital FootprintsDigital Footprints underpin the entire intervention development space. The background of the project is built upon human shopping and interaction behaviour online when encountering deceptive patterns. These deceptive patterns have been established using mobile gaming micro-transaction data, online grocery shopping log-in and rewards data, among other data sources. Digital Footprints data can further support the findings from the thematic analysis by further showing cultural and social trends around drinking (e.g., increased purchasing of seasonal beers and ciders in the summer and during sporting tournaments). The purpose of the drinking identified through those social and cultural trends gauge the appropriateness of proposed alcohol interventions. Beyond this, digital footprints data around engagement with health and wellness promoting applications (e.g., active users and app downloads) provides greater insight into the types of health messaging that garner attention and can be used to further inform how to approach those currently outside the health-engaged group. Digital footprints serve to attach larger societal trends to the smaller-scaled interviews and thematic analysis conducted as part of the study. ResultsInitial findings have shown opportunities for nudging light to moderate drinkers who primarily consume beer, wine, or cider. Spirits have been identified as difficult to substitute due to a lack of substitution options in the low alcohol spirit category that are widely available on the consumer market via online grocery retailers. Conclusions &amp; ImplicationsWithout significant change, costs to the National Health Service (NHS) in alcohol related harm are set to rise by over 1 billion GBP. Alcohol consumption is a public health risk and there are opportunities to utilise digital footprint informed interventions to engage the public in preventative interventions.

Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial.

Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701. DERR1-10.2196/53684.

"When a man drinks alcohol it's cool but when a woman drinks she is a hoe": A qualitative exploration of alcohol, gender, stigma, and sexual assault in Moshi, Tanzania.

Alcohol's ever-increasing global use poses a distinct threat to human well-being, with intake and associated burdens rising especially quickly in low- and middle-income countries like Tanzania. Prior research has shown alcohol use and related consequences differ by gender in Moshi, Tanzania, with important implications for both clinical care and future alcohol-reduction interventions. This study builds upon this knowledge by providing a deeper understanding of how gender differences affect alcohol-related stigma and sexual assault among Emergency Department (ED) and Reproductive Health Center (RHC) patients at Kilimanjaro Christian Medical Center (KCMC) in Moshi. In-depth interviews were conducted among ED and RHC KCMC patients (n = 19) selected for participation via purposive sampling. A mix of inductive and deductive coding schemes was used to identify themes and subthemes. All data were analyzed through a grounded theory approach. Gender roles that linked men with financial responsibilities and women with child caretaking led to different expectations on alcohol intake, with alcohol use encouraged for men but vilified for women. Women who drank, for example, were deemed poor mothers and undesirable spouses. Patients likewise emphasized that both alcohol-related stigma and sexual violence disproportionately impacted women, the latter fueled through alcohol use, with serious and lasting acts of discrimination and isolation from community members seen among women alcohol users but not for men. Women alcohol users in Moshi are subject to severe social consequences, facing disproportionate stigma and sexual violence as compared to men. Alcohol-related treatment for women should be mindful of the disproportionate burdens present in this context while treatment for men should be cognizant of the social pressures to drink. Strategies to address and/or mitigate these factors should be incorporated in subsequent care and interventions.

Does Reducing Alcohol Use Among People with HIV Alleviate Psychological Distress and Symptoms of Depression? A Randomized Controlled Trial in Tshwane, South Africa

Although alcohol use is associated with depression, it is unclear if brief alcohol reduction interventions can ameliorate depression and psychological distress among people with HIV (PWH). We use data from a two-arm randomised controlled trial to examine this question. PWH on antiretroviral treatment (ART) were randomly assigned to receive a brief intervention or treatment as usual (n = 622). Screening was done with the Alcohol Use Disorders Identification Test (AUDIT), AUDIT-C, Centre for Epidemiological Studies Depression inventory and Kessler Psychological Distress Scale, at baseline and at 3- and 6-months post-baseline. Changes in depression and psychological distress was assessed using analysis of covariance models with baseline measures of alcohol consumption, sex and age included as covariates and adjusting for baseline symptom severity. Changes in alcohol consumption between baseline and follow-up were included in the analysis to establish if this affected outcomes. For both the intervention and control groups, there were significant reductions in symptom severity at 3-months and 6-months for depression and psychological distress, but no significant between group differences were observed. Reductions in alcohol consumption were significantly associated with reductions in depression and psychological distress, supporting the hypothesis that alcohol use is linked to depression among PWH.Trial Registration Pan African Clinical Trials Register, PACTR201405000815100.nh

Shouldn’t We Know This Already? UK Women’s Views About Communicating the Link Between Alcohol Consumption and Risk of Breast Cancer

