Differences among out-of-treatment drug injectors who use stimulants only, opiates only or both: implications for treatment entry.

The goal of this study was to compare drug and alcohol use, psychological symptoms and substance abuse treatment entry among 583 street-recruited, out-of-treatment injection drug users (IDUs) who used stimulants only, opiates only or both stimulant and opiate. Data analyzed from structured interviews indicated that stimulant-only users had the most severe alcohol problems and the highest psychological symptom scores for hostility, paranoia and psychoticism. In the 2 months following their interview only 3% of the stimulant-only users entered substance abuse treatment, as compared to nearly half of the participants in the other two groups. Even after controlling for variables that differed among the groups by logistic regression analysis, stimulant only users were still 24-25 times less likely than opiate only or both stimulant and opiate users to enter treatment. Researchers and clinicians are challenged to better understand and address the unique needs of stimulant users, including potential psychological problems and alcohol abuse, in order to attract them to treatment and serve them through a comprehensive treatment approach.

Methadone maintenance as HIV risk reduction with street-recruited injecting drug users.

OBJECTIVE: To compare changes in HIV risk behaviors between street-recruited opiate injectors who entered and remained in methadone maintenance treatment and those who did not. METHODS: Three hundred sixteen participants were interviewed at baseline, received outreach interventions, and were interviewed again 6 months later. RESULTS: Significant (p <.001) reductions in HIV-related risk behaviors, including frequency of injecting, injecting with used (dirty) needles, and sharing injection paraphernalia, were demonstrated. Participants (31%) who entered and remained in methadone maintenance treatment for at least 90 days before follow-up showed a significantly greater reduction in heroin injections than those who did not. They did not show a greater reduction in using dirty needles or sharing other injection paraphernalia. CONCLUSIONS: These findings suggest that although methadone maintenance may reduce injection frequency, it does not reduce other HIV-related risk behaviors above and beyond what can be accomplished through outreach interventions. Treatment facilities and outreach intervention programs should collaborate to provide a comprehensive approach to reducing HIV risk behaviors among drug injectors both in and out of drug treatment.

The effects of offering free treatment to street-recruited opioid injectors.

AIMS: The goal of this investigation was to assess the treatment entry impact of offering free treatment to street-recruited injecting opioid users, and to determine which variables differentiated subjects who entered treatment when it was free, compared to those who entered when they had to pay for treatment. DESIGN: Three hundred and sixty-two out-of-treatment opioid injectors, recruited through street outreach, were randomly assigned to receive or not receive a coupon for 90 days of free substance abuse treatment. Demographics, desire for treatment, drug use and HIV risk behaviors were assessed prior to assignment. FINDINGS: Subjects were characterized by frequent and long-term drug use, numerous arrests, a variety of behaviors that placed them at risk for HIV, and ambivalence about entering substance abuse treatment. Offering free treatment led to significantly greater treatment entry (53% vs. 33%) and retention (155 days vs. 83 days). Entry into free treatment was particularly high, compared to those who had to pay for treatment, among subjects who had never been in treatment (43% vs. 23%) and those who reported that they did not want to enter treatment (24% vs. 6%). Subjects who entered free treatment were significantly less likely to have family problems than those who paid for their treatment. CONCLUSIONS: Opioid addicts recruited on the street and offered free methadone maintenance treatment are likely to enter and remain in treatment, even if they have never been in treatment before or claim not to want treatment. Different treatment approaches may be necessary if such subjects are motivated more by the removal of financial obstacles than other factors, such as family problems.

Sex related HIV risk behaviors: differential risks among injection drug users, crack smokers, and injection drug users who smoke crack.

This study was designed to assess differences in sex-related risk behaviors between drug injectors who did not smoke crack cocaine, crack smokers who did not inject drugs, and drug users who both injected drugs and smoked crack. Current drug users (i.e. used within the past 30 days) from 22 cities were recruited and assessed. The sample (n = 26,982) included 28% who injected only, 42% who smoked crack only, and 30% who both injected and smoked crack. Results showed that active drug users were at risk of HIV infection through sexual transmission: in the 30 day period prior to their interview, 28% reported sex with two or more individuals, 23% had an IDU sex partner, and 24% had exchanged sex for drugs or money. In addition, more than 80% did not use a condom during sex. Crack only smokers and crack smoking injectors were more likely than injectors only to report multiple sex partners and exchanging sex. Because of these high risk behaviors, condom use was of particular importance. The number of days of alcohol use and having an IDU sex partner were independently associated with not using a condom. Crack smoking injectors reported the highest average number of days of alcohol consumption and were the most likely to have had an IDU sex partner.

