title: Changes in HIV risk behaviors among patients receiving combined pharmacological and behavioral interventions for heroin and cocaine dependence.
abstract: Cocaine use is associated with injecting and sexual HIV risk behaviors. This study was a randomized controlled trial of behavioral interventions for cocaine dependence and HIV risk behaviors among dually (cocaine and heroin) dependent outpatients. Methadone maintenance was augmented with cognitive-behavioral therapy (CBT), contingency management (CM), both (CBT+CM), or neither. The study sample (n=81) was 52% female, 70% African American, and 37.9+/-7.0 years old. Proportions reporting HIV risk behaviors at intake were: 96.3% (78/81) injection drug use, 56.8% (46/81) sharing needles, 30.9% (25/81) unprotected sex, 28.4% (23/81) trading sex for money or drugs. Proportions who no longer reported behaviors at study exit were: 51.3% (40/78) injection drug use, 91.3% (42/46) sharing needles, 88% (22/25) unprotected sex, 91.3% (21/23) trading sex for money or drugs. Participants receiving CBT+CM were more likely to report cessation of unprotected sex relative to control (OR=5.44, 95% CI 1.14-26.0, p=0.034) but this effect was no longer significant after adjusting for drug-negative urines. These results suggest broad beneficial effects of methadone maintenance augmented with behavioral interventions for reducing HIV risk behaviors.
authors.affiliation: Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD 21224, USA. jschroed@intra.nida.nih.gov
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Schroeder
authors.forename: David H
authors.initials: DH
authors.lastname: Epstein
authors.forename: Annie
authors.initials: A
authors.lastname: Umbricht
authors.forename: Kenzie L
authors.initials: KL
authors.lastname: Preston
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology / Q000635:transmission*; D006556:Heroin Dependence / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D016485:Needle Sharing / Q000009:adverse effects; D012309:Risk-Taking; D011477:Sex Work; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000523:psychology / Q000534:rehabilitation; D047568:Unsafe Sex
chemical_list: D008691:Methadone