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Cited by 17Substance Abuse Treatment and OutcomesHIV, Drug Use, Sexual RiskHomelessness and Social Issues

Screening and Brief Intervention for Substance Misuse: Does It Reduce Aggression and HIV-Related Risk Behaviours?

Open access
Ward, Catherine L., Mertens, Jennifer R., Bresick, Graham F., Little, Francesca, Weisner, Constance M.·2015·Alcohol and Alcoholism
DOI 10.1093/alcalc/agv007PMC PMC4398989
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Abstract

PURPOSE: To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk behaviours. METHODS: Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse. Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline interview, with a 3-month follow-up. RESULTS: Participants who received the intervention were significantly more likely to reduce their alcohol use than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours. CONCLUSIONS: Reducing substance misuse through any means reduces aggression; other interventions are needed for HIV risk reduction.

Integrity signals

Registry

Crossref · 10.1093/alcalc/agv007

Cites

37 of 37 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 33 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    In the subgroup using alcohol at risky levels, substance use reduction was associated with higher odds of a zero aggression score at follow-up (OR = 2.32, P = 0.010).

    “In the sub-group with risky levels of alcohol use, we observed a similar reduction in terms of the increased odds of a zero score at follow-up that was significant (OR = 2.32, P = 0.010)”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The zero-inflated negative binomial model assumes that some zero aggression scores are structural, meaning some respondents have no propensity for violence.
  • Findingown data

    Among the full sample who reduced their overall substance use, the odds of a zero aggression score at follow-up were higher than at baseline (OR = 3.71, P < 0.0001).

    “by the increased odds of a zero score at follow-up compared with baseline (OR = 3.71, P < 0.0001)”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: The zero-inflated negative binomial model assumes that some zero aggression scores are structural, meaning some respondents have no propensity for violence.
  • Findingown data

    Participants in the intervention arm reduced their substance use more than those in the control arm.

    “the intervention group did reduce their substance use more than the control group”
    • Also stated in: § DISCUSSION · plain
      “our intervention did reduce substance misuse”
    Quote in the paperSubstantial claim
  • Findingown data

    For the risky-alcohol subgroup, mean aggression score reduction was not significantly different between substance-use reducers and non-reducers (ratio 0.86, P = 0.320).

    “the reduction in mean aggression scores (OR = 0.86, P = 0.320) was not significantly different between those who reduced their substance use at follow-up and those who did not.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: The zero-inflated negative binomial model assumes that some zero aggression scores are structural, meaning some respondents have no propensity for violence.
  • Findingown data

    There was no significant difference in change in HIV risk behaviour between those who reduced substance use and those who did not (median change zero in both groups, Kruskal-Wallis P = 0.3086).

    “However, the median change was zero for both groups, and the groups did not differ significantly, Kruskal-Wallis P-value = 0.3086.”
    • Also stated in: § Abstract · plain
      “participants who reduced substance misuse (whether as an effect of the intervention or not) also reduced aggression but not HIV risk behaviours.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 6
  • May combine two claims. 16

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The majority of the sample (61.43%) reported zero aggression at baseline.

    “The majority of the sample (223; 61.43%) reported zero aggression at baseline”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    HIV risk behaviour scores showed little change or between-group variation.

    “However, there is very little change or variation by group in the HIV risk behaviour scores.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The data hinted that HIV risk scores more often fell among non-reducers and more often rose among substance-use reducers.

    “There is an indication of higher percentages of decreased HIV risk scores (i.e.negative changes) among those who did not reduce their substance use and higher percentages of increased HIV risk scores (i.e.positive changes) among those who did reduce their substance use.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Substance misuse is linked to various sexual risk behaviours and to outcomes such as sexually transmitted infections including HIV and unintended pregnancy.

    “substance misuse has been found to be associated with a range of sexual risk behaviours, such as early sexual debut, multiple partners and no or inconsistent condom use, and with the consequences of risk behaviours, such as sexually transmitted infections (including HIV) and unintended pregnancies (Fergusson and Lynskey, 1996;Kotchick et al., 2001;Tapert et al., 2001).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Fergusson and Lynskey, 1996

      Not checked in the free run.

    • cites Kotchick et al., 2001 source

      Not checked in the free run.

    • cites Tapert et al., 2001 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Both arms reduced substance use, and the between-arm difference was small.

    “This is possibly because both the intervention and control groups reduced their substance misuse, and the difference between the two groups was small-as might be expected from a very light-touch intervention.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The study was a randomized controlled trial in primary care.

    “Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Relationship characteristics, partner trust and intimacy, and patterns of substance misuse may matter more for sexual risk behaviour than substance use itself.

    “the nature of the relationship, its length and partners' experiences of trust and intimacy (Halpern-Felsher et al., 1996) and patterns of substance misuse (such as binge-drinking and marijuana use; Guo et al., 2002) may be more important in sexual risk behaviour than simply use of substances.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Halpern-Felsher et al., 1996 source

      Not checked in the free run.

