Randomized trial to reduce club drug use and HIV risk behaviors among men who have sex with men. A randomized trial of a brief alcohol intervention for needle exchangers (BRAINE). A brief intervention for hazardous drinkers in a needle exchange program. Cluster randomised trial of the effectiveness of motivational interviewing for universal prevention. Telephone-administered motivational interviewing reduces risky sexual behavior in HIV-positive late middle-age and older adults: a pilot randomized controlled trial. Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. A randomized trial of motivational interviewing and feedback with heavy drinking college students. Brief intervention in alcohol-positive traffic casualties: is it worth the effort? Dismantling motivational interviewing and feedback for college drinkers: a randomized clinical trial.
The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for 1 year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p < .02; small to medium effect size). MI did not result in a significant reduction in risky sex relative to education. The results support the use of MI targeting club drug use in at-risk or mildly dependent users not seeking treatment but not in more severely dependent users. MI does not appear effective in reducing risky sexual behavior in this population. To test motivational interviewing (MI) as a brief intervention for reducing alcohol use among needle exchange clients.
                Randomized clinical trial.
                Needle exchange program-Providence, Rhode Island, USA.
                Between 2/98 and 10/99, we recruited 187 AUDIT-positive (>8) active injection drug users.
                Those assigned to a brief motivational intervention (MI) condition received two 1-hour therapist sessions following assessment visits, 1 month apart, focusing on alcohol use and HIV risk-taking.
                Control and MI subjects received identical research assessments at baseline, 1 and 6 months following study enrollment. At 6 months, study outcomes included days of alcohol use measured using the time-line follow-back method.
                Study retention was 96.8% at 6 months. Participants reported an average of 12.0 drinking days at baseline and 8.3 at 6 months. Significant reductions in drinking days were observed in both treatment conditions. We found significant treatment x baseline drinking day interaction effects. Tests for simple main effects were significant for subjects with above median (>9) baseline drinking day frequency, but not for those with below median baseline drinking frequency. Comparisons on dichotomous outcomes provided supporting evidence of treatment efficacy; those in MI were over two times more likely than controls to report reductions of 7 days or more (P < 0.05).
                This study provides the first direct evidence that brief MI can decrease alcohol use among active injection drug users with drinking problems. Heavier drinkers seem best suited for this intervention, but the optimal intensity of treatments and which components of brief intervention are most effective deserve further study. Active injection drug users (IDUs) who are also hazardous alcohol users are at particularly high risk for HIV transmission due to sharing of injection equipment. We recruited AUDIT-positive injectors from the Providence, RI needle exchange program for a randomized clinical trial testing the effect of a brief motivational intervention (MI) on frequency of injection-related HIV risk behavior (IRRB). HIV drug risk behavior was measured as the number of days on which subjects reported sharing works using the 30-day Timeline Followback Method. Overall, 109 subjects reported a mean reduction of IRRB days of 9.1 days from baseline to 6-month follow-up (p <.001). When compared to controls, there was a trend in reduction of IRRB days to zero at follow-up for MI subject (OR = 2.1; 95% CI = 0.9-4.5), and strongly significant reductions in IRRB days across a range of alternative improvement thresholds. Results from this study demonstrate that MI reduces drug-related HIV risk behaviors among active IDUs. As a brief intervention, MI may be a useful adjunct to existing services intended to reduce harm. The prevention of initiation of tobacco, alcohol and drug use is a major societal challenge, for which the existing research literature is generally disappointing. This study aimed to test the effectiveness of adaptation of Motivational Interviewing (MI) for universal prevention purposes, i.e. to prevent initiation of new substance use among non-users, and to reduce risks among existing users.
                Cluster randomised trial with 416 students aged 16-19 years old recruited in 12 London Further Education colleges without regard to substance use status. Individualised MI was compared with standard practice classroom-delivered Drug Awareness intervention, both delivered over the course of one lesson. Prevalence, initiation and cessation rates for the 3 target behaviours of cigarette smoking, alcohol consumption and cannabis use, along with reductions in use and harm indicators after both 3 and 12 months were assessed.
                This adaptation of MI was not demonstrated to be effective in either intention-to-treat or sub-group analyses for any outcome. Unexpected lower levels of cannabis initiation and prevalence were found in the Drug Awareness control condition.
                This particular adaptation of MI is ineffective as a universal drug prevention intervention and does not merit further study.
                Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. By 2014, 50% of all adults living with HIV/AIDS will be 50-plus years of age. This pilot randomized controlled trial assessed the efficacy of two telephone-delivered motivational interviewing (MI) interventions to reduce risky sexual behavior in HIV-infected adults 45-plus years old. Eligible participants reported engaging in at least one occasion of unprotected anal and/or vaginal intercourse in the 3 months prior to study enrollment. Participants were randomly assigned to receive four sessions of telephone-delivered MI, one session of telephone-delivered MI, or no MI. Relative to 4-session MI participants, Controls reported approximately three times as many episodes of unprotected sex at 3- and 6-month follow-up, while 1-session MI participants reported four times as many unprotected sex acts at 3- and 6-month follow-up. No differences in condom use were observed between 1-session MI and Control participants. Additional large-scale studies that evaluate this intervention approach are warranted. This study evaluated the use of a brief motivational interview (MI) to reduce alcohol-related consequences and use among adolescents treated in an emergency room (ER) following an alcohol-related event. Patients aged 18 to 19 years (N = 94) were randomly assigned to receive either MI or standard care (SC). Assessment and intervention were conducted in the ER during or after the patient's treatment. Follow-up assessments showed that patients who received the MI had a significantly lower incidence of drinking and driving, traffic violations, alcohol-related injuries, and alcohol-related problems than patients who received SC. Both conditions showed reduced alcohol consumption. The harm-reduction focus of the MI was evident in that MI reduced negative outcomes related to drinking, beyond what was produced by the precipitating event plus SC alone. Motivational interviewing (MI) is a brief intervention that has been shown to reduce heavy drinking among college students. Because all college studies of MI to date have included a personalized feedback report, it remains unclear which of the components is necessary to produce behavior change. This study evaluated the separate and collective effects of MI and feedback among 122 "binge" drinking college students. Participants were randomized to: (1) MI with feedback, (2) MI without feedback, (3) Mailed feedback only, (4) MI with mailed feedback, or (5) Assessment only control. At an eight-week follow-up, all groups reduced their consumption, peak BAC, consequences, and dependence symptoms. For females, there were reductions in consequences and dependence symptoms in groups that received feedback, as compared to groups that did not receive feedback. For females, there was an effect of the feedback on consequences and dependence symptoms, but was no overall effect of MI on any outcome measure. This study aimed at testing the effectiveness of a brief motivational intervention (BI) compared with a minimal intervention (MI) for reducing alcohol consumption in adult, alcohol-positive traffic casualties.
                Patients were recruited at the emergency room of a trauma hospital and screened for alcohol by a qualitative saliva test (positive from a blood alcohol concentration of 0.02 g/l). Positive patients (13.3%) who accepted entering the study were randomly allocated into BI and MI. Baseline assessment was the same for all patients. Blind telephone follow-ups were performed at months 3, 6, and 12, and results were analysed by protocol and by intention-to-treat analysis.
                After 1 year of follow-up, 67% of the patients had reduced their consumption, the percentage of heavy drinkers had dropped by 47%, and 62% of baseline AUDIT-C positive patients (hazardous drinkers) had become negative. Binge drinking dropped significantly (P < 0.05). Results at month 12 were in line with the previous ones.
                The effectiveness of BI compared with MI has not been verified, but a significant reduction in consumption has been observed in the whole sample, without significant differences by type of intervention. The persistence and dimension of changes suggest a real effect of both interventions, although the lack of a pure control group does not allow definitive conclusions. Traffic casualties are in a teachable moments to benefit from easy and cheap interventions. Motivational interviewing (MI) is a counseling style that has been shown to reduce heavy drinking among college students. To date, all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style. This study was a dismantling trial of MI and feedback among heavy-drinking college students. After an initial screen, 279 heavy-drinking students were randomized to (a) Web feedback only, (b) a single MI session without feedback, (c) a single MI session with feedback, or (d) assessment only. At 6 months, MI with feedback significantly reduced drinking, as compared with assessment only (effect size = .54), MI without feedback (effect size = .63), and feedback alone (effect size = .48). Neither MI alone nor feedback alone differed from assessment only. Neither sex, race or ethnicity, nor baseline severity of drinking moderated the effect of the intervention. Norm perceptions mediated the effect of the intervention on drinking. MI with feedback appears to be a robust intervention for reducing drinking and may be mediated by changes in normative perceptions.
There is moderate quality evidence, coming from two trials which suggests that MI is effective in reducing short term viral load and unprotected sexual acts. There is moderate quality evidence from one trial that MI is effective in reducing alcohol use. There is a need for more trials which report on outcomes such as adherence to medication, mortality and quality of life in youth.