A randomized controlled trial of an integrated alcohol reduction intervention in patients with hepatitis C infection.
Hepatitis C (HCV) and alcohol use are patient risk factors for accelerated fibrosis progression, yet few randomized controlled trials have tested clinic-based alcohol interventions. 181 patients with HCV and qualifying alcohol screener scores at three liver center settings were randomly assigned to: 1) medical provider-delivered Screening, Brief Intervention, and Referral to Treatment (SBIRT), including motivational interviewing counseling and referral out for alcohol treatment (SBIRT-only), or 2) SBIRT plus six months of integrated co-located alcohol therapy (SBIRT+Alcohol Treatment). The Timeline Followback Method assessed alcohol use at baseline, 3, 6, and 12 months. Co-primary outcomes were alcohol abstinence at 6 months and heavy drinking days between 6 and 12 months. Secondary outcomes included grams of alcohol consumed per week at 6 months. Mean therapy hours across six months were 8.8 for SBIRT-only and 10.1 for SBIRT+Alcohol Treatment participants. The proportion of participants exhibiting full alcohol abstinence increased from baseline to 3, 6, and 12 months in both treatment arms, but no significant differences were found between arms (baseline to 6 months, 7.1% to 20.5% for SBIRT-only; 4.2% to 23.3% for SBIRT+Alcohol Treatment; p=0.70). Proportions of participants with any heavy drinking days decreased in both groups at 6 months but did not significantly differ between the SBIRT-only (87.5% to 26.7%) and SBIRT+Alcohol Treatment (85.7% to 42.1%) arms (p=0.30). Although both arms reduced average grams of alcohol consumed per week from baseline to 6 and 12 months, between-treatment effects were not significant. Conclusion: Patients with current or prior HCV-infection will engage in alcohol treatment when encouraged by liver medical providers. Liver clinics should consider implementing provider-delivered SBIRT and tailored alcohol treatment referrals as part of standard of care.
Proeschold-Bell, RJ; Evon, DM; Yao, J; Niedzwiecki, D; Makarushka, C; Keefe, KA; Patkar, AA; Mannelli, P; Garbutt, JC; Wong, JB; Wilder, JM; Datta, SK; Hodge, T; Naggie, S; Fried, MW; Muir, AJ
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