Brief Motivational Intervention for Intimate Partner Violence and Heavy Drinking in the Emergency Department

Abstract

Intimate partner violence (IPV) and heavy drinking are co-occurring public health problems, but integrated brief interventions for these conditions have not been tested.OBJECTIVE To determine whether a brief motivational intervention provided at the time of an emergency department (ED) visit reduces IPV and heavy drinking. DESIGN, SETTING, AND PARTICIPANTSA randomized clinical trial conducted at 2 US academic urban EDs between January 2011 and December 2014 to assess the effectiveness of a motivational intervention for IPV-involved female ED patients (ages: 18-64 years; N = 600) who exceeded sex-specific safe drinking limits. All received social service referrals; 2:2:1 to brief intervention (n = 242), assessed control (n = 237), or no-contact control (n = 121).INTERVENTIONS A 20-to 30-minute manual-guided motivational intervention (recorded and monitored for fidelity) delivered by master's-level therapists with a follow-up telephone booster. The assessed control group received the same number of assessments as the brief intervention group; the no-contact control group was assessed only once at 3 months. MAIN OUTCOMES AND MEASURESIncidents of heavy drinking and experiencing IPV measured over prespecified, 12 weekly assessments using an interactive voice response system. RESULTSOf 600 participants, 80% were black women with a mean age of 32 years. Retention was 89% for 2 or more interactive voice response system calls. Seventy-eight percent of women completed the 3-month interview, 79% at 6 months, and 71% at 12 months. During the 12-week period following the brief motivational intervention, there were no significant differences between the intervention group and the assessed control group on weekly assessments for experiencing IPV (odds ratio [OR], 1.02; 95% CI, 0.98-1.06) or heavy drinking (OR, 0.99; 95% CI, 0.96-1.03). From baseline to 12 weeks, the number of women with any IPV in the past week decreased from 57% (134 of 237) in the intervention group to 43% (83 of 194) and from 63% (145 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 8%). From baseline to 12 weeks, the number of women with past week heavy drinking decreased from 51% (120 of 236) in the intervention group to 43% (83 of 194) and from 46% (107 of 231) in the assessed control group to 41% (77 of 187) (absolute difference of 3%). At 12 months, 43% (71 of 165) of the intervention group and 47% (78 of 165) of the assessed control group reported no IPV during the previous 3 months and 19% (29 of 152) of the intervention group and 24% (37 of 153) of the control group had reduced their alcohol consumption to sex-specific National Institute on Alcohol Abuse and Alcoholism safe drinking levels.CONCLUSIONS AND RELEVANCE For women experiencing IPV and heavy drinking, the use of a brief motivational intervention in the ED compared with assessed and no-contact controls did not significantly reduce the days of heavy drinking or incidents of IPV. These findings do not support a brief motivational intervention in this setting.

Integrated Multicomponent Interventions for Safety and Health Risks Among Black Female Survivors of Violence: A Systematic Review

“…Two studies targeted stress and one reproductive health. The combination of outcomes assessed were violence and mental health in six studies (Coker et al, 2012; El-Mohandes et al, 2008; Fallot et al, 2012; Johnson et al, 2011; Joseph et al, 2009; Zlotnick, Capezza, & Parker, 2011), violence, mental health, and HIV risk in one study (Gilbert et al, 2006), mental health and HIV risk in four studies (Cocozza et al, 2005; Ghee et al, 2009; Rountree et al, 2014; Zhang et al, 2013), violence and HIV risk in two studies (Mittal et al, 2017; Rhodes et al, 2015), stress and mental health in two studies (Dutton et al, 2013; Nicolaidis et al, 2012), and violence and reproductive health in one study (Kiely, El-Mohandes, El-Khorazaty, & Gantz, 2010). …”

“…With the exception of TREM (Fallot et al, 2011), all studies assessing future safety focused on IPV. The eligibility criteria for including women in the intervention trial was only IPV (Coker et al, 2012), both IPV and drug/alcohol use (Gilbert et al, 2006; Rhodes et al, 2015), IPV and sexual risk behavior (Mittal et al, 2017), IPV and PTSD (Johnson et al, 2011), or IPV as one of the risks (i.e., active smoking, depression, environmental tobacco exposure; El-Mohandes et al, 2008; Joseph et al, 2009; Kiely et al, 2010). TREM (Fallot et al, 2014) participants had a history of physical and/or sexual abuse and a co-occurring mental health and substance abuse problem.…”

“…With the exception of Condensed Seeking Safety Intervention (Ghee et al, 2009), all multicomponent interventions addressing HIV risk focused on survivors of IPV (Online Appendix). The Brief Motivational Interviewing intervention (20–30 min) with telephone booster at 10 days was not effective in reducing drug/alcohol-related HIV risk of heavy drinking (Rhodes et al, 2015). The RPRS intervention including participants in substance abuse treatment program was successful in reducing use of specific drugs but not others and in reducing sexual HIV risk behavior of multiple sexual partners but not nonuse of condoms (Gilbert et al, 2006).…”

A feasibility test of a brief motivational interview intervention to reduce dating abuse perpetration in a hospital setting.

“…Cunningham and colleagues, who conducted a brief intervention similar to Real Talk in that it was for primarily Black and Hispanic adolescents living in poverty in an urban area and took place in an emergency department, found that their intervention reduced self-reported moderate and severe dating violence victimization for up to one year following the intervention, even if it didn’t impact perpetration (Cunningham et al, 2013). Cunningham et al’s results are particularly notable given that a large-scale RCT conducted by a research team in Philadelphia recently concluded that there was no effect of a similar brief intervention for adult, alcohol-using, female victims of partner abuse in an emergency department setting (Rhodes et al, 2015). In short, the literature about the impact of brief intervention on either adult or adolescent partner abuse perpetration or victimization is too sparse, too disparate in terms of inclusion criteria, measures, and methods, and too divergent in results to be able to draw any conclusion about the potential for this form of tertiary prevention to be worthy of investment.…”

Being Superwoman: Low Income Mothers Surviving Problem Drinking and Intimate Partner Violence

“…The sample of 32 adult women for our study was derived from a randomized control trial that took place in two urban academic emergency rooms/trauma centers (Rhodes et al 2015; Rhodes, Rodgers, Sommers, Hanlon & Crits-Christoph, 2014). The parent study sought to assess effectiveness of a manualized motivational interviewing (MI) intervention for IPV-involved women reporting problem drinking patterns at the time of their ED visit.…”