Health-related service utilization and HIV risk behaviors among HIV infected injection drug users and crack smokers.

This study was designed to assess utilization of health-related services and HIV risk related behaviors by HIV infected drug users one year prior to and two years following the availability of Ryan White Title I funding. Using a cross-sectional design, a total of 777 drug injectors and crack smokers from five US cities were surveyed, over three waves of data collection, about their use of drug treatment, medical services, housing, mental health, and case management and about their sex and drug-related risk behaviors. For all service categories and in each wave, including the year prior to Title I funding, HIV risk behaviors were lower among those who used health-related services, with the exception of housing. Use of services did not increase significantly following the disbursement of Title I funds except for housing and case management. These findings suggest that it may be necessary to increase the attractiveness of health-related services, not just funding for services, for HIV infected substance abusers.

Predictors of increased condom use following HIV intervention with heterosexually active drug users.

Research with injection drug users (IDUs), at risk for acquiring and transmitting HIV, has focused primarily on their risky drug practices, with far less attention paid to their risky sex behaviors. The purpose of this study was to determine what variables were associated with an increase in condom use following an HIV intervention with 3357 IDUs in nine cities. Participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention, and during 22% of their sexual encounters six months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive (odds ratio OR = 2.49), to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). Discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers.

PIP: This study determined the predictors associated with an increase in condom use following an HIV intervention among 3357 heterosexually active injection drug users (IDUs) in nine cities. Subjects were interviewed using the Risk Behavior Assessment, and re-interviewed approximately 6 months later using the Risk Behavior Follow-up Assessment. Findings revealed that participants reported using condoms during 15% of their sexual encounters prior to the HIV intervention and during 22% of their sexual encounters 6 months later. A logistic regression analysis indicated that individuals who increased their condom use were likely to be HIV seropositive [odds ratio (OR) = 2.49], to have received AIDS information prior to the intervention (OR = 1.28), to have multiple sex partners (OR = 2.14), to be single with multiple sex partners (OR = 1.34), or to have exchanged drugs or money for sex (OR = 1.33). The discussion focuses on the generally low incidence of condom use and the need for increased intervention, particularly among drug users in monogamous relationships and sex workers. Findings indicate the need for a more effective means of inducing change in the sexual behaviors of IDUs.

Substance abuse treatment for high-risk adolescents.

Adolescent substance abuse is rising dramatically in the United States. This observation is especially troubling given the association between substance use and HIV, as well as other sexually transmitted diseases. Surprisingly, there have been few carefully constructed, controlled studies examining different treatment approaches with adolescent substance abusers. In our review of the literature, we note that family therapy and, to a lesser extent, cognitive behavioral therapy, received the most attention as intervention strategies with adolescents. Both approaches appear to have some success, although further research is necessary. In addition, developing and assessing strategies to improve family involvement in treatment requires additional investigation.

The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents.

OBJECTIVE: To assess HIV-related drug and sex risk behaviors and evaluate factors associated with change in risk behaviors among runaway and homeless adolescents, 244 street youth were recruited from a community drop-in center serving high-risk youth. METHOD: Using a cross-sectional design, approximately half of study participants received training in a peer-based intervention that included principles derived from the health belief model, while the remaining subjects received no intervention. Subjects were interviewed at baseline, immediately following the intervention (for those receiving the training) and 3 months later. Logistic regression and analysis of covariance were used to analyze intervention effects. RESULTS: Compared to youth in the control condition, runaways receiving the intervention significantly increased their knowledge about HIV. Contrary to the health belief model, in multivariate analyses knowledge and greater perceived chance for HIV were associated with high risk behavior. On the other hand, lower concern about HIV infection was also associated with high risk behavior, supporting the health belief model. CONCLUSIONS: Despite the intervention's success in increasing knowledge of HIV and AIDS, the association between knowledge, perceived likelihood of infection and high risk behaviors suggest that, without other alternatives, runaways will maintain their risks. The association noted between lower concern and high risk behaviors underscores the challenge faced in developing effective interventions with this population.