    • cites Guo et al., 2002 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Participants were randomly assigned using block randomization to intervention or minimally enhanced usual care.

    “half of the participants were randomly assigned (using block randomization) to receive a brief motivational intervention plus a referral resource list (n = 206); the other half (n = 197) received usual care plus a referral resource list (minimally enhanced usual care or mEUC; Freedland et al., 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Freedland et al., 2011 source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    Three hundred sixty-three patients completed both interviews, giving a 90% follow-up rate.

    “A total of 363 patients completed both baseline and follow-up interviews, with a follow-up rate of 90% ( please see Fig. 1 for further details).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Trained nurse practitioners delivered the brief motivational intervention and were supervised weekly to ensure fidelity.

    “Trained nurse practitioners used the procedures outlined in Health Behaviour Change: A Guide for Practitioners (Rollnick et al., 1999) to carry out brief motivational interventions addressing alcohol and drug use and were supervised weekly in order to ensure fidelity of the intervention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rollnick et al., 1999

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Norms feedback interventions have been shown to reduce substance misuse and HIV risk behaviours separately.

    “Norms feedback interventions have proven useful in reducing both substance misuse (Neville, 2015) and HIV risk behaviours (Kelly et al., 1991) separately”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Neville, 2015

      Not checked in the free run.

    • cites Kelly et al., 1991 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Research on substance abuse treatment and aggression usually studies only interventions that specifically target aggression and, apart from one exception, does not test whether lowering substance misuse alone lowers aggression.

    “Studies of substance abuse treatment and aggression thus typically examine only interventions that include a specific focus on aggression and-with one exception (Goodall et al., 2012)-do not examine whether simply reducing substance misuse is sufficient also to reduce aggression.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Goodall et al., 2012 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The reduction in aggression from lowering substance use applies at least to minor forms like yelling and slapping, but not necessarily to serious aggression.

    “Our results suggest, therefore, that reducing substance misuse (through any means) can reduce aggression, at least in minor forms such as yelling and slapping that may precede more serious forms, but they do not speak to more serious forms of aggression.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Substance misuse is a major contributor to both aggression and HIV risk.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Those lost to follow-up were more likely to be in low-risk groups.

    “Those lost to follow-up were more likely to fall in the low-risk groups (Mertens et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Mertens et al., 2014 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many brief alcohol interventions in trauma settings lower trauma and injury recidivism, which suggests they may also affect aggression.

    “This is despite a robust set of studies finding that many brief interventions in trauma settings for alcohol use alone do reduce trauma and injury recidivism, implying that there may be some effect on aggression (Nilsen et al., 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Nilsen et al., 2008 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Some trials find effects several months after a single brief intervention, but many preventive interventions lose effect over time.

    “While some trials show effects at several months after one brief intervention (see, for instance, WHO Brief Intervention Study Group, 1996, which showed effects at 9 months post-intervention), many preventive interventions show a drop-off of effect over time (Nation et al., 2003).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites WHO Brief Intervention Study Group, 1996 source

      Not checked in the free run.

    • cites Nation et al., 2003 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In South Africa and other low- and middle-income countries, substance abuse, aggression, and HIV risk behaviours are highly prevalent.

    “In the South African context (as in many other low-and middle-income countries), there are twin problems with regard to intervening in risk behaviours: substance abuse, aggression and HIV risk behaviours all occur at high levels (Coovadia et al., 2009)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Coovadia et al., 2009 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Brief motivational interventions are simple enough for paraprofessionals to deliver and brief enough to integrate into service systems more easily than longer interventions.

    “Brief motivational interventions are precisely the kind of intervention that appear to meet these criteria: their simple delivery format means that paraprofessionals can probably be trained to deliver them, and their brevity makes them easier to integrate into service systems than longer, more complex interventions.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Screening plus a single session of brief motivational intervention is insufficient to reduce substance use, aggression, and HIV risk behaviour.

    “Yet our results suggest that perhaps the simplest of such interventions-screening and a single-session brief motivational intervention-while it can reduce alcohol use (Mertens et al., 2014), is not sufficient to achieve the goal of reducing substance use as well as aggression and HIV risk behaviour.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mertens et al., 2014 source

      Not checked in the free run.

    • Rests on an assumption: Substance misuse is a major contributor to both aggression and HIV risk.
19 of 19

  • The authors state this as an assumption.

    The zero-inflated negative binomial model assumes that some zero aggression scores are structural, meaning some respondents have no propensity for violence.

    “This model assumes that some of the zeroes are structural zeroes in that some respondents have no propensity for violence (33% of all respondents recorded a zero score for aggression at both time points).”

  • The paper relies on this without support.

    Substance misuse is a major contributor to both aggression and HIV risk.

    “Substance misuse also plays a key role in both aggression and HIV risk.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Other studies reported a statistically significant reduction in total ASSIST scores.

    “Some studies found no effect on total Alcohol Smoking and Substance Involvement Screening Test (ASSIST) scores [62,68], while others reported a statistically significant reduction in total ASSIST scores [49,69].”

