Dominick L. Frosch

Sexual HIV risk among gay and bisexual male methamphetamine abusers

The current report examined HIV-related high risk sexual behaviors among a small sample of gay and bisexual male methamphetamine abusers in Los Angeles. Participants were 16 methamphetamine-abusing or -dependent gay or bisexual males who participated in a treatment demonstration project between 1989 and 1993. All participants completed the NIDA/WAVE survey, a detailed inventory of HIV-related risk behaviors. Findings indicate a strong connection between methamphetamine abuse and high-risk sexual behavior. For the 12 months prior to treatment 62.5% of participants reported having anal insertive sex without a condom, and 56.3% reported having sex with someone who had HIV. Drug use before or during sex, measured on a 5-point Likert scale, was frequent (M = 4.27, SD = 0.7). Implications for treatment of gay and bisexual male methamphetamine abusers and prevention of HIV among this population are discussed.

Associations between tobacco smoking and illicit drug use among methadone-maintained opiate-dependent individuals.

Tobacco chippers are individuals who smoke regularly yet are not nicotine dependent. In the present study, the authors examined the prevalence of tobacco chipping among methadone-maintained opiate abusers. Furthermore, the authors examined associations between tobacco and illicit substance use by comparing heavy smokers, tobacco chippers, and nonsmokers. Results demonstrate that tobacco chipping occurs among methadone-maintained individuals. Illicit substance use, measured through urine toxicology, was found to increase in a stepwise fashion from nonsmokers, to chippers, to heavy smokers. Smoking status (nonsmoker, chipper, heavy smoker) proved a more powerful predictor of cocaine and opiate use than daily methadone dose. Findings lend support to existing evidence suggesting associations between tobacco and opiate and cocaine use and strongly suggest that smoking cessation should be offered to all methadone-maintained individuals.

Substance Abuse Treatment as HIV Prevention for Men Who Have Sex with Men

Substance abuse is a prominent risk behavior associated with HIV transmission, particularly for men who have sex with men (MSM) and who engage in sex while using substances. This paper argues that substance abuse treatment has significant value as an HIV-prevention method to the extent that treatment outcome influences sexual risk behaviors for MSM, presumably toward lower risk. We review studies of treatment and HIV risk behaviors for MSM, and describe the current status of effective substance abuse treatments. Clinical issues important to MSM receiving treatment are discussed: gay-specific versus mainstream treatment, gay sexuality issues in substance abuse treatment, gay Alcoholics Anonymous, and ethnicity issues. Based on these arguments, we make the following policy recommendations: (1) develop treatment strategies that target substance use and high-risk sexual behavior simultaneously, (2) recognize treatment as HIV prevention in this population, and (3) educate counselors on cultural and sexual risk issues specific to substance-abusing MSM.

Overdose, suicide attempts and death among a cohort of naltrexone-treated opioid addicts

In a study evaluating naltrexone with either an intensive psychosocial protocol or standard community treatment for opioid dependence, 13 of 81 subjects overdosed within a 12-month period of study participation. There were four fatalities, one of which was a suicide. Among the nine nonfatal overdoses, there were four suicide attempts. Characteristics of subjects and naltrexone-taking are described.

Optimizing smoking cessation outcomes among the methadone maintained

Several studies have shown high levels of interest in smoking cessation among methadone maintained heroin users, yet little is known about how to intervene most effectively with this population. The present study examined data from a large controlled trial of behavioral therapy in combination with nicotine replacement to find predictors of smoking cessation among the methadone maintained. Logistic regression analyses showed that less nicotine dependence, as measured by the Fägerstrom Test of Nicotine Dependence, and greater age were associated with higher rates of tobacco cessation. Greater opiate use, fewer nicotine patches used, and any tobacco smoking during weeks 2 and 3 of the intervention significantly negatively predicted smoking cessation outcomes.

Using latent-variable models to analyze smoking cessation clinical trial data: an example among the methadone maintained.

The relationship between tobacco and illicit drug use was examined among 166 methadone-maintained persons participating in a smoking cessation intervention. Latent-growth latent-variable models showed a significant relationship during treatment between rates of change in heroin and rates of change in tobacco use, with increased heroin use corresponding with increased tobacco use. Although levels of cocaine use were related to levels of tobacco use, there was no significant relationship between the rates of change of the 2 substances. A more traditional longitudinal structural equation model demonstrated a significant relationship between more heroin use during treatment and negative smoking cessation outcomes at 6-month follow-up. Findings demonstrate the utility of latent-growth models for analyzing short-term clinical trial data and strongly suggest that successful smoking cessation in this population requires a concurrent focus on reducing heroin use.

Naltrexone for opioid dependence: evaluation of a manualized psychosocial protocol to enhance treatment response

The clinical application of the narcotic antagonist, naltrexone for the treatment of opioid dependence has been minimal. This study evaluated the impact of a multi-component, manualized, psychosocial protocol designed to enhance the clinical value of naltrexone for opioid dependence treatment. Eighty-one detoxified individuals meeting DSM-IV criteria for opioid dependence were inducted onto naltrexone and randomly assigned to either a standard (ST) group, with monthly medical monitoring visits, or an enhanced (EN) group in which participants received counseling and educational interventions three times per week. EN group participants took more study medication, were retained in treatment longer, used less opioids while in treatment and showed greater improvement on a number of psychological/affective dimensions. The improved performance of the EN group was relatively short-lived as there were no significant group differences at 6- or 12-month post-admission follow-up points. [Rawson RA, McCann MJ, Shopta...