Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000.

OBJECTIVE To determine predictors of injection drug use cessation and subsequent relapse among a cohort of injection drug users (IDUs). METHODS IDUs in Baltimore, MD were recruited through community outreach in 1988-1989. Among IDUs with at least three follow-up visits, parametric survival models for time to injection cessation (>or=6 months) and subsequent relapse were constructed. RESULTS Of 1327 IDUs, 94.8% were African American, 77.2% were male, median age was 34 years, and 37.7% were HIV-infected. Among 936 (70.5%) subjects who ceased injection, median time from baseline to cessation was 4.0 years. Three-quarters subsequently resumed injection drug use, among whom median time to relapse was 1.0 year. Factors independently associated with a shorter time to cessation were: age <30 years, stable housing, HIV seropositivity, methadone maintenance treatment, detoxification, abstinence from cigarettes and alcohol, injecting less than daily, not injecting heroin and cocaine together, and not having an IDU sex partner. Factors independently associated with shorter time to injection relapse were male gender, homelessness, HIV seropositivity, use of alcohol, cigarettes, non-injection cocaine, sexual abstinence and having a longer time to the first cessation. CONCLUSIONS This study provides strong support for targeting cessation efforts among young IDUs and severely dependent, unstably housed, and HIV-infected individuals.

[1]  D R Hoover,et al.  Illicit drug use in one's social network and in one's neighborhood predicts individual heroin and cocaine use. , 2001, Annals of epidemiology.

[2]  R. Booth,et al.  Methadone maintenance as HIV risk reduction with street-recruited injecting drug users. , 2001 .

[3]  D. Vlahov,et al.  Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. , 1996, American journal of public health.

[4]  R. Shore,et al.  Methadone maintenance and other factors associated with intraindividual temporal trends in injection-drug use. , 1996, Journal of substance abuse treatment.

[5]  G. Canino,et al.  Remission from drug dependence symptoms and drug use cessation among women drug users in puerto rico. , 2004, Archives of general psychiatry.

[6]  J. Toumbourou,et al.  Treatment level progress and time spent in treatment in the prediction of outcomes following drug-free therapeutic community treatment. , 1998, Addiction.

[7]  D. Metzger,et al.  Decreasing international HIV transmission: the role of expanding access to opioid agonist therapies for injection drug users. , 2005, Addiction.

[8]  D. Gerstein,et al.  HIV risk behaviors in African-American drug injector networks: implications of injection-partner mixing and partnership characteristics. , 2002, Addiction.

[9]  A Munoz,et al.  The Alive Study: A Longitudinal Study of HIV-1 Infection in Intravenous Drug Users: Description of Methods , 1991, NIDA research monograph.

[10]  W Mandell,et al.  Drug network characteristics as a predictor of cessation of drug use among adult injection drug users: a prospective study. , 1999, The American journal of drug and alcohol abuse.

[11]  S. Tortu,et al.  Cessation of Drug Use: Impact of Time in Treatment , 2000, Journal of psychoactive drugs.

[12]  D. Simpson,et al.  Drug abuse treatment retention and process effects on follow-up outcomes. , 1997, Drug and alcohol dependence.

[13]  D. DiNitto,et al.  Gender Differences in Dually-Diagnosed Clients Receiving Chemical Dependency Treatment , 2002, Journal of psychoactive drugs.

[14]  S. Avants,et al.  How injection drug users coped with testing HIV-seropositive: implications for subsequent health-related behaviors. , 2001, AIDS education and prevention : official publication of the International Society for AIDS Education.

[15]  D. Vlahov,et al.  Drug-related behavior change for HIV transmission among American injection drug users. , 1994, Addiction.

[16]  David W. Hosmer,et al.  Applied Survival Analysis: Regression Modeling of Time-to-Event Data , 2008 .

[17]  D. K. Griffin,et al.  The consistency of self-reported HIV risk behavior among injection drug users. , 1994, American journal of public health.

[18]  H. Harwood,et al.  Economic cost of alcohol and drug abuse in the United States, 1992: a report. , 1999, Addiction.

[19]  D. Vlahov,et al.  Longitudinal patterns of drug injection behavior in the ALIVE Study cohort,1988-2000: description and determinants. , 2003, American journal of epidemiology.