ABSTRACT Alcohol is a causal factor in about 10% of breast cancer (BCa) cases, but awareness of this link is low. This study explored how to raise awareness and inform the development of an intervention using the COM-B model (capability, opportunity, motivation, behavior) framework. Eight online focus groups were conducted with 36 participants (6 expert stakeholders,and 30 women aged 40–65). Participants reflected on a package of information about alcohol and BCa and discussed how to impart this information and encourage women to reduce drinking. Thematic analysis of focus group transcripts was undertaken. Three themes were identified: understanding ineffective messaging; transitions and challenges; and message acceptability. Current health information about alcohol was perceived as judgmental and BCa was put down to chance. Mid-life consisted of many challenges that could lead to increased consumption, but menopause transition may be a key moment for alcohol reduction. Barriers and enablers to communicating risk information and encouraging alcohol reduction were mapped onto the COM-B model. Psychological capability (relating to knowledge), social opportunity (in the form of social pressure) and automatic motivation (relating to drinking to cope) were barriers to behavior change. These will be targeted in an alcohol reduction intervention. It is important to tailor information to women’s experiences, taking into account the social benefits of drinking, and encourage the development of healthy coping strategies. Acceptable intervention messages may include personal stories, clear statistics, and suggest healthy alternatives to drinking. It is vital that messaging does not appear judgmental or patronizing.

Understanding Patients’ Experiences with a Brief Alcohol Reduction Intervention among People Living with HIV in Uganda: A Qualitative Study

Background: Brief alcohol reduction interventions for people living with HIV (PLWH) have resulted in mixed findings with some studies showing null or limited treatment effects. To better understand factors that may contribute to their success or failure, this qualitative study sought to explore participants’ experiences in a randomized trial (RCT) of a brief counseling-based alcohol reduction intervention, including challenges that may have impeded alcohol reduction. Methods: We conducted in-depth semi-structured interviews with 24 PLWH engaging in unhealthy alcohol use, who were enrolled in an RCT to reduce alcohol consumption conducted in southwestern Uganda in 2019–2020 (NCT03928418). We used a collaborative thematic approach to analyze data from transcribed and translated audio recordings. Results: Perceived benefits of the intervention included increased awareness of alcohol use and its impact on personal finances, the relationship between alcohol use and violence, and a commitment to drinking reduction. Participants experienced several barriers to decreasing their alcohol use, including: prevailing social norms about alcohol use, lack of social support, and economic and social consequences of the COVID-19 pandemic. Conclusion: Factors in the immediate contexts of PLWH in low-income settings, including social norms influencing alcohol consumption and lack of social support, may impede the impact of alcohol reduction interventions, especially during times of stress such as the COVID-19 pandemic.

Validation of the combined Patient Health Questionnaire Anxiety and Depression Scale among people with HIV in Vietnam.

Our study aims to examine the factor structure, validity, and reliability of the combined scale Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) among people with HIV (PWH) in Vietnam. Baseline data from an alcohol-reduction intervention trial among ART clients in Thai Nguyen, Vietnam were used for this analysis (n = 1547). A score ≥10 on the PHQ-9, GAD-7 and PHQ-ADS scale was considered having clinically meaningful depression, anxiety and distress symptoms. Factor structure of the combined PHQ-ADS scale was validated using confirmatory factor analysis, and three models were tested: a one-factor, a two-factor, and a bi-factor model. Reliability and construct validity were examined. The prevalence of clinically meaningful depression and anxiety symptoms was 7% and 2%, respectively, while 19% had distress symptoms. A bi-factor model had the best fit to the data (RMSEA = 0.048; CFI = 0.99; TLI = 0.98). The Omega index of the bi-factor model was 0.97. The scale showed good construct validity through negative associations between depression, anxiety, distress symptoms and quality of life. Our study supports the use of a combined scale to measure general distress for PWH, which has good validity, reliability and is unidimensional enough to justify the use of a composite depression and anxiety score.

Efficacy of alcohol reduction interventions among people with HIV as evaluated by self-report and a phosphatidylethanol (PEth) outcome: protocol for a systematic review and individual participant data meta-analysis

IntroductionUnhealthy alcohol use is associated with a range of adverse outcomes among people with HIV (PWH). Testing the efficacy and promoting the availability of effective interventions to address unhealthy alcohol...

"My Family Was Also Happy": Couples' Qualitative Reports of a Combined Behavioral Economics and Cognitive Behavioral Therapy Intervention to Reduce Alcohol Use and Intimate Partner Violence.

