Promise of a couples' intervention in reducing alcohol and other drug use: Results from a cluster randomized trial in South Africa

Background: Alcohol and other drug use (AOD) contribute to substantial morbidity among young South Africans and heighten risk for HIV and other adverse health outcomes. Adapted interventions were fielded with workshops conducted within each smaller community with couples living in a large high-density Cape Town township (R01AA018076).

Methods:  290 heterosexual couples recruited from drinking establishments in 30 neighborhoods were randomized to either: couple’s intervention; separate women’s and men’s group interventions; and women’s intervention only.  All participants received biological testing and completed baseline and six-month follow-up interviews with 94% completion. We used multivariable Poisson and logistic regression, adjusted for neighborhood clustering and baseline measures, to compare cannabis, methamphetamine, and alcohol use by gender between participants randomized to the couples’ intervention and those in the comparison groups.

Results: The mean age was 25 years. At baseline, 10% of women and 37% of men used cannabis, 4% of women and 15% of men used methamphetamine, and 31% of women and 70% of men reported frequent binge drinking. At follow-up, the odds of cannabis use was lower among women (OR=0.21; 95% CI: 0.05, 0.90) and men (OR=0.14; 95% CI: 0.07, 0.31) in the couples’ intervention relative to the comparison groups. Men in the couples’ intervention reported a lower odds of methamphetamine use (OR=0.28; 95% CI: 0.11, 0.68), and a lower rate of binge drinking (IRR: 0.75; 95% CI: 0.66, 0.85).

Conclusions: A couples-focused intervention led to reductions in cannabis use among women and men and reductions in methamphetamine use and binge drinking among men.