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).
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.
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.