Intensive Motivational Interviewing for Heavy Drinking among Women

Investigating the unique service and treatment needs of women with alcohol use disorder: Literature review and key informant perspectives in British Columbia

Alcohol Use Disorder (AUD) is a medical condition uniquely affecting the female population, requiring widespread restructuring of current services to increase treatment utilization and efficacy. This review synthesizes the literature on the service and treatment needs of women with AUD. A literature search and review were conducted following PRISMA guidelines. Key informant information was collected during interviews with health leaders. Data from literature searches and interviews were analyzed to identify common themes. Results found women face more barriers when accessing and receiving AUD treatment. Major barriers include stigma, location, transportation, and childcare, which contribute to the AUD treatment gap among women. Recommendations to reduce barriers include (1) implementing universal screening, (2) improving care provider education and awareness, (3) providing childcare services, (4) establishing a strong client-clinician relationship, (5) building a community approach for Indigenous clients, (6) improving Managed Alcohol Programs, and (7) expanding virtual substance use prescribing practices.

Psychosocial Interventions for Alcohol and/or Drug Misuse and Use Disorders in Women: A Systematic Review

Background: Although men and women who misuse substances have different needs, no rigorous systematic literature review has been conducted examining psychosocial substance use interventions for women across a broad range of types of therapeutic approaches and populations. Materials and Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to guide this review. English language, peer-reviewed research articles indexed in PubMed, PsycINFO, CINAHL Complete, and Web of Science through May 6, 2021, were searched. Peer-reviewed articles were included in the review if they were written in English; described a randomized controlled trial of a psychosocial intervention to reduce substance misuse and related problems in women; and reported quantitative data on alcohol or illicit drug use as an outcome that was linked to the interventions. Results: A total of 51 articles met eligibility criteria, reflecting a broad array of interventions with different levels of methodological rigor. Several, but not most, interventions were tailored to meet the needs of specific subgroups of women, but evidence regarding the efficacy of tailoring was inconclusive. Overall, 61% of studies reported one or more positive substance-related intervention effects, with target substance (alcohol only vs. other drugs only or both alcohol and other drugs) and intervention dosage associated with intervention success. Conclusions: Fewer studies targeting alcohol only reported one or more positive intervention outcomes. This warrants further study, given that polysubstance use is the norm, not the exception. Future research might also focus on reducing treatment barriers to women, as this has the potential to improve overall treatment outcomes for this population.

Characteristics of women with alcohol use disorders who benefit from intensive motivational interviewing

BACKGROUND

Women with alcohol disorders have more severe problems related to their drinking than men. They have higher mortality from alcohol-related accidents and enter treatment with more serious medical, psychiatric, and social consequences.

Objective: This study assessed the effects of Intensive Motivational Interviewing (IMI), a new, 9-session counseling intervention for women with drinking problems.

Methods: A randomized clinical trial was conducted with 215 women. Most were white (83%), college educated (61%), and older (mean age 51). Half received IMI and half a standard single session of MI (SMI) along with an attention control (nutritional education).

Results: Generalized estimating equations models showed women who were heavy drinkers at baseline in the IMI condition reduced heavy drinking more than those in the SMI condition at 2-, 6-, and 12-month follow-up. Analyses of disaggregated subgroups showed IMI was most effective for women with low psychiatric severity, more severe physical and impulse control consequences associated with drinking, and higher motivation. However, formal 3-way interaction models (condition by moderator by time) showed significant effects primarily at 2 months.

Conclusions: Improvements associated with IMI were limited to heavy drinking and varied among subgroups of women. Studies of women with more diverse characteristics are needed.

A descriptive analysis of concurrent alcohol and substance use among patients living with HIV/HCV co-infection

The objectives of this study were to estimate the prevalence of concurrent alcohol and substance use among patients living with HIV/HCV co-infection and to compare demographic and clinical characteristics of those with concurrent alcohol and substance to those with alcohol or substance use, and to those who were abstinent. We conducted an analysis of patient reported outcomes data of patients living with HIV/HCV co-infection (n = 327) who transitioned from primary care to sub-specialty care for evaluation of candidacy for HCV treatment at a university-affiliated HIV Clinic. The prevalence of self-reported concurrent alcohol and substance use was 33%. A higher proportion of those with concurrent alcohol and substance use were currently smoking tobacco, and those who were abstinent had higher ratings of health-related quality of life compared to those with alcohol or substance use. To reduce patients' risk for progression to advanced stages of HIV, HCV, and liver-related disease due to continued alcohol and substance and tobacco use, social workers and other health care professionals are encouraged to develop and implement intervention strategies to assist patients living with HIV/HCV co-infection in efforts to achieve behavioral change.

Brief Motivational Interventions: Strategies for Successful Management of Complex, Nonadherent Dental Patients

Motivational interviewing (MI) is an evidence-based approach to resolving patient ambivalence to change. MI techniques can be effectively used by dentists in assessing and managing substance use risk and may add minimal time to the patient interview. Although MI's greatest utility has been in the area of improving general oral hygiene in order to reduce caries and other preventable conditions, its use in addressing controlled substance risk is well established in other health care disciplines. These techniques do not require special training in mental health assessment and can be effectively used by dentists and dental hygienists.

Heavy Drinking among Women Receiving Intensive Motivational Interviewing: 6-Month Outcomes

Compared to men, women with alcohol use disorders experience more severe consequences related to drinking. Intensive Motivational Interviewing (IMI) is a new 9-session version of Motivational Interviewing (MI) designed for women with alcohol use disorders. The current study reports outcomes from a randomized clinical trial of IMI compared to a single session of MI. Data were collected at baseline, 2-month, and 6-month follow-up. In addition to a standard "intent-to-treat" (ITT) analysis, we conducted disaggregated subgroup analyses of women who were heavy drinkers and a "per protocol" (PP) analysis of women in the IMI condition who attended 7-9 sessions (80% of the IMI sample). Women in both study conditions made large reductions in drinking between baseline and 2 months that were maintained at 6 months. Generalized estimating equation (GEE) models using the full sample (N = 215) did not show time by condition differences, but heavy drinkers(n = 153) receiving IMI showed significantly larger reductions in drinking at 2- and 6-month follow-up than the comparison condition. Assessment of heavy drinkers using the PP sample showed larger between condition differences favoring IMI at both follow-up time points. Results support the efficacy of IMI in terms of reducing drinking, particularly among women who are heavy drinkers.