Changes in HIV risk behaviors among patients receiving combined pharmacological and behavioral interventions for heroin and cocaine dependence.
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.
Schroeder
Jennifer R
JR
Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD 21224, USA. jschroed@intra.nida.nih.gov
Epstein
David H
DH
Umbricht
Annie
A
Preston
Kenzie L
KL
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
D008691:Methadone