Brief Interventions in the Emergency Department for Alcohol and HIV/Sexual Risk

Linkages between alcohol use and HIV/sexual risk behaviors have been observed in multiple
groups and each behavior has been successfully treated individually. Indeed, some studies
suggest these behaviors can be successfully treated together. The Emergency Department (ED)
provides a venue through which many patients with multiple risks are treated. Yet, to date
no study has addressed these behaviors together in an ED, where admission may represent an
opportunistic moment when patients are particularly willing to discuss these risky
behaviors. Motivational Interviewing (MI) has demonstrated promise with alcohol risk in the
ED in several of our previous studies, and has shown promise with sexual risk populations as
well. Accordingly, this study (N=302) will address whether a one session multiple risk MI
can more effectively decrease and maintain reduction in alcohol use, alcohol related
problems, and sexual risk taking following discharge from the ED than Brief Advice (BA).
Baseline, MI Session 1 and BA will be administered in the ED. Follow-ups will be conducted
at 3, 6 and 9 months. This project will allow us to address the next phase of our program of
research that has been designed to develop easily disseminable treatments for high-risk
populations in medical settings. This study will also address potential mediators
(motivation to change risk taking, self-efficacy) of MI effects. We will also examine
whether reductions in sexual risk associated with MI compared to BA are accounted for by
reduced drinking. A tertiary aim will examine the moderating effect of co-occurring
substance use on outcomes. The cost-effectiveness of the interventions will also be
addressed. Thus, this study will address two significant Public Health problems and provide
significant information about MI mechanisms that may be relevant to the treatment community.

Inclusion Criteria:

- Male and female patients older than 18 who receive medical care in the ED *score
positive (> 8 for males; > 6 for females) for harmful alcohol use on the AUDIT
screening questionnaire and report past 3-month binge drinking

- be sexually active (past 6 months)

- endorse any past-year sex-risk behavior criterion, including:

- having more than one sexual partner

- having sexual intercourse without a condom

- consuming alcohol prior to or during sex

- sing illicit drugs (or using licit drugs to get high) prior to or during
sex.

Exclusion Criteria:

- Patients under the age of 18; Patients in a mutually monogamous relationship for
longer than 1 year will be excluded unless either the patient or his/her partner are
HIV+ or has unknown HIV status. Other exclusion criteria include:

- scoring below 18 on a mini-mental status exam

- no verifiable address

- plans to move outside a 45-mile radius within the follow-up period.