A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs.

Abstract

This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored. Method: Latinxs (N ϭ 296; 63% male, M age ϭ 41 years) who reported 2ϩ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months. Results: Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d ϭ .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d ϭ .34, 95% CI [Ϫ.60, Ϫ.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d ϭ .17, 95% CI [Ϫ.33, Ϫ.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d ϭ .20, 95% CI [Ϫ.39, Ϫ.01]). Conclusions: Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse.

Addressing social stressors in a brief motivational interview improve mental health symptoms for Latinx heavy drinkers

“…Minorities face additional, unique stressors related to their minority status, such as discrimination, stress related to migration and adaptation to a new country, feeling discriminated against, living in poverty, reduced access to economic opportunities, or exposure to crime (Cano et al, 2015, 2017; Nalven & Spillane, 2018; Ornelas & Perreira, 2011). These stressors have been associated with symptoms of depression and anxiety among Latinx heavy drinkers (Abraido‐Lanza, Echeverria, & Florez, 2016; Lee et al, 2019).…”

“…MI also has preliminary evidence supporting its efficacy in treating anxiety (Westra, Arkowitz, & Dozois, 2009); the MI focus on the therapeutic relationship may be particularly relevant to anxious people experiencing difficulties with interpersonal relationships (Westra et al, 2009). MI is also presumed to have a strong impact with marginalized individuals because it prioritizes autonomy and unique self‐worth (T. B. Moyers & Martin, 2006), thus augmenting collaboration and engagement (Lee et al, 2019; Miller & Rose, 2009; Parsons, Lelutiu‐Weinberger, Botsko, & Golub, 2014). Prior research has extended this idea by investigating whether a MI discussion that addressed sensitive topics/stressful experiences (i.e., experiences of discrimination) would encourage individuals to consider changes in their responses to the stressor (i.e., decrease drinking; Lee, Colby, et al, 2016).…”

“…Our parent clinical trial of a cultural adaptation of MI (CAMI; targeting stressors) compared to MI showed significant reductions in percent heavy drinking days and frequency of alcohol‐related consequences through 12‐month follow up when compared with baseline. CAMI participants with high self‐reported discrimination and who were less acculturated (at baseline) reported significantly less frequent alcohol consequences than MI participants (Lee et al, 2019). In this secondary analysis, the goal was to explore whether CAMI and MI might also have an effect on mental health symptoms.…”

“…These questions are particularly germane to tests of culturally adapted interventions. Acculturation has been found to moderate alcohol treatment outcomes; less acculturated Latinxs demonstrate a stronger treatment response to adapted MI (for alcohol use) than do more acculturated Latinxs (Carroll et al, 2009; Field & Caetano, 2010; Lee et al, 2019). A review of studies on culturally adapted cognitive behavior therapy for depression and anxiety (Griner & Smith, 2006; Hall, Ibaraki, Huang, Marti, & Stice, 2016) similarly shows that less acculturated individuals have stronger treatment response to culturally adapted interventions than more highly acculturated individuals.…”

“…Discrimination was chosen as a moderator because it is an experience that contributes to minority stress (Abraido‐Lanza et al, 2016; Araújo Dawson & Panchanadeswaran, 2010; Torres, Driscoll, & Voell, 2012). In the parent trial, among participants who experienced higher levels of discrimination at baseline, those who received CAMI reported significantly fewer adverse consequences related to alcohol use at 3 months follow‐up compared to those who received MI (Lee et al, 2019). In this secondary analysis, we hypothesized that both conditions (CAMI, MI) would result in reduced anxiety/depressive symptoms and that CAMI participants would report significantly greater improvements in these symptoms compared to MI participants.…”