Motivational Interviewing Video Reinforcement Intervention for Acute Alcohol Related Hepatitis Liver Transplant Recipients

Abstract: Background/Significance: Alcohol use following liver transplant (LT) for acute alcohol hepatitis (AAH) are similar if not higher than for alcohol cirrhosis LT recipients with some suffering early alcohol related medical consequences and death (Im 2016, Lee 2018). We lack strategies to motivate individuals to participate in addiction counseling to prevent relapse following AAH LT.

Methods: Eligible participants underwent AAH LT at our center within the past 2 years. We designed an innovation of motivational interviewing (MI) using patient-generated “positive change talk” as a video feedback technique to promote and maintain motivation for abstinence. Participants completed a videotaped MI session designed to elicit change talk. From this session, positive change talk video clips were extracted and loaded on an iPad. Over the 4-months, participants were instructed to view clips weekly and at times of high craving. Insight, self-awareness, motivation were measured at intake, 2 and 4 months, with a qualitative interview about the intervention at study end. The primary aim was to determine if participants perceived their library of video clips helpful to motivate abstinence and participate in addiction therapy. We used cutting edge wearable alcohol biosensors (ABM) to monitor alcohol use. Institutional Review Board approval was obtained.

Results: The 10 participants were 50% female, 100% white, age 38+5.8, 30% married/partner, met criteria for moderate/severe AUD and abstinent 8.9+5.3 months. All participants reported abstinence during the study and no alcohol use was identified by ABM. All six of the 10 participants not in treatment before LT started addiction counseling thereafter. Across all assessments participants showed consistent motivation and taking steps to address alcohol use (SOCRATES). Self-efficacy to not drink (Alcohol Abstinence Self-efficacy scale) improved significantly over the 4 months (-3.2, p= 0.01, Cohen’s d = -1.0). Reductions in concerns over possible relapse (Advance Warning of Relapse) and in consequences due to alcohol use (Short Inventory of Problems) were non-significant. From the qualitative interviews: participants found the videos helpful in motivating and maintaining abstinence, reaffirmed their decision to remain abstinent, and reinforced their reasons for abstinence. Participants noted that, as time passed, they needed reminders of why they did not want to drink and the promises they made to themselves/others. They emphasized seeing themselves talk about their alcohol issues was more helpful than a clinician speaking about their recovery. Some felt videos were better earlier in recovery and the formatting could be improved.

Conclusion/Implications: Participants found the videos useful in maintaining abstinence and reinforced their commitment to sobriety that they felt would diminish over time. Some suggested refinements to the format, content, and delivery of the intervention. In addition, strategies for easier creation and deployment of video clips are required for this technique to be deployed in a clinical trial to test for efficacy.