Effects of Optimism and Stage of Change on Alcohol Use and Problems Among Sexual Minority Men with HIV Participating in a Brief Motivational Interviewing Intervention

Overview

Journal J Subst Use Addict Treat

Specialty Psychiatry

Date 2024 Dec 13

PMID 39672337

Authors

Benjamin L Berey

Nadine R Mastroleo

David W Pantalone

Kenneth H Mayer

Peter M Monti

Christopher W Kahler

Affiliations

Soon will be listed here.

Abstract

Introduction: Disseminating effective alcohol interventions for sexual minority men (SMM) with HIV remains a crucial public health endeavor. Motivational interviewing (MI) interventions are an established approach to reducing alcohol use, yet more research is needed to determine predictors of MI treatment outcomes and underlying mechanisms related to sustained behavior change among SMM with HIV. This pre-registered secondary analysis tested whether action-related stage of change mediated effects of a MI intervention on future alcohol use and problems among SMM with HIV, and whether individual differences in trait optimism moderated these associations.

Methods: SMM with HIV who engaged in frequent alcohol use (N = 180) were randomized to MI or assessment-only treatment as usual (TAU). Participants completed a semi-structured Timeline Follow-Back interview to measure past-month alcohol use as well as self-reports assessing stage of change, trait optimism, and alcohol problems at baseline and 3- and 12-months post-baseline.

Results: Structural equation models controlling for baseline alcohol use and stage of change indicated that 3-month action significantly mediated effects of MI on 12-month drinks per week. Likewise, the indirect effect of 3-month action was moderated by higher levels of trait optimism. When employment status, education level, and annual family/household income were included as covariates in the model, being employed significantly predicted 12-month alcohol use, and mediation and moderated mediation effects were no longer statistically significant. Stage of change did not mediate effects of MI on 12-month alcohol problems, and this indirect effect was not moderated by trait optimism.

Conclusions: The present study provides further evidence supporting action-related stage of change as a mechanism linking MI to alcohol use reductions. Results demonstrated that SMM with HIV who were more optimistic tended to take more action towards reducing their alcohol use and suggest that MI-based interventions may benefit from integrating components aimed at augmenting patients' optimism. Yet, covarying for current economic status substantially impacted findings and underscores the need to critically consider how broader socioecological contexts can impact treatment outcomes.

References

Miller W, Rose G . Toward a theory of motivational interviewing. Am Psychol. 2009; 64(6):527-37. PMC: 2759607. DOI: 10.1037/a0016830. View

Scheier M, Carver C, Bridges M . Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the Life Orientation Test. J Pers Soc Psychol. 1994; 67(6):1063-78. DOI: 10.1037//0022-3514.67.6.1063. View

Kalolo A, Gautier L, Radermacher R, Srivastava S, Meshack M, De Allegri M . Factors influencing variation in implementation outcomes of the redesigned community health fund in the Dodoma region of Tanzania: a mixed-methods study. BMC Public Health. 2021; 21(1):1. PMC: 7777388. DOI: 10.1186/s12889-020-10013-y. View

Heinonen K, Raikkonen K, Matthews K, Scheier M, Raitakari O, Pulkki L . Socioeconomic status in childhood and adulthood: associations with dispositional optimism and pessimism over a 21-year follow-up. J Pers. 2006; 74(4):1111-26. DOI: 10.1111/j.1467-6494.2006.00404.x. View

Kahler C, Liu T, Cioe P, Bryant V, Pinkston M, Kojic E . Direct and Indirect Effects of Heavy Alcohol Use on Clinical Outcomes in a Longitudinal Study of HIV Patients on ART. AIDS Behav. 2016; 21(7):1825-1835. PMC: 5219952. DOI: 10.1007/s10461-016-1474-y. View

Cook S, Heather N, McCambridge J . Posttreatment motivation and alcohol treatment outcome 9 months later: findings from structural equation modeling. J Consult Clin Psychol. 2014; 83(1):232-237. PMC: 4352962. DOI: 10.1037/a0037981. View

Alterman A, Cacciola J, Ivey M, Habing B, Lynch K . Reliability and validity of the alcohol short index of problems and a newly constructed drug short index of problems. J Stud Alcohol Drugs. 2009; 70(2):304-7. PMC: 2653616. DOI: 10.15288/jsad.2009.70.304. View

