Stepped Tx for Alcohol Use Disorder Studied in HIV Patients

Integrated stepped alcohol treatment (ISAT) reduces alcohol consumption in patients with HIV and a known drinking problem, according to a study published online in The Lancet HIV.

E. Jennifer Edelman, M.D., from the Yale School of Medicine in New Haven, Connecticut, and colleagues randomly assigned participants (1:1) to receive the three-step ISAT (63 patients) or treatment as usual (including referral to substance use treatment services; 65 patients). The study was conducted at five Veterans Affairs-based HIV clinics in the United States. Out of 128 participants, 125 were men and 101 were black (mean age, 54 years). Eligible patients met criteria for alcohol use disorder using the Diagnostic and Statistical Manual for Mental Disorders-IV criteria for alcohol abuse or dependence. The number of drinks per week during the previous 30 days was measured at week 24. ISAT involved three steps: eight sessions of addiction physician management (step 1), four more sessions of addiction physician management plus motivational enhancement therapy (step 2), and specialty referral (step 3).

The researchers report that 20 percent of participants were lost to follow-up. Based on the 57 patients in the ISAT group completing the trial, 30 advanced to step 2, and 17 of the 30 advanced to step 3. More patients in ISAT received one alcohol treatment medication (51 percent in ISAT versus 26 percent in treatment as usual; P = 0.004). Participants in both groups reduced their alcohol consumption, but there was not a significant difference in number of drinks per week between the groups at week 24 (least squares mean, 10.4 drinks per week in the ISAT group versus 15.6 drinks per week in the treatment as usual group; adjusted mean difference, −4.2; 95 percent confidence interval, −9.4 to 0.9; P = 0.11). At 52 weeks, the investigators found that ISAT patients had fewer heavy drinking days, drank less per drinking day, and had more days of abstinence as well as improved HIV outcomes.

"Future efforts should focus on promoting ISAT with attention to enhancing patient engagement and retention in alcohol-related care," the authors write.

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