Facilitating treatment entry among out-of-treatment injection drug users.

OBJECTIVE: High risk injection practices are common among injecting drug users (IDUs), even following intervention efforts. Moreover, relapse to risk behaviors has been reported among those who initiate risk reduction. Substance abuse treatment offers the potential to reduce or eliminate injecting risk behaviors through drug cessation. We report on the effectiveness of two intervention strategies in facilitating treatment entry among out-of-treatment IDUs: motivational interviewing (MI), and intervention developed to help individuals resolve their ambivalence about behavior change, and free treatment for 90 days. These conditions were compared with an intervention focusing on a hierarchy of safer injecting practice, referred to here as risk reduction (RR), and no free treatment. METHODS: Nearly 200 out-of-treatment IDUs were randomly assigned to one of four experimental conditions: MI/free treatment, MI/no free treatment, RR/free treatment, and RR/no free treatment. Regardless of assignment, we assisted anyone desiring treatment by calling to schedule the appointment, providing transportation, and waiving the intake fee. RESULTS: Overall, 42% of study participants entered treatment. No significant differences were found between MI and RR; however, 52% of those assigned free treatment entered compare with 32% for those who had to pay. Other predictors of treatment entry included prior treatment experiences, perceived chance of contracting acquired immunodeficiency syndrome (AIDS) greater than 50%, "determination" stage of change, greater frequency of heroin injecting, and fewer drug-using friends. CONCLUSIONS: These findings support the importance of removing barriers to treatment entry.

Effectiveness of HIV/AIDS interventions on drug use and needle risk behaviors for out-of-treatment injection drug users.

Abstract-This study presents an evaluation of the effectiveness of the AIDS Community-Based Outreach/Intervention projects implemented as part of the National Institute on Drug Abuse (NIDA) Cooperative Agreement (CA), which began in 1990 and is currently ongoing. Participants in the CA were randomly assigned to one of two interventions: a NIDA/CA-developed standard intervention (SI); or the SI plus a site-specific enhanced intervention (EI). Analyses of drug use and needle-related risk behaviors were conducted among injection drug users (IDUs) in eight participating cities where follow-up rates of at least 60% were obtained (N=3,743). Results indicated that IDUs significantly reduced their needle-related risk behaviors following delivery of the interventions and that a substantial portion entered substance abuse treatment. However, there was relatively little to support the effectiveness of more expensive and involved enhanced interventions. A number of factors associated with increasing or maintaining high risk behaviors, including an HIV negative serostatus and a greater perceived chance of acquiring AIDS, were also observed. Continued outreach to drug injectors is recommended, as well as the development of new and creative interventions targeting individuals who are HIV negative and those who are aware of their high risk status but have not changed their behaviors in response to risk-reduction interventions.

[Infected abdominal aneurysm with retroperitoneal fibrosis--a case successfully treated conservatively]. / Zapalny tetniak aorty brzusznej ze zwlóknieniem zaotrzewnowym-przypadek pomyslnie leczony zachowawczo.

53 year old men suffered from abdominal pain, vomiting, lack of appetite, loss of weight, with ESR > 100 mm Hg and moderate anaemia was presented. Many diagnostic procedures were without results and finally laparotomy was taken. The microscopic examination of specimen of periaortic tissue revealed retroperitoneal fibrosis accompanying atherosclerotic aortae. Corticotherapy and antilipemic drugs were given. After 3 years a complete remission of periaortic pathologic mass was observed. This case could prove the autoimmunological hypothesis of retroperitoneal fibrosis.

Effective services for homeless substance abusers.

A heterogeneous and representative sample of 323 homeless individuals in the metropolitan-Denver area with alcohol or other substance abuse problems received a comprehensive array of substance-abuse treatment services. Following treatment, these individuals showed dramatic improvement on average in their (a) levels of alcohol and drug use, (b) housing status, (c) physical and mental health, (d) employment, and (e) quality of life. Those who received more service improved more than those who received less service. These improvements are attributable, at least partly, to the treatment rather than to alternative hypotheses such as spontaneous remission. However, the rate of improvement generally slowed during the six-month follow-up period. A random half of the clients received intensive case management in addition to the other services. Case management marginally increased clients' contacts with addictions counselors, but had little effect on the level of other services received or on the tailoring of services to client needs. As a result, case management also had little, if any, effect on outcomes.