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Aims In HIV-infected individuals, heavy drinking compromises survival. In HIV primary care, the efficacy of brief motivational interviewing (MI) to reduce drinking is unknown, alcohol-dependent patients may need greater intervention and resources are limited. Using interactive voice response (IVR) technology, HealthCall was designed to enhance MI via daily patient self-monitoring calls to an automated telephone system with personalized feedback. We tested the efficacy of MI-only and MI+HealthCall for drinking reduction among HIV primary care patients. Design Parallel random assignment to control (n = 88), MI-only (n = 82) or MI+HealthCall (n = 88). Counselors provided advice/education (control) or MI (MI-only or MI+HealthCall) at baseline. At 30 and 60 days (end-of-treatment), counselors briefly discussed drinking with patients, using HealthCall graphs with MI+HealthCall patients. Setting Large urban HIV primary care clinic. Participants Patients consuming ≥4 drinks at least once in prior 30 days. Measurements Using time-line follow-back, primary outcome was number of drinks per drinking day, last 30 days. Findings End-of-treatment number of drinks per drinking day (NumDD) means were 4.75, 3.94 and 3.58 in control, MI-only and MI+HealthCall, respectively (overall model χ2, d.f. = 9.11,2, P = 0.01). For contrasts of NumDD, P = 0.01 for MI+HealthCall versus control; P = 0.07 for MI-only versus control; and P = 0.24 for MI+HealthCall versus MI-only. Secondary analysis indicated no intervention effects on NumDD among non-alcohol-dependent patients. However, for contrasts of NumDD among alcohol-dependent patients, P < 0.01 for MI+HealthCall versus control; P = 0.09 for MI-only versus control; and P = 0.03 for MI+HealthCall versus MI-only. By 12-month follow-up, although NumDD remained lower among alcohol-dependent patients in MI+HealthCall than others, effects were no longer significant. Conclusions For alcohol-dependent HIV patients, enhancing MI with HealthCall may offer additional benefit, without extensive additional staff involvement.

Cognitive-behavioral therapy (CBT) depends on adequate cognitive functioning in patients, but prolonged cocaine use may impair cognitive functioning. Therefore, cognitive impairment may impede the ability of cocaine abusers to benefit from CBT. To begin to address this issue, we investigated the relationship between cognitive impairment and two treatment outcomes, therapy completion and abstention. Eighteen carefully screened non-depressed cocaine-dependent patients in a psychopharmacological clinical trial were administered the MicroCog computerized battery to assess cognitive performance at treatment entry. T-tests were used to compare cognitive functioning between completers (patients remaining in treatment at least 12 weeks) and dropouts. The results indicated that treatment completers had demonstrated significantly better cognitive performance at baseline than patients who dropped out of treatment. Cognitive domains that significantly distinguished between treatment completers and dropouts were attention, mental reasoning and spatial processing. This study provides preliminary evidence that cognitive impairments may decrease treatment retention and abstinence in CBT of cocaine dependence.

Background-The purpose of this study was to assess the procedural validity of the substance disorder modules of the lay-administered Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Version (AUDADIS-5) through clinician re-appraisal re-interviews. * Correspondence, Deborah S. Hasin, Department of Psychiatry, Columbia University Medical Center, 1051 Riverside Drive #123, New York, NY 10032. Phone: 1-646-774-7909, Fax: 1-646-774-7920; deborah.hasin@gmail.com. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Disclaimer:The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of sponsoring organizations, agencies, or the U.S. government. Author DisclosuresNo authors have any relevant financial interests. ContributorsDrs. Saha, Goldstein, Jung, Zhang and Grant collected, cleaned and analyzed the data and critically reviewed drafts of the manuscript. Dr. Hasin collected the data, wrote, and revised drafts of the manuscript. Ms. Greenstein, and Ms. Aivadyan collected, cleaned and analyzed the data and critically reviewed drafts of the manuscript. Ms. Stohl analyzed the data and critically reviewed drafts of the manuscript. Drs. Aharonovich and Nunes consulted to the data collection and critically reviewed drafts of the manuscript. All authors have read and approved of submission of this version of the manuscript. Conflict of InterestNo conflict declared. HHS Public Access Author Manuscript Author ManuscriptAuthor Manuscript Author ManuscriptMethods-The study employed a test-retest design among 712 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). A clinicianadministered, semi-structured interview, the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5) was used as the re-appraisal. Kappa coeffients indicated concordance of the AUDADIS-5 and PRISM-5 for DSM-5 substance use disorder diagnoses, while intraclass correlation coefficients (ICC) indicated concordance on dimensional scales indicating the DSM-5 criteria count for each disorder.Results-With few exceptions, concordance of the AUDADIS-5 and the PRISM-5 for DSM-5 diagnoses of substance use disorders ranged from fair to good (κ=0.40-0.72). Concordance on dimensional scales was excellent (ICC≥0.75) for the majority of DSM-5 SUD diagnoses, and fair to good (ICC=0.43-0.72) for most of the rest.Conclusions-As indicated by concordance with a semi-structured clinician-admi...