Improving intimate partner violence interventions requires understanding pathways to change among couples participating in these interventions. This article presents qualitative data from 18 males and 16 females who participated in a combined behavioral economics (contingency management) and cognitive behavioral therapy alcohol and violence reduction intervention trial in Bengaluru, India. Results confirmed several theorized pathways of change, as well as identified further mechanisms through which the intervention supported the change. These included the emotional impacts of incentives, perceived and actual accountability via breathalyzers and family involvement, and enhanced support gained through counseling skills. Findings reveal critical insights into intervention design for future implementation.

Self-reported alcohol use versus phosphatidylethanol in behavioral trials: A study of people living with HIV in Tshwane, South Africa.

Accurately quantifying alcohol use among persons with HIV (PWH) is important for validly assessing the efficacy of alcohol reduction interventions. We used data from a randomized controlled trial of an intervention to reduce alcohol use among PWH who were receiving antiretroviral therapy in Tshwane, South Africa. We calculated agreement between self-reported hazardous alcohol use measured by the Alcohol Use Disorders Identification Test (AUDIT; score ≥8) and AUDIT-Consumption (AUDIT-C; score ≥3 for females and ≥4 for males), heavy episodic drinking (HED) in the past 30 days, and heavy drinking in the past 7 days with a gold standard biomarker--phosphatidylethanol (PEth) level (≥50 ng/mL)--among 309 participants. We used multiple logistic regression to assess whether underreporting of hazardous drinking (AUDIT-C vs. PEth) differed by sex, study arm, and assessment time point. Participants' mean age was 40.6 years, 43% were males, and 48% were in the intervention arm. At 6 months, 51% had PEth ≥50 ng/mL, 38% and 76% had scores indicative of hazardous drinking on the AUDIT and AUDIT-C, respectively, 11% reported past 30-day HED, and 13% reported past 7-day heavy drinking. At 6 months, there was low agreement between AUDIT-C scores and past 7-day heavy drinking relative to PEth ≥50 (sensitivities of 83% and 20% and negative predictive values of 62% and 51%, respectively). Underreporting of hazardous drinking at 6 months was associated with sex (OR = 3.504. 95% CI: 1.080 to 11.364), with odds of underreporting being greater for females. Steps should be taken to decrease underreporting of alcohol use in clinical trials.

Alcohol use as a mediator of the effect of two alcohol reduction interventions on mental health symptoms of ART clients in Vietnam

ABSTRACT We aimed to examine the mediating role of alcohol use in the pathway from the interventions to depression and anxiety symptoms using data from a randomized controlled trial among people living with HIV (PWH) with hazardous alcohol use (n = 440) in Thai Nguyen, Vietnam. Participants were randomized into either a combined intervention (CoI), a brief intervention (BI) and a standard of care arm. Both interventions were based on cognitive behavioral therapy and motivational enhancement therapy. Alcohol use was measured as the percentage of days abstinent from alcohol in the last 30 days. Symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. Alcohol use was a significant mediator of the effects of two alcohol interventions on depression symptoms, but not anxiety symptoms. There were significant indirect effects via alcohol use of both interventions on depression symptoms at 12 months (CoI: mean difference (MD) = −0.134; 95%CI: −0.251, −0.035); (BI: MD = −0.141; 95%CI: −0.261, −0.038). There were no significant direct or total effects of the interventions on either symptoms at 12 months. Interventions with a dual focus on mental health and alcohol disorders are needed to determine optimal ways to tackle these common comorbidities among PWH.

Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong.

Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151.

Correlates of high phosphatidylethanol (PEth) levels and their concordance with self-reported heavy alcohol consumption among men who have sex with men who binge drink alcohol.

Heavy alcohol use, including binge drinking, is associated with high morbidity and mortality among men who have sex with men (MSM). Self-reported alcohol measures may lead to inaccurate estimates due to recall and social desirability biases. Objective alcohol biomarkers like phosphatidylethanol (PEth) can be used to corroborate self-report and could help to inform treatment approaches and research strategies for alcohol using MSM. From 2015 to 2020, alcohol using MSM ≥18 years were enrolled in a randomized controlled trial evaluating the efficacy of naltrexone in reducing binge drinking. Using this trial's baseline data, we applied multivariable logistic regression to identify the correlates of high PEth levels (i.e., ≥87 ng/ml) and concordance between PEth levels and self-reported heavy drinking. Of 118 MSM, 64% had PEth levels ≥87 ng/ml and 72% had PEth levels that were concordant with self-reported heavy alcohol use. Factors significantlyassociated in separate models with elevated PEth levels were income ≥$60,000 (adjusted odds ratio [aOR]=4.09; 95% CI=1.13 to 14.82), being employed (aOR=4.04; 95% CI=1.45 to 11.32), episodic cannabis use (aOR=4.63; 95% CI=1.27 to 16.92), and any alcohol/substance use prior to or during anal intercourse (aOR=2.52; 95% CI=1.08 to 5.90). Living with HIV was associated with significantly lower odds of elevated PEth levels (aOR=0.23; 95% CI=0.09 to 0.61). Factors associated with significantly higher concordance between PEth levels and self-reported heavy alcohol use included at least weekly use of poppers (aOR=6.41; 95% CI=1.27 to 32.28) and polysubstance use (aOR=2.53; 95% CI=1.02 to 6.27). Living with HIV was associated with lower odds of concordance (aOR=0.36; 95% CI=0.14 to 0.97). PEth may enhance the detection of heavy drinking among MSM, including the identification of subpopulations that may benefit from targeted alcohol reduction interventions. However, PEth values for MSM living with HIV showed modest concordance with self-reported alcohol use and may need to be supplemented with additional biomarkers or evaluated against a different cutoff.

Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial.

BackgroundAlcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF.ObjectiveTo address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties.MethodsWe performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants’ motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score.ResultsBetween October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by –10.5 (95% CI –19.5 to –1.5) units in the control arm and –28.2 (95% CI –36.9 to –19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of –3.9 (95% CI –6.2 to –1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial.ConclusionsThis study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans.Trial RegistrationClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9fInternational Registered Report Identifier (IRRID)RR2-10.2196/19720

Situational and motivational factors associated with unhealthy alcohol use among Russian women with HIV and hepatitis C Virus co-infection

IntroductionAlcohol use is prevalent among Russian women with HIV and hepatitis C Virus (HCV) co-infection despite alcohol's known harmful health effects for this population. Identifying factors that facilitate continued unhealthy alcohol use is critical to developing effective alcohol reduction interventions. This study assessed situational and motivational factors associated with unhealthy alcohol use among HIV/HCV co-infected women in clinical care in St. Petersburg, Russia. MethodsGuided by the motivational model for alcohol use, we conducted 30 semi-structured interviews with women living with HIV/HCV co-infection to identify situational and motivational factors associated with unhealthy drinking and barriers and facilitators to abstaining. Interviews were recorded and analyzed using a thematic analysis approach. ResultsDespite awareness of the health risks associated with alcohol use, many women reported heavy episodic drinking, particularly in social situations. A key motive for drinking was coping with negative emotions triggered by stressful situations, such as work- and family-related conflicts. Key situational factors included drinking with family and friends and in social situations. Women who endorsed negative drinking coping motives were the most motivated to stop drinking. Health concerns were also cited as reasons to stop drinking; however, few women reported that their doctors recommended that they abstain. ConclusionsSeveral situational and motivational facilitators of alcohol use and barriers to alcohol reduction were identified, as well as some opportunities for prevention, among women in care for HIV in Russia. Awareness-raising and training regarding the adverse consequences of alcohol use among persons with HIV/HCV co-infection should include clinicians, patients and relatives.

Binge Drinkers Shouldn’t Set Their Own Alcohol Reduction Goals! Evaluating the Effectiveness of Different Goal-Based Alcohol Reduction Interventions among Young People

ABSTRACT The present research aimed to investigate the relative effectiveness of three types of alcohol reduction intervention. Participants were 354 university students from an Australian university. After completing an initial survey, they were randomly assigned to either (a) follow national guidelines for alcohol consumption, (b) set their own personal alcohol consumption reduction goal, or (c) work with their peers to set a goal. Participants then recorded their alcohol consumption in a drinking diary over a period of four weeks. The results showed that participants in the personal goal condition reported significantly higher alcohol consumption than those in the national guidelines conditions, with participants in the group goal condition reporting mid-level alcohol consumption. This effect was moderated by binge drinking propensity. Personal goal setting was most likely to lead to higher alcohol consumption when participants scored relatively high on measures of binge drinking propensity. These findings highlight the point that different types of alcohol reduction interventions may be effective for different types of people. In particular, people who have a relatively high propensity for binge drinking should be encouraged to follow goals that have been set by authorities (e.g., national guidelines) rather than by themselves.

Effects of Alcohol Reduction Interventions on Blood Pressure.

Much of alcohol's purported negative impact on a population's health can be attributed to its association with increased blood pressure, rates of hypertension, and incidence of cardiovascular disease (CVD). Less attention, however, has been placed on the association of the positive impact of alcohol reduction interventions on physical health. This review delineates the evidence of blood pressure reductions as a function of alcohol reduction interventions based on current care models. The findings of this review suggest two things: (1) sufficient evidence exists for a relationship between alcohol reductions and blood pressure generally, and (2) little evidence exists for the relationship between alcohol reductions and blood pressure for any one care model currently employed in the health system. The evidence base would benefit from more studies using established alcohol reduction interventions examining the impact of these interventions on blood pressure.