Thomas W. Irwin

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 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.

Randomized Trial to Reduce Club Drug Use and HIV Risk Behaviors among Men Who Have Sex with Men.

The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for 1 year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p < .02; small to medium effect size). MI did not result in a significant reduction in risky sex relative to education. The results support the use of MI targeting club drug use in at-risk or mildly dependent users not seeking treatment but not in more severely dependent users. MI does not appear effective in reducing risky sexual behavior in this population.

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 knowin about the extent of drug- and alcohol-use disorders among MSM and, second, how these may vary among MSM who differ by ethniclracial 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.

The Consequences of Compulsive Sexual Behavior: The Preliminary Reliability and Validity of the Compulsive Sexual Behavior Consequences Scale

The consequences of any excessive behavior can serve as a proxy indicator of problem severity. This appears especially salient for the diagnosis of non-paraphilic compulsive sexual behavior (CSB) because of the influence of societal norms on the pathologizing of frequent consensual ego-syntonic sexual behavior. The current study is a preliminary examination of the psychometric properties, descriptive features, concurrent validity, and ability to detect change over time of a measure designed to assess the consequences of non-paraphilic CSB. The sample consisted of 34 (26 end of treatment) gay and bisexual men enrolled in a double-blind placebo-controlled medication trial testing the efficacy of an SSRI in reducing CSB symptoms. Results indicate that the measure demonstrated good internal and test-retest reliability, concurrent validity, and was able to detect change in symptoms over the course of the 12-week period. Items related to intimate relations were most resistant to change and items related to intrapersonal conflict and impulse control were most likely to change. No differences existed in the reduction of consequences between medication and placebo groups. Consequences were only moderately correlated with frequency measures suggesting these constructs should be examined separately. Taken together, results suggest that measuring consequences can reveal important clues into the domains most affected by CSB, provide clues into those domains that are resistant to change, and aid in individualized treatment planning.

Non-Paraphilic Compulsive Sexual Behavior and Psychiatric Co-morbidities in Gay and Bisexual Men

This study explored the features of non-paraphilic compulsive sexual behavior (NPCSB) in a community sample of 183 gay and bisexual men in New York City who reported difficulty controlling their sexual behavior. Several diagnostic and face valid measures of NPCSB and Axis I comorbidity were administered. Results indicated that NPCSB is associated with a range of problem behaviors, a fairly coherent pattern of symptoms that can be assessed with good inter-rater reliability, is distinct from other related disorders, and provides a moderate fit to the dependence model but with other unique features. Implications for classification and treatment will be discussed.

Combining Motivational Interviewing and Cognitive-Behavioral Skills Training for the Treatment of Crystal Methamphetamine Abuse/Dependence

SUMMARY Methamphetamine addiction in men having sex with men (MSM) represents a particular challenge to the clinician. It requires attention both to the fundamental skills the client needs to acquire in order to attain abstinence, and to the clients level of motivation to change his behavior. What follows is a brief review of the state of the art of Motivational Interviewing (MI) and Cognitive-Behavioral Therapy (CBT) for addictions in general, and for crystal meth specifically. Much of the material presented here is not specific to treatment of crystal meth addiction in gay men; however, there are some aspects of treatment that are specific to treating crystal problems in MSM that are highlighted through out this paper. This paper goes on to present the rationale and basic strategies encompassed by both motivation enhancement and skills-based treatment approaches.

Children of substance abusing women on federal welfare : Implications for child well-being and TANF policy

SUMMARY The present study sought to characterize well-being indicators for a sample of children of substance dependent TANF women. Participants were 372 mothers meeting DSM-IV criteria for substance dependence and 156 non-substance abusing women from two urban counties in New Jersey. Children of substance dependent TANF mothers experienced significant vulnerabilities, as demonstrated by higher levels of contextual risk factors and negative behavioral and emotional and school outcomes. Overall, these rates were about double those found in children of non-substance abusing mothers. Results highlight the need for multi-systemic services to address the problems experienced by substance abusing TANF women and their children.

Self-Efficacy and Attributions about Change in Persons Attempting to Reduce Compulsive Sexual Behavior with Medication vs. Placebo

Self-efficacy is well-established as an important predictor of long-term health outcomes. There is an emerging literature indicating that taking psychiatric medications without combined behavioral interventions result in poorer long-term outcomes. This is particularly relevant for those using medication for short-term symptom management, including individuals suffering from compulsive sexual behavior (CSB). The purpose of this pilot study was to examine whether post-treatment attributions about change and self-efficacy for future behavior change differed between those taking a placebo or medication for persons attempting to reduce CSB. Participants were 26 gay and bisexual men seeking treatment for CSB who participated in a 12-week double blind placebo controlled trial examining the short-term effectiveness of citalopram. Self-efficacy and attribution assessments were presented to participants after breaking the blind. Participants in the medication group scored significantly lower on post-treatment self-efficacy to change in the future without medication and were more likely to attribute change in CSB to the medication, though no group differences existed on the primary CSB outcome measure. Results suggest that prescription practices for CSB should at minimum include therapeutic techniques that increase confidence to change without medication once it is discontinued.

Strategies for the treatment of methamphetamine use disorders among gay and bisexual men

SUMMARY There is a growing need for treatment services that specifically target methamphetamine for gay and bisexual men. There may be significant barriers for the client in engaging in a treatment program, including thought disturbances and paranoia. A high level of ambivalence in spite of extreme adverse consequences from use is also relatively common among those presenting for treatment. Many people do recover if they are willing to commit to a structured treatment plan. Models of treatment that have been shown to be successful include motivational interviewing (MI), cognitive behavioral therapy (CBT), and community reinforcement with contingency management. The Matrix Model was developed specifically for stimulant use disorders and includes many of these components as well as 12-step facilitation. Although it has been suggested that methamphetamine dependence may be more difficult to treat than other drug use dependence, empirical evidence suggests that success for methamphetamine treatment has not been shown to be different than for other stimulants, such as cocaine.