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Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information
Intervention Description
Target Population
Active injection drug users (IDUs) who were also heavy alcohol users
Goals of Intervention
- Reduce alcohol use
- Reduce or eliminate
injection-related risk behaviors
Brief Description
BRAINE is a brief motivational
interviewing intervention consisting of
two individualized sessions focusing on
alcohol use and HIV risk-taking. The
first session, lasting 60 minutes,
consists of assessing the participant’s
degree of hazardous drinking, providing
feedback, identifying relationships
between drinking and negative
consequences including HIV risk
behaviors, reviewing HIV drug risk
behaviors, and identifying personal
goals and potential barriers for
behavior change. The counselor provides
an atmosphere to enhance the
participant’s motivation to change, uses
an empathic therapeutic style, and
supports the participant’s self-efficacy
for behavior change. The counselor helps
the participant with setting goals and
developing a “change plan” concerning
future alcohol consumption designed to
reduce the link between drinking and
other hazardous behaviors, particularly
borrowing injection equipment from
someone else. A copy of the “change
plan” is given to the participant to
refer to at home. A second motivational
interviewing session, lasting 30-45
minutes, occurs 1 month later for
reinforcement. This session is to review
the “change plan,” discuss any recent
negative consequences from drinking, and
help participant’s assess their own
alcohol-related injection risk behaviors
and come up with ways to reduce this
risk. The counselor helps the
participant set goals and develop
another “change plan” for achieving
these goals. A copy of the “change plan”
is again provided to the participant.
Participants are also given a list of
referrals for substance abuse and
medical treatment at both sessions. |
Theoretic Basis
- Motivational interviewing principles
Intervention Duration
One 60-minute and one 30-45 minute session
delivered 1 month apart
Intervention Settings
Research site at Rhode Island Hospital
Deliverer
A social worker Ph.D. level counselor
trained in motivational interviewing
Delivery Methods
- Counseling
- Goal setting
- Develop risk reduction
plan
- Printed materials
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Intervention Package Information
An intervention package is not available at this time. Please contact Dr.
Michael D. Stein, Division of General Internal Medicine, Rhode Island Hospital,
593 Eddy Street, Providence, RI 02903. email:
mstein@lifespan.org for details on
intervention materials.
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Evaluation Study and Results
The original evaluation study was
conducted in Providence, RI between 1998 and
2000.
Key Intervention Effects
- Reduced sharing of injection
equipment
Study Sample
The baseline and analytic sub-sample of 109 injection drug users (IDUs) who
had shared injection equipment in the past
30 days is characterized by the following:
- 90% White, 10% other
- 62% Male, 38% Female
- Mean age of 36 years
- Mean education of 11 years
Recruitment Settings
Three needle exchange program sites
Eligibility Criteria
Subjects were eligible for the study if they
were English speaking adults (18 years or
older) who had attended a NEP in the past 6
months, had injected heroin or cocaine in
the prior 30 days, and had scored 8 or
higher on the AUDIT (Alcohol Use Disorders
Identification Test).
Assignment Method
Injection drug users (N = 187) were randomly
assigned to 1 of 2 groups: BRAINE (n = 95)
or comparison (n = 92).
Comparison Group
The comparison group was given a
standard list of referrals for substance
abuse and medical treatment both at baseline
and 1 month later
Relevant Outcomes Measured and Follow-up Time
- Alcohol use, measured as number of
days in past 30 days in which alcohol
was used, was assessed at 1 month and 6
months.
- Number of injection-related risk days in
past 30 days, measured as number of days in
past 30 days in which the participant used
any needles, cotton, or cooker after someone
else had used it, regardless of cleaning
(borrowed injection equipment), was assessed
at 1 month, and 6 months.
- The 1-month assessment was 1 month after
the first intervention session and
immediately before the second intervention
session. The 6-month assessment was 5 months
after completion of the intervention.
Participant Retention
- BRAINE intervention:
97% retained at 5 months after
intervention
- Control:
97% retained at 5 months after
intervention
Significant Findings
- This intervention fails to meet the
best-evidence criteria due to small
analytical sample sizes.
- Among those that shared equipment at
baseline, IDUs in the intervention group
were significantly more likely than
those in the control group to reduce the
number of injection-related risk days by
75% (p < .05) or by 1 or more days (p <
.05) at the 5-month follow-up.
- Among those that shared equipment at
baseline, IDUs in the intervention group
were significantly more likely than
those in the control group to move to a
lower risk category (based on the number
of injection-related risk days) from
baseline to the 5-month follow-up (p
<.05).
Considerations
- Among those that shared equipment at baseline, more intervention
participants than control participants, reported 25%, 50%, and complete
(100%) reductions in their number of injection-related risk days, although
the findings using these percent reduction categories were not statistically
significant (all p’s < .10).
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References and Contact Information
- Stein, M.D., Anderson, B., Charuvastra, J.M., Maksad, J., & Friedmann, P.D.
(2002). A brief intervention for hazardous drinkers in a needle exchange
program. Journal of Substance Abuse Treatment, 22, 23-31.
- Stein, M.D., Charuvastra, A., Maksad, J., & Anderson, B.J. (2002). A
randomized trial of a brief alcohol intervention for needle exchangers
(BRAINE). Addiction, 97, 691-700.
Researcher: Dr. Michael D. Stein, Division of General
Internal Medicine, Rhode Island Hospital, 593 Eddy Street, Providence, RI
02903. email: mstein@lifespan.org
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Link to a PDF document
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Link to non-CDC Web site
