This article contains a comprehensive, critical review of the acquired immunodeficiency syndrome (AIDS)-risk-reduction literature on interventions that have targeted risky sexual behavior and intravenous drug use practices. A conceptually based, highly generalizable model for promoting and evaluating AIDS-risk behavior change in any population of interest is then proposed. The model holds that AIDS-risk reduction is a function of people's information about AIDS transmission and prevention, their motivation to reduce AIDS risk, and their behavioral skills for performing the specific acts involved in risk reduction. Supportive tests of this model, using structural equation modeling techniques, are then reported for populations of university students and gay male affinity group members.

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Changing AIDS-risk behavior.

This review synthesizes drug abuse outcome studies that included a family-couples therapy treatment condition. The meta-analytic evidence, across 1,571 cases involving an estimated 3,500 patients and family members, favors family therapy over (a) individual counseling or therapy, (b) peer group therapy, and (c) family psychoeducation. Family therapy is as effective for adults as for adolescents and appears to be a cost-effective adjunct to methadone maintenance. Because family therapy frequently had higher treatment retention rates than did nonfamily therapy modalities, it was modestly penalized in studies that excluded treatment dropouts from their analyses, as family therapy apparently had retained a higher proportion of poorer prognosis cases. Re-analysis, with dropouts regarded as failures, generally offset this artifact. Two statistical effect size measures to contend with attrition (dropout d and total attrition d) are offered for future researchers and policy makers.

https://psycnet.apa.org/journals/bul/122/2/170.pdf

Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies.

AIDS and the health crisis of the U.S. urban poor: The perspective of critical medical anthropology.

Designing studies to examine hepatitis C virus (HCV) transmission via the shared use of drug injection paraphernalia other than syringes is difficult because of saturation levels of HCV infection in most samples of injection drug users (IDUs). The authors measured the incidence of HCV infection in a large cohort of young IDUs from Chicago, Illinois, and determined the risk of HCV seroconversion associated with specific forms of sharing injection paraphernalia. From 1997 to 1999, serum samples obtained from 702 IDUs aged 18-30 years were screened for HCV antibodies; prevalence was 27%. Seronegative participants were tested for HCV antibodies at baseline, at 6 months, and at 12 months. During 290 person-years of follow-up, 29 participants seroconverted (incidence: 10.0/100 person-years). The adjusted relative hazard of seroconversion, controlling for demographic and drug-use covariates, was highest for sharing "cookers" (relative hazard = 4.1, 95% confidence interval: 1.4, 11.8), followed by sharing cotton filters (relative hazard = 2.4, 95% confidence interval: 1.1, 5.0). Risks associated with syringe-sharing and sharing of rinse water were elevated but not significant. After adjustment for syringe-sharing, sharing cookers remained the strongest predictor of seroconversion (relative hazard = 3.5, 95% confidence interval: 1.3, 9.9). The authors conclude that sharing of injection equipment other than syringes may be an important cause of HCV transmission between IDUs.

/pdf/risk-of-hepatitis-c-virus-infection-among-young-adult-1amoru0odp.pdf

Risk of Hepatitis C Virus Infection among Young Adult Injection Drug Users Who Share Injection Equipment

This article presents evidence for the effectiveness of a strategy for engaging adolescent drug users and their families in therapy. The intervention method is based on strategic, structural, and systems concepts. To overcome resistance, the identified pattern of interactions that interferes with entry into treatment is restructured. Subjects were 108 Hispanic families in which an adolescent was suspected of. or was observed, using drugs. Subjects were randomly assigned to a strategic structuralsystems engagement (experimental) condition or to an engagement-as -usual (control) condition. Subjects in the experimental condition were engaged at a rate of 93% compared with subjects in the control condition, who were engaged at a rate of 42%. Seventy-seven percent of subjects in the experimental condition completed treatment compared wiih 25"! of subjects in the control

Engaging adolescent drug abusers and their families in treatment: a strategic structural systems approach.

Part I: Aids and Drug Use. Sorensen, Introduction: The AIDS-Drug Connection. Wermuth, Case: Implication for AIDS Prevention. Guydish, Golden, Hembry, Needle Sharing, Needle Cleaning, and Risk Behavior Change Among Injection Drug Users. Choi, Wermuth, Unsafe Sex and Behavior Change. Gibson, Catania, Peterson, Theoretical Background. Part II: Preventative Interventions With Drug Abusers and Sexual Partners. Batki, London, Drug Abuse Treatment for HIV Infected Drug Abusers. Sorensen, London, Morales, Group Counseling. Gibson, Lovelle-Drache,Individual Counseling. Wermuth, Robbins, Choi, Eversley, Reaching and and Counseling Women Sexual Partners. Part III: Social Implications. Sorensen, Guydish, Adopting Effective Interventions. Wermuth, Sorensen, Franks, People, Programs, and Policies. Appendix: Where to Get Help or Information.

Preventing AIDS in Drug Users and Their Sexual Partners

Use of methamphetamine, a potent central nervous system stimulant, increased in the early- to mid-1990s in the United States, concentrated in the west, midwest, and south. The use and trade of methamphetamine was facilitated by a fairly simple production process and the involvement of numerous small entrepreneurs as well as drug-trafficking syndicates. National data from the 1994 Drug Abuse Warning network revealed that for the period from 1991 to 1994 methamphetamine use among short-stay hospital patients more than tripled, and methamphetamine-related deaths reported by medical examiner offices nearly tripled. In addition, the Treatment Episode Data Set revealed a 43 percent increase in treatment-program admissions in which clients identified methamphetamine as the primary drug of abuse. Nonetheless, methamphetamine use did not become widespread in the U.S. population. Low-income and unemployed young white men continue to be the group most likely to use methamphetamine, but by the mid-1990s the drug had ...

Methamphetamine use: hazards and social influences.

Drug abuse programs often experience difficulties involving clients' families in treatment. This article describes general principles and specific techniques for recruiting family members in drug abuse programs and in other treatment settings. Stanton and Todd's principles of recruiting for family therapy in drug programs generally apply, adapted to a project that involves only one family member in multifamily groups and provides psychoeducational training rather than therapy. Additional principles include: focusing on family members who live with the client, tailoring recruitment to the needs of individual families, emphasizing how the family member will benefit, addressing resistance directly, helping families to build a support network, and informing family members of what is expected of them. The psychoeducational approach shows promise as a beneficial adjunct to client-focused treatment and as a gateway to more extensive family treatment.

Enlisting family support in drug treatment.

Family functioning as a predictor of progress in substance abuse treatment.

The problems of patients with dual diagnoses (substance abuse and psychiatric disorders) have only recently come under study. While attempting to assess the feasibility of offering services to family members of dual-diagnosis patients, the authors encountered problems in delivering services to the patients themselves. These problems included inadequate reporting methods, lack of a combined treatment approach, lack of family involvement, and inadequate referral resources. This paper discusses some of the impediments to treatment and areas of needed research.

Laurie Wermuth

Papers

Preventing AIDS in Drug Users and Their Sexual Partners

Methamphetamine use: hazards and social influences.

Enlisting family support in drug treatment.

Family functioning as a predictor of progress in substance abuse treatment.

Treatment Providers' Assessment of Dual-Prognosis Patients: Diagnosis, Treatment, Referral, and Family Involvement