[20]  B. Sibthorpe,et al.  Circumstances surrounding needle use transitions among injection drug users: implications for HIV intervention. , 1994, The International journal of the addictions.

[21]  R. Brookmeyer,et al.  Validity of self-reported needle exchange attendance among injection drug users: implications for program evaluation. , 2002, American journal of epidemiology.

[22]  H. Sahai,et al.  Between-city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamon, Puerto Rico. , 2001 .

[23]  D. Raisch,et al.  Opioid Dependence Treatment, Including Buprenorphine/Naloxone , 2002, The Annals of pharmacotherapy.

[24]  S. Hemby,et al.  Synergistic elevations in nucleus accumbens extracellular dopamine concentrations during self-administration of cocaine/heroin combinations (Speedball) in rats. , 1999, The Journal of pharmacology and experimental therapeutics.

[25]  M. Langendam,et al.  Methadone maintenance and cessation of injecting drug use: results from the Amsterdam Cohort Study. , 2000, Addiction.

[26]  R. Terry,et al.  Coping strategies and continued drug use among methadone maintenance patients. , 1996, Addictive behaviors.

[27]  Samuel R. Friedman,et al.  Social Networks, Drug Injectors’ Lives, and HIV/AIDS , 1999, AIDS Prevention and Mental Health.

[28]  D. Vlahov,et al.  Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users. , 1993, Addiction.

[29]  D. Simpson.  Treatment for drug abuse. Follow-up outcomes and length of time spent. , 1981, Archives of general psychiatry.

[30]  G. Bammer,et al.  The impact on retention of expansion of an Australian public methadone program. , 2000, Drug and Alcohol Dependence.

[31]  D. Hartel,et al.  Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City. , 1998, Public health reports.

[32]  T J Crowley,et al.  Substance abuse treatment entry, retention and effectiveness: out-of-treatment opiate injection drug users. , 1996, Drug and alcohol dependence.

[33]  D. Vlahov,et al.  New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1. , 1991, American journal of epidemiology.

[34]  J. Marsden,et al.  Change and stability of change after treatment of drug misuse: 2-year outcomes from the National Treatment Outcome Research Study (UK). , 2002, Addictive behaviors.

[35]  D. Vlahov,et al.  Risk factors for shooting gallery use and cessation among intravenous drug users. , 1991, American journal of public health.

[36]  D. Lewis,et al.  Access to narcotic addiction treatment and medical care: prospects for the expansion of methadone maintenance treatment. , 1999, Journal of addictive diseases.

[37]  D. Vlahov,et al.  Correlates of HIV infection among young adult short-term injection drug users , 2000, AIDS.

[38]  W. H. Hall,et al.  Effective medical treatment of opiate addiction , 1998 .

[39]  D. Simpson,et al.  Motivation as a predictor of early dropout from drug abuse treatment. , 1993 .

[40]  F. Gutzwiller,et al.  Feasibility, safety, and efficacy of injectable heroin prescription for refractory opioid addicts: a follow-up study , 2001, The Lancet.

[41]  D. Cox,et al.  Analysis of Survival Data. , 1985 .

[42]  R. Coutinho,et al.  Large decline in injecting drug use in Amsterdam, 1986–1998: explanatory mechanisms and determinants of injecting transitions , 2001, Journal of epidemiology and community health.

[43]  S. Weinstein,et al.  Gender Differences and Similarities in African-American Crack Cocaine Abusers , 1995, The Journal of nervous and mental disease.

[44]  S. Stancliff,et al.  Methadone maintenance treatment (MMT): a review of historical and clinical issues. , 2000, The Mount Sinai journal of medicine, New York.

[45]  D. Vlahov,et al.  The prevalence of homelessness among injection drug users with and without HIV infection , 2000, Journal of Urban Health.

[46]  E. V. van Ameijden,et al.  Maximum impact of HIV prevention measures targeted at injecting drug users , 1998, AIDS.

[47]  A T McLellan,et al.  Substance Abuse Treatment , 2011 .

[48]  D. Metzger,et al.  HIV prevention among injection drug users: The need for integrated models , 2003, Journal of Urban Health.

[49]  D. Vlahov,et al.  Correlates of enrollment in methadone maintenance treatment programs differ by HIV-serostatus , 2000, AIDS.