University at Buffalo - The State University of New York

Published: September 29, 2005

By LOIS BAKER and KATHLEEN WEAVER
Reporter Contributors

Two UB researchers have received grants totaling more than $3.6 million from the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

Kurt H. Dermen, senior research scientist at UB's Research Institute on Addictions (RIA), is principal investigator on a study being funded by a $2.4 million NIAAA grant that will focus on improving the understanding of women's alcohol use and risky sexual behavior, and the impact of alcohol treatment on women's HIV risk behaviors.

"Most people think, and there is evidence supporting this, that drinking can contribute to risky sexual behavior and increased risk for HIV infection," said Dermen. "Because we know women in alcohol treatment programs have a higher risk of HIV, we want to develop more efficient, targeted HIV prevention programs for them."

Working under a $1.28 million NIAAA grant, Richard D. Blondell, associate professor of family medicine, will lead a team developing and testing a new program designed to improve abstinence rates after alcohol detoxification.

Blondell will conduct the pilot study with patients in the alcohol detoxification unit at the Erie County Medical Center. Researchers from RIA will help direct the project.

"About 50 percent of problem drinkers never get into treatment after detox, and half the people who do go through detox are drinking again after 30 days," he added. "Detoxification costs approximately $3,500 each time, so there are lots of reasons to look at how to improve on this."

According to the Centers for Disease Control and Prevention, the number of new AIDS cases per year among men in the United States has remained relatively unchanged over the past several years. Among women, however, the occurrence of AIDS is increasing.

Dermen said that "four out of five women who become infected with HIV contract it through sexual contact with men, so prevention efforts with women need to focus on encouraging safer sexual behavior."

Relatively few women have been included in past research on HIV risk among individuals with alcohol problems. The newly funded project, which focuses solely on women, will fill critical gaps in existing data.

The "Women's HOPE" (Health Opinions, Perceptions and Experiences) Study will recruit 300 women from outpatient treatment programs and 150 women from inpatient treatment programs to participate in the research. Women will be asked about substance use, sexual behavior and related experiences, attitudes and beliefs.

Dermen and colleagues are interested in how different treatment experiences, individual characteristics and other factors in women's lives impact alcohol and other drug use and risky sexual behaviors, such as having multiple partners and having sex without using condoms. Clients will be interviewed when admitted to treatment and again at three-month intervals during the following year.

Primary questions to be answered will relate to how drinking influences sexual behavior and whether reducing drinking among women in treatment leads to a reduction in risky sex.

"Being intoxicated may make it seem less 'important' to use protection against HIV," explained Dermen. "However, heavy drinking may, for instance, also get in the way of a woman's keeping a job, which could leave her financially dependent on a male sexual partner. Under these circumstances, a woman may find it more difficult to insist on using condoms during sex."

The study will run for four years and provide employment to six full-time staff members. Dermen's co-investigator on the study is Maria Testa, a senior research scientist at RIA, adjunct associate professor in the School of Social Work, and research associate professor in the Department of Psychology.

The study led by Blondell will compare three approaches to encourage alcoholics to stop using alcohol and to enter a rehabilitation or self-help program after leaving the hospital detoxification unit. The interventions will involve a total of 150 patients and will take place while patients are in the hospital. The typical detoxification hospital stay is three and a half days, Blondell said.

Participants will be assigned randomly to one of three groups: a "usual care" group, a professional-counseling group and a group that will participate in a novel, peer-delivered "12-step facilitation" delivered by trained volunteers who are recovering from alcoholism.

"Usual care" in this detoxification unit involves a physical exam, an interview with a case manager to plan for aftercare and twice-a-day group discussion sessions.

Patients randomized to the second protocol will receive usual care, plus a 60-minute "Motivational Enhancement Therapy" (MET) intervention, a well-established program used with alcohol abusers delivered by a paid professional trained in the method. MET, based on a therapist-patient relationship, comprises a discussion on the pros and cons of drinking and factors that brought the patient to treatment. The therapist provides feedback, addresses long-term consequences of alcohol abuse, makes a plan with the client for aftercare and attempts to generate motivation to change.

The third and novel intervention employs pairs of volunteers trained in Blondell's "Peer-Delivered Twelve Step Facilitation," or P-TSF. This interpersonal approach calls for volunteers to approach the patient as a friend. They talk about their own experiences with alcohol problems and describe how they changed their lives. They refer to alcoholism as a fatal illness, express the difficulty of overcoming it without help, attempt to instill hope and discuss a spiritual aspect of recovery without discussing religion.

Data on the interventions will be collected at admission and at one, three and six months. Blondell hypothesizes that MET will be better than usual care in inducing participation in a rehabilitation program and in maintaining abstinence, and that the peer volunteers will be at least as successful as MET.

"If peer volunteers are successful at improving the outcomes of patients admitted for alcohol detox, then recovering alcoholics could be used by programs throughout the country to help patients improve their lives," Blondell said. "This could be done with little additional costs to hospitals and health insurance companies.

"It is also likely that this service work will help the volunteers as well," he said. "It is known that helping others helps to protect volunteers from relapsing back to drinking."