Pantalone D, Nelson K, Batchelder A, Chiu C, Gunn H, Horvath K . A Systematic Review and Meta-Analysis of Combination Behavioral Interventions Co-Targeting Psychosocial Syndemics and HIV-Related Health Behaviors for Sexual Minority Men. J Sex Res. 2020; 57(6):681-708. PMC: 7457381. DOI: 10.1080/00224499.2020.1728514. View

Reid A, Carey K . Interventions to reduce college student drinking: State of the evidence for mechanisms of behavior change. Clin Psychol Rev. 2015; 40:213-24. PMC: 4537835. DOI: 10.1016/j.cpr.2015.06.006. View

Surace A, Zelaya D, Guy A, Mastroleo N, Durst A, Pantalone D . Examining the Impact of Race on Motivational Interviewing Implementation and Outcomes with HIV+ Heavy Drinking Men Who Have Sex with Men. Int J Environ Res Public Health. 2022; 19(7). PMC: 8997518. DOI: 10.3390/ijerph19073930. View

10.

Zelaya D, Guy A, Surace A, Mastroleo N, Pantalone D, Monti P . Modeling the Impact of Race, Socioeconomic Status, Discrimination and Cognitive Appraisal on Mental Health Concerns Among Heavy Drinking HIV+ Cisgender MSM. AIDS Behav. 2022; 26(12):3925-3938. PMC: 9643651. DOI: 10.1007/s10461-022-03719-0. View

11.

Huh D, Mun E, Larimer M, White H, Ray A, Rhew I . Brief motivational interventions for college student drinking may not be as powerful as we think: an individual participant-level data meta-analysis. Alcohol Clin Exp Res. 2015; 39(5):919-31. PMC: 4502982. DOI: 10.1111/acer.12714. View

12.

Chiesi F, Galli S, Primi C, Innocenti Borgi P, Bonacchi A . The accuracy of the Life Orientation Test-Revised (LOT-R) in measuring dispositional optimism: evidence from item response theory analyses. J Pers Assess. 2013; 95(5):523-9. DOI: 10.1080/00223891.2013.781029. View

13.

McCabe S, Hughes T, West B, Veliz P, Boyd C . DSM-5 Alcohol Use Disorder Severity as a Function of Sexual Orientation Discrimination: A National Study. Alcohol Clin Exp Res. 2019; 43(3):497-508. PMC: 6397073. DOI: 10.1111/acer.13960. View

14.

Calling S, Ohlsson H, Sundquist J, Sundquist K, Kendler K . Socioeconomic status and alcohol use disorders across the lifespan: A co-relative control study. PLoS One. 2019; 14(10):e0224127. PMC: 6797188. DOI: 10.1371/journal.pone.0224127. View

15.

Segerstrom S . Optimism and Resources: Effects on Each Other and on Health over 10 Years. J Res Pers. 2013; 41(4). PMC: 3861054. DOI: 10.1016/j.jrp.2006.09.004. View

16.

McDevitt-Murphy M, Murphy J, Williams J, Monahan C, Bracken-Minor K, Fields J . Randomized controlled trial of two brief alcohol interventions for OEF/OIF veterans. J Consult Clin Psychol. 2014; 82(4):562-8. PMC: 4114986. DOI: 10.1037/a0036714. View

17.

Carver C, Scheier M, Segerstrom S . Optimism. Clin Psychol Rev. 2010; 30(7):879-89. PMC: 4161121. DOI: 10.1016/j.cpr.2010.01.006. View

18.

Meevissen Y, Peters M, Alberts H . Become more optimistic by imagining a best possible self: effects of a two week intervention. J Behav Ther Exp Psychiatry. 2011; 42(3):371-8. DOI: 10.1016/j.jbtep.2011.02.012. View

19.

Guy A, Zelaya D, Surace A, Mastroleo N, Pantalone D, Monti P . Discrimination and alcohol problems among heavy drinking HIV-positive men who have sex with men: The buffering effect of a brief Motivational Intervention to reduce alcohol use. Drug Alcohol Depend. 2022; 233:109384. PMC: 8968970. DOI: 10.1016/j.drugalcdep.2022.109384. View