How injection drug users coped with testing HIV-seropositive: implications for subsequent health-related behaviors.

At entry into methadone maintenance treatment, 94 HIV-positive injection drug users (IDUs) completed the Coping Reponses Inventory, which asked them to "describe your feelings and experiences when you first learned you were HIV positive." Controlling for time since HIV testing, a reliance on avoidance coping following HIV testing was correlated with high levels of recent HIV risk behavior and poor health at entry into the study. The use of any coping strategy, particularly approach strategies, was related to medication adherence. Hierarchical regression analysis showed that avoidance coping accounted for a significant proportion of the variance in recent HIV risk behavior over and above that accounted for by the other variables. Other independent predictors of continued risk behavior were poor health, lack of social support, and low levels of HIV/AIDS knowledge. The need for interventions to help injection drug users (IDUs) cope subsequent to testing HIV seropositive is discussed.

Spiritual and religious support in recovery from addiction among HIV-positive injection drug users.

The current study examined the association between support and comfort derived from religion or spirituality and abstinence from illicit drugs in a sample of 43 HIV-positive injection drug users entering a methadone maintenance program. Patients with high ratings of perceived spiritual or religious support were abstinent from illicit drugs significantly longer during the first six months of methadone maintenance than were patients with lower ratings. Controlling for the influence of pretreatment variables (addiction and psychiatric severity, CD4 count, social support, and optimism), and during-treatment variables (methadone dose and attendance at counseling sessions), hierarchical regression analysis showed that strength of religious and spiritual support was a significant independent predictor of abstinence. These findings suggest that spirituality may be an important dimension of patient experience to assess in future addiction treatment outcome research.

Predictors of nonadherence to HIV-related medication regimens during methadone stabilization.

Nonadherence to HIV-related medication regimens among drug-abusing patients decreases therapeutic effectiveness and may limit patient access to newer, highly active antiretroviral therapies (HAART). A number of factors have been associated with medication nonadherence; however, few studies have examined predictors of nonadherence specifically in HIV-positive drug abusers. In the current study, a comprehensive assessment battery was administered to 42 HIV-positive, injection drug users beginning methadone maintenance. HIV-related medication adherence was assessed weekly by self-report during the 4-week methadone stabilization phase. Thirty-six percent of patients reported less than 80% adherence to their medication regimen at entry into methadone. Medication adherence increased significantly during the 4-week stabilization phase. Significant zero-order correlations were found between nonadherence during stabilization and viral load, low educational attainment, depression, and neuropsychological tests of problem solving ability and cognitive flexibility. Independent predictors of nonadherence were low levels of education and poor emotional functioning. Implications for early intervention are discussed.

The influence of coping and depression on abstinence from illicit drug use in methadone-maintained patients.

Use of illicit drugs by opioid-dependent patients maintained on methadone undermines the benefits of methadone maintenance treatment. Because supplemental pharmacologic approaches have met with limited success, it is important to identify psychological mechanisms associated with drug use that potentially could contribute to the development of more effective treatments. To investigate this issue, the current study assessed coping and depression in 307 methadone-maintained patients and found a reliance on avoidant coping strategies, most notably by depressed patients. Patients who achieved abstinence following a 12-week coping skills training intervention decreased the use of avoidant coping strategies. Drug use at the 6-month follow-up was related to gains made during treatment, specifically reduced cognitive avoidance, reduced depression, and number of drug-free weeks during treatment.

Continuation of high-risk behavior by HIV-positive drug users. Treatment implications.

Drug users who are positive for the human immunodeficiency virus (HIV) represent a major vector of HIV transmission, yet relatively little is known about their continued drug- and sex-related HIV-risk behavior, which may impede the development of effective risk-reduction interventions. In this study, 50 HIV-seropositive injection drug users entering methadone maintenance treatment completed a comprehensive risk assessment battery, including self-report of HIV-risk behavior since learning HIV serostatus, and measures of risk-reduction information, motivation, and behavioral skills. We found that a disconcertingly high proportion of patients (66%) reported having engaged in HIV-risk behavior since learning their HIV-seropositive status. Level of HIV-related knowledge did not predict high-risk behavior. Drug-related risk behavior was predicted by psychiatric severity and poor behavioral skills. Sex-related risk was predicted by low levels of motivation and poor behavioral skills. Implications of these findings for treatment are discussed.