Culturally Adapted Motivational Interviewing's Effects on Drinking in Response to Immigration and Acculturation Stressors Among Latinx Immigrants with Heavy Drinking Problems

Background and Purpose: Alcohol misuse is of growing concern among Latinx/Latino/Hispanic (hereafter Latinx) Americans, the largest racial/ethnic minority group in the United States (US). Culturally adapted motivational interviewing (CAMI) is a form of motivational interviewing (MI) that was adapted to address immigration- and acculturation-related stressors (e.g., discrimination, sense of alienation) among Latinx immigrants with heavy drinking problems. This study aimed to test the hypotheses that (1) receiving CAMI was associated with reduced immigration/acculturation stress and related drinking, and (2) treatment effects differed by participants’ acculturation and perceived discrimination levels.

Methods: This study employed a single group pre-post study design and used data from a randomized controlled trial (RCT) that compared standard MI with CAMI for first/second-generation Latinx immigrants with heavy drinking problems. Participants in this study were the 149 participants who were randomized to the CAMI condition in the parent trial (N=149). Immigration/acculturation stress was assessed with the Measure of Immigration and Acculturation Stressors (MIAS), which includes four subscales: relational stress, ethnic discrimination stress, attenuated aspirations stress, and sense of alienation. Drinking in response to immigration/acculturation stress was measured with the Measure of Drinking Related to Immigration and Acculturation Stressors (MDRIAS), which assesses participants’ frequency of drinking in response to the scenarios described in MIAS. R was used for data analysis. For the primary analysis, we conducted linear mixed modeling for repeated measures to examine outcome changes between the baseline and the 6-month and 12-month follow-ups. For the moderation analysis, time x moderator interaction was included in each model to represent moderation effects.

Results: Compared to baseline, there were significant decreases in all outcomes (i.e., total scores and subscale scores of MIAS and MDRIAS) at 6- and 12-month follow-ups, except for the attenuated aspiration stress subscale score at the 6- and 12-month follow-ups and the sense of alienation subscale score at the 6-month follow-up. Moderation analysis results showed that lower acculturation levels were significantly associated with larger baseline-follow-up decreases in total MIAS score (both 6-month and 12-month follow-ups), total MDRIAS score (6-month follow-up), relational stress (both follow-ups), drinking related to ethnic discrimination stress (6-month follow-up), sense of alienation (both follow-ups), and drinking related to the sense of alienation scores (6-month follow-up). Higher levels of perceived discrimination were significantly associated with larger decreases in total MIAS score (12-month follow-up), total MDRIAS score (both follow-ups), relational stress (12-month follow-up), drinking related to relational stress (12-month follow-up), ethnic discrimination stress (both follow-ups), drinking related to ethnic discrimination stress (both follow-ups), and drinking related to the sense of alienation scores (both follow-ups).

Conclusions and Implications: Study results suggested that CAMI reduced immigration and acculturation stress and related drinking among Latinx immigrants with heavy drinking problems. Larger improvements were observed among the relatively more vulnerable subgroups (i.e., less acculturated and more discriminated participants). Although this study was exploratory in nature, its results were consistent with those of the parent RCT, i.e., greater treatment improvements were found in the same subgroups and thus supports our findings. Larger studies with more rigorous designs are needed.