    From A scoping review of substance use brief interventions in Africa (2024) · cites this paper as [69]

    The Data analysis section defines substance-use reduction as any reduction in ASSIST scores, and the Discussion says both groups reduced substance misuse. Neither passage reports a statistical test showing a significant reduction in total ASSIST scores; the significant results in the Results section concern aggression scores instead. Page numbers were not available in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Brief interventions delivered from a motivational intervention framework showed evidence of efficacy at the primary care setting to reduce alcohol use.

    “Similarly, this mode of delivery showed evidence of efficacy at the primary care setting to reduce alcohol use [76,91,93]”

    From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [93]

  • In the systematic review, 6 studies evaluated brief interventions in South Africa.

    “In our systematic review, 6 studies evaluated brief interventions in South Africa [67,79–81,93,94].”

    From Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary (2022) · cites this paper as [93]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Alcohol-risk non-reducer count exceeds subgroup size

    Minor

    The intervention arm has 14 alcohol-risk non-reducers, yet its follow-up cell reports 15 participants with zero aggression and uses a denominator of 33.

  • Aggression estimate falls outside its confidence interval

    Minor

    Table 4 reports a ratio of 1.96 for non-reducers, but its stated 95% confidence interval ends at 1.71. The point estimate cannot lie outside its own interval.

  • Intervention subgroup baseline counts do not sum to the total

    Minor

    The non-reducer and reducer rows list 25 and 40 participants with zero baseline aggression, respectively, but their total is reported as 64 rather than 65.

    Reported 64 · recomputed 65

  • Intervention baseline HIV-risk mean exceeds both subgroup means

    Minor

    The reported overall baseline mean of 1.23 cannot be the combined mean of subgroups whose means are 1.10 and 1.20.

  • Baseline zero-aggression count conflicts with the median

    Minor

    If 223 of 363 participants had a baseline aggression score of zero, the median must be zero, not two.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 12

  1. Anderson, 2015, Alcohol and violence, 291
  2. Anderson, 2003, Human aggression: A social-cognitive view, 296
  3. Goodall, 2015, Preventing violence through intervention in the health system, 225
  4. Institute of Medicine, 2006, Improving the Quality of Health Care for Mental and Substance-use Conditions: Quality Chasm Series
  5. Long, 1997, Regression Models for Categorical and Limited Dependent Variables
  6. Metzger, 1998, Drug abuse treatment as AIDS prevention, Public Health Rep, 113, 97
  7. National Institute on Drug Abuse, 2011, Screening for Drug use in General Medical Settings: Quick Reference Guide
  8. Neville, 2015, Preventing violence through changing social norms, 239
  9. Rollnick, 1999, Health Behavior Change: A Guide for Practitioners
  10. Straus, 1996, The revised conflict tactics scale (CTS2): Development and preliminary psychometric data, J Fam Issues, 17, 283, 10.1177/019251396017003001 · DOI · Paper page
  11. Weisner, 2001, Rethinking access to alcohol treatment, Recent Dev Alcohol, 15, 107
  12. WHO Brief Intervention Study Group, 1996, A cross-national trial of brief interventions with heavy drinkers, Am J Public Health, 86, 948, 10.2105/AJPH.86.7.948 · DOI · Paper page

Cited by

Sorted by citations

Authors
Ward, C. L., Mertens, J. R., Bresick, G. F., Little, F., & Weisner, C. M.
Affiliations
  • University of Cape Town (ZA)
  • Kaiser Permanente (US)
Corresponding author
Ward, Catherine L.
ORCID
Venue
Alcohol and Alcoholism
Publisher
Oxford University Press (OUP)
Published
2015-03-02
Volume
50
Issue
3
Pages
302-309
ISSN
  • 0735-0414 (ISSN-L)
  • 1464-3502
DOI
10.1093/alcalc/agv007
PMC
PMC4398989
OpenAlex
W2112470561
Semantic Scholar
540ca262952488aab7f4f3e3bb86b49b003be4d3
Cited by
17
References
37
Citations by year
2025: 1 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 2 · 2020: 2 · 2019: 1 · 2017: 2
FWCI
0.52
Type
journal article
Language
en
Open access
Locations
  • Alcohol and Alcoholism (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • University of Cape Town
  • National Institute on Drug Abuse (R21DA022557)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
Keywords
screening and brief intervention, substance abuse, aggression, HIV risk behavior, alcohol consumption reduction, motivational interventions, primary care, substance use screening
MeSH terms
Adolescent, Aggression, Alcoholism, Marijuana Abuse, Community Health Centers, Female, Humans, Hypnotics and Sedatives, Male, Mass Screening, Primary Health Care, Psychotherapy, Brief, Referral and Consultation, Risk-Taking, South Africa, HIV Infections, Treatment Outcome, Substance-Related Disorders, Amphetamine-Related Disorders, Cocaine-Related Disorders, Young Adult, Motivational Interviewing

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