Promoting Motivation: Intervention for Alcohol Cessation in Alcohol Liver Disease

University Of Pittsburgh At Pittsburgh, Pittsburgh PA

Investigators

Abstract

Project Summary: Alcohol Associated Liver Disease (ALD) is one of the most common types of liver disease in the US accounting for 50,000 deaths and 30% of all liver transplants each year. Successful treatment of ALD requires abstinence from alcohol. However, following a hospitalization for ALD rates of return to alcohol use are high and drinking is the strongest predictor of readmission and mortality. Few addiction interventions for ALD patients have been investigated and, notably, all rely on standard addiction treatments that are largely not accepted by non-treatment seeking ALD patients. To address the gaps in ALD patient care we propose an innovative addiction treatment approach to their post-hospitalization management. Motivational Interviewing (MI) is a widely used, evidence-based therapeutic technique to elicit positive change talk (i.e., concerning their own reasons for wanting to change their behavior; considered the active ingredient of MI) in order to improve insight into their addiction and promote abstinence and treatment engagement. While MI can initiate the motivation and intention for change, without ongoing re-enforcement these effects wane over time. We will refine and pilot an innovative Motivational Interviewing Video Reinforcement intervention (MIVR) to extend the impact of a single MI session using video clips of the patient’s self-generated positive change talk from that session. Providing a library of personalized, on demand videos provides ongoing access to a video reinforcement intervention of their own self-endorsed reasons not to drink. This reminds the patient of themselves during a period of high motivation to promote self-awareness and insight that will leverage initially heightened, and then bolster flagging motivation for abstinence over time. We propose a two-stage project. In Stage I we will use qualitative methods iteratively within a user- centered design approach to further refine our intervention. In Stage II, we will evaluate the final version of the intervention in a 6-month randomized controlled trial (RCT) of 50 ALD patients who either receive an MI session focused on abstinence followed by on-demand MI videos (MIVR) (n=25) or an MI session focused on abstinence followed by access to public health message video clips (Enhanced Usual Care-EUC)(n=25). MIVR and EUC groups will be asked to view their video clips weekly. Using standardized measures at intake, 3 months, 6 months, and 12 months we will collect quantitative data on key outcomes (e.g., motivation, insight, treatment engagement, alcohol use) and qualitative data from those assigned to MIVR. The aims of the study are to determine usability, acceptability, and feasibility of the refined MIVR intervention for ALD patients as measured by satisfaction, rates of viewing video clips and perceptions on use. We will also evaluate whether the refined MIVR intervention increases motivation and treatment engagement and reduces alcohol use compared to EUC.