A randomized controlled trial of goal choice interventions for alcohol use disorders among men who have sex with men.

This study tested the efficacy of behavioral treatments for alcohol use disorders (AUD) among men who have sex with men (MSM) and who are at risk for HIV transmission. HIV-negative MSM with current AUD (N = 198) were recruited, offered treatment focused on reducing drinking and HIV risk, and followed during treatment and 12 months posttreatment. Participants (n = 89) accepted treatment and were randomized to either 4 sessions of motivational interviewing (MI) or 12 sessions of combined MI and coping skills training (MI + CBT). Other participants (n = 109) declined treatment but were followed, forming a non-help-seeking group (NHS). MI yielded significantly better drinking outcomes during the 12-week treatment period than MI + CBT, but posttreatment outcomes were equivalent. NHS participants significantly reduced their drinking as well. Service delivery and treatment research implications are discussed.

Barriers to employability among substance dependent and nonsubstance-affected women on federal welfare: implications for program design.

OBJECTIVE: This study examined barriers to employability among women meeting criteria for a substance dependence disorder who were identified by routine screening conducted in welfare offices. The characteristics of these women were compared to other women on welfare who did not have a substance use disorder. METHOD: A sample of 214 substance dependent women on federal welfare were recruited to participate in a substance use disorders welfare demonstration project. An additional 69 nonsubstance-affected women on welfare served as a comparison sample. All participants were assessed in welfare settings through a standardized battery of measures. RESULTS: Substance dependent women reported moderate to severe substance use problems. They also reported significantly higher rates than the women with no substance use disorder of other barriers such as domestic violence, mental health problems, legal problems, child welfare investigations and fewer job skills. CONCLUSIONS: Findings raise questions about the likely effectiveness of existing welfare reform services in addressing the needs of substance dependent women.

Alcohol and sexual HIV risk behavior among problem drinking men who have sex with men: An event level analysis of timeline followback data.

While heavy drinking among men who have sex with men (MSM) has been shown to be associated with an increase in sexual risk taking, a temporal relationship between drinking and an increase in subsequent HIV risk behaviors among adult samples has been less obvious. This study used an event level analysis to examine this relationship among HIV negative problem drinking MSM. Within subjects analyses show a higher probability of unprotected anal intercourse after drinking. Post-hoc analyses of within subjects data indicate that drinking increases risk taking when engaging in receptive anal intercourse but not for insertive anal intercourse. Findings from this study support evidence that drinking is a factor that increases risk taking among HIV negative problem drinking MSM, particularly for receptive anal intercourse.

A double-blind study of citalopram versus placebo in the treatment of compulsive sexual behaviors in gay and bisexual men.

OBJECTIVE: Compulsive sexual behavior (CSB) is a condition characterized by loss of control over sexual behavior and repeated negative consequences, including unsafe sex. Selective serotonin reuptake inhibitors have been found to reduce CSB symptomatology in open-label trials. The objective of this study was to conduct a preliminary double-blind, placebo-controlled evaluation of the efficacy, acceptability, and tolerability of citalopram in the treatment of CSB. METHOD: Twenty-eight men who have sex with men who met the threshold for CSB on the basis of existing validated measures participated in a 12-week, double-blind trial of citalopram 20 to 60 mg/day to evaluate its effects on CSB symptoms. The primary efficacy measure was the Yale-Brown Obsessive Compulsive Scale-Compulsive Sexual Behavior. The study was conducted from June 2002 to April 2004. RESULTS: Significant treatment effects were obtained for sexual desire/drive (p < .05) and frequency of masturbation (p < .01) and pornography use (p < .05). Both groups reduced sexual risk, but did not differ significantly. CONCLUSIONS: This study provides partial support for the effectiveness of citalopram for reducing symptoms of CSB in this population. Larger-scale trials are recommended to determine the public health benefits of this treatment.

Drug-use patterns among men who have sex with men presenting for alcohol treatment: differences in ethnic and sexual identity.

Two important gaps in our current understanding of drug and alcohol use among men who have sex with men (MSM) are that, first, little is known about the extent of drug- and alcohol-use disorders among MSM and, second, how these may vary among MSM who differ by ethnic/racial or sexual identity. This article is a descriptive study of the alcohol- and drug-use patterns and alcohol and drug diagnoses in an ethnically and sexually diverse sample of treatment-seeking MSM whose primary diagnosis is either alcohol abuse or alcohol dependence. The severity of alcohol problems did not vary by either ethnic or sexual identity, although the types of drugs that were used by participants did. African Americans reported a significantly higher number of drinks per drinking day compared with those in the other ethnic categories.Gay-identified men and those identified as either non-Hispanic Whites or Hispanic/Latino were significantly more likely to have used stimulant drugs (amphetamine or methamphetamine) in the past 6 months, and non-Hispanic Whites were less likely to have used marijuana compared with the other ethnic groups. A very high rate of comorbidity of drug- and alcohol-use disorders was found in this sample of ethnically diverse MSM. These results have important implications for the design of effective treatment interventions.