Saturday, January 17, 2009

A Randomized Controlled Trial of Goal Choice Interventions for Alcohol Use Disorders Among Men Who Have Sex With Men

This is an article by Jon Morgenstern, a leading scientist/clinician who demonstrates the non-ideological, evidence-based perspective that should guide SAMHSA. People like him could provide the leadership for this organization that we need.

Journal of Consulting and Clinical Psychology
Copyright 2007 by the American Psychological Association
2007, Vol. 75, No. 1

A Randomized Controlled Trial of Goal Choice Interventions for Alcohol Use Disorders Among Men Who Have Sex With Men

Jon Morgenstern
Columbia University

Thomas W. Irwin and Milton L. Wainberg
New York State Psychiatric Institute

Jeffrey T. Parsons
Hunter College and the Graduate Center of the City University of New York

Frederick Muench
Columbia University

Donald A. Bux Jr.
New York State Psychiatric Institute

Christopher W. Kahler
Brown University

Susan Marcus and Jay Schulz-Heik
Mount Sinai School of Medicine

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N - 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n - 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI CBT). Other participants (n - 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.

Keywords: cognitive– behavior therapy, motivation enhancement therapy, alcohol abuse, alcohol dependence, men who have sex with men

Substantial advances have been made in the last 20 years in the development of behavioral interventions to treat alcohol use disorders (AUD). We now have a number of modestly effective interventions, including proven treatments for abstinence as well as moderated drinking goals (Miller & Wilbourne, 2002). Among the important challenges facing treatment research today is finding strategies to improve the potency of existing interventions as well as to extend research to broader, more representative populations, such as those with co-occurring disorders, who might have been excluded from initial efficacy trials. In addition, the majority of individuals with AUD do not seek treatment (National Institute on Alcohol Abuse and Alcoholism, 2000). Thus, it is important to extend well-developed treatment research methodologies to test strategies to engage and treat individuals with AUD who do not typically seek treatment. As described below, the current study addresses these issues in the context of developing and testing a behavioral intervention for men who have sex with men (MSM) with AUD and at high risk for HIV transmission, who were in early phases of readiness to change drinking behavior.

Extending Research on Brief, Moderated Drinking Goal Interventions
Experts have argued that the current specialty care substance use disorder treatment system impedes access to care because it requires a precommitment to abstinence and seeks to place patients in intensive treatments (e.g., Humphreys & Tucker, 2002). More people would seek care if treatments were briefer and allowed for the selection of drinking goals. Although evidence strongly supports the efficacy of brief, moderated goal interventions (Moyer, Finney, Swearingen, & Vergun, 2002), there are some important limitations. Moderated goal intervention studies typically select a limited spectrum of individuals with AUD, often referred to as problem drinkers. These individuals may have mild to moderate alcohol dependence but are relatively socially stable and do not have co-occurring drug use disorders or other significant psychological or social problems. An examination of the efficacy of brief, moderated goal interventions in more problem-prone populations, similar to the vast majority of those currently seeking treatment, is needed. Second, although brief, moderated goal interventions are effective, many individuals continue to drink at hazardous rates following treatment. Thus, it is important to consider whether the potency of these interventions could be improved.

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