Motivational Interviewing and Harm Reduction among Hospitalized Patients with Alcohol Use Disorder in Lusaka, Zambia: A Randomized Controlled Trial

Background: Evidence on motivational interviewing for alcohol use disorder in hospitalized psychiatric settings in Zambia is limited. This study assessed its effect on harm reduction among hospitalized adults with alcohol use disorder (AUD) in Lusaka, Zambia. Methods: A single-blind randomized controlled trial was conducted among 84 inpatients diagnosed with alcohol use disorder using DSM-5 criteria. Participants were assigned to either motivational interviewing plus treatment as usual or treatment as usual alone. Alcohol Use Disorders Identification Test (AUDIT) scores were measured at baseline and 6 weeks. Harm reduction was defined as improvement in AUDIT score and alcohol-risk category. Results: The median age was 32 years, 89.3% were male, and 90.5% had alcohol dependence at baseline. Overall, 71/84 (84.5%) participants achieved harm reduction. This did not differ significantly between the groups (85.7% vs. 83.3%, p > 0.05). The median AUDIT score decreased from 25 to 11 (p = 0.0001). Older age predicted harm reduction (AOR 1.14, 95% CI 1.01–1.28), while a monthly income of K1,500–K5,000 predicted lower odds versus > K5,000 (AOR 0.03, 95% CI 0.01–0.74). Conclusion: Motivational interviewing showed no significant added benefit over treatment as usual, although substantial short-term harm reduction was observed overall. Larger trials are needed.