Preliminary study of alcohol problem severity and response to brief intervention

Lindsay R Meredith, Erica N Grodin, Mitchell P Karno, Amanda K Montoya, James MacKillop, Aaron C Lim, Lara A Ray, Lindsay R Meredith, Erica N Grodin, Mitchell P Karno, Amanda K Montoya, James MacKillop, Aaron C Lim, Lara A Ray

Abstract

Background: Findings have been mixed as to whether brief intervention (BI) is appropriate and effective for individuals with more severe alcohol use problems. Motivation to change drinking has been supported as a mechanism of behavior change for BI. This exploratory study examined aspects of motivation as mechanisms of clinical response to BI and alcohol problem severity as a moderator of treatment effects.

Methods: Non-treatment-seeking heavy drinkers (average age = 35 years; 57% male) were randomized to receive BI (n = 27) or attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and post-intervention: importance, confidence, and readiness. Moderated mediation analyses were implemented with treatment condition as the focal predictor, changes in motivation as mediator, 1-month follow-up drinks per day as the outcome, and an alcohol severity factor as second-stage moderator.

Results: Analysis of importance displayed a significant effect of intervention condition on importance (p < 0.003) and yielded a significant index of moderated mediation (CI - 0.79, - 0.02), indicating that the conditional indirect effect of treatment condition on drinking through importance was stronger for those with higher alcohol severity. For all motivation indices, alcohol severity moderated the effect of post-intervention motivation levels on drinking (p's < 0.05). The direct effect of treatment condition on drinking was not significant in any model.

Conclusions: Findings highlight the relevance of considering one's degree of alcohol problem severity in BI and alcohol screening efforts among non-treatment seeking heavy drinkers. These nuanced effects elucidate both potential mechanisms and moderators of BI response. Trial registration Clinicaltrials.gov: NCT04710095. Registered January 14, 2021-retrospectively registered, https://ichgcp.net/clinical-trials-registry/NCT04710095 .

Keywords: Alcohol; Brief intervention; Motivation to change; Problem severity.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Conceptual diagram for dimensions of motivation to change. Dimensions of motivation to change are importance, readiness, and confidence; intervention condition is a dichotomous variable (0 = control condition; 1 = brief alcohol intervention); alcohol problem severity factor represents participants’ severity factor score from a principal component analysis constructed via baseline measures and interviews
Fig. 2
Fig. 2
Statistical diagram and model equations for importance of change conditional process analysis. Conditional process model equations: Yi=c0′+c1′Xi+b1Mi+b2Mi+b3Mi∗Wi+b4U1i+b5U2i+eyi; Mi=a0+a1Xi+a2U1i+acU21+eMi; Yi=1.43-0.29Xi-0.17Mi+1.32Wi-0.22Mi∗Wi+0.60U1i+0.03U2i+eyi; Mi=1.52+1.53Xi+0.12U1i+0.58U2i+eMi. Intervention condition is a dichotomous variable (0 = control condition; 1 = brief alcohol intervention); alcohol problem severity factor represents participants’ severity factor score from a principal component analysis constructed via baseline measures and interviews; baseline importance of change and baseline drinks per day served as covariates; * indicates significance at the p < 0.05 level and ** at the p < 0.01 level
Fig. 3
Fig. 3
Moderating effect of alcohol problem severity factor on the relationship between motivation to change indices and follow-up drinks per day. This depiction shows a significant second stage interaction effect of alcohol problem severity factor by post-intervention motivation to change indices on follow-up drinks per day across intervention conditions and after holding baseline ratings and drinks per day constant; alcohol problem severity represents participants’ severity factor score from a principal component analysis constructed via baseline measures and interviews; the interaction effects are presented at the probed 16th, 50th, and 84th percentile alcohol severity factor values for the total sample

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