Wallace Mandell

Using social network analysis to study patterns of drug use among urban drug users at high risk for HIV/AIDS

Few studies have examined the current social relationships of injecting drug users. This paper examines the structural and relationship characteristics of the social networks of injecting drug users, and the relation of social network characteristics to the HIV infection risk behavior of frequency of injecting heroin and cocaine. The study sample was comprised of 293 inner city injecting drug users in Baltimore, Maryland. Most participants (89%) reported at least one family member in their social network, and 44% listed their mother or step-mother in their network. Presence of family members in personal social networks was not related to patterns of drug use examined here; however, those who reported a partner in their personal social network injected significantly less often than those who did not report a partner. Network density and size of drug subnetworks were positively associated with frequency of drug injection. The results of this study suggest that social network analysis may be a useful tool for understanding the social context of HIV/AIDS risk behaviors.

Reliability and validity of self reported illegal activities and drug use collected from narcotic addicts

In follow-up of 1,500 drug-using applicants to the NIMH civil commitment program under Titles I and III of the Narcotic Addict Rehabilitation Act, efforts were made to measure the reliability and validity of self-reported criminal and drug-taking behavior. Various methods to assure reliable and valid responses were developed and implemented. These methods included choice of interviewer, intraquestionnaire safeguards, interview-reinterview procedures, and use of police records and urinalysis reports. Overall, the results indicated that the responses for 829 respondents were reliable. The greatest limitation to the validity study was the incomplete and unreliable police records and urinalysis reports.

The long-term outcome of a personal network-oriented HIV prevention intervention for injection drug users: The SAFE study

Social influence processes have been found to affect numerous drug and health-related behaviors. We postulated that by using a network-oriented intervention it may be possible to capitalize on social influence processes to reduce human immunodeficiency virus (HIV) risk behaviors. The present study used an experimental study design for delivering a psychoeducational acquired immunodeficiency syndrome (AIDS) preventive intervention to injection drug sharing networks. Participants were recruited from the ALIVE study, an epidemiological study in Baltimore. In the present paper we examine the self-reported behavioral outcomes of 117 injection drug users 18 months after the baseline interview. HIV seronegative experimental participants reported significantly less frequent needle sharing and less injecting of heroin and cocaine than controls. In multiple logistic regression models of HIV seronegative participants, there was a significant negative association between assignment to the experimental group and the HIV-related behaviors of needle sharing and sharing of cookers in the prior 6 months; controls were 2.8 times more likely than experimentals to report needle sharing and were 2.7 times more likely to report sharing cookers. The results of this 18-month follow-up suggest that among injection drug users network-oriented interventions may be a promising approach to HIV prevention.

Correlates of needle sharing among injection drug users

OBJECTIVES The sharing of contaminated injection equipment is the primary mode of human immunodeficiency virus (HIV) transmission for injection drug users. This study examined demographic factors, life events, and drug use practices that are potential risk factors for sharing injection equipment. METHODS Between February 1988 and March 1989, 2921 active injection drug users were interviewed and questioned about their backgrounds, life-styles, and patterns of injection drug use. RESULTS Of 2524 participants who reported injecting drugs within the 6 months prior to study enrollment, 70.4% reported recent needle sharing. A multivariate analysis found needle sharing to be more frequent among those with a history of arrest and lower socioeconomic status, even after accounting for other demographic and drug use variables. In addition, recent needle sharing was higher in male homosexual or bisexual men than in their heterosexual counterparts. CONCLUSIONS These data suggest that injection drug users have an economic motive to share needles and that the availability of free and legal needles may reduce levels of needle sharing.

Social network characteristics and injecting HIV-risk behaviors among street injection drug users.

As an alternative approach to individually-focused understanding of HIV risk behavior, this study explored the relationship between social network characteristics and HIV-risk injecting behaviors. Subjects were 499 inner-city injection drug users (IDUs) recruited from the streets of Baltimore, Maryland. Analysis of structural and functional network data indicates that a substantial proportion of drug sharing network members also provided social support, often because of family and sexual partner relationships. IDUs with larger drug networks which also provided social support were more likely to share needles, while IDUs with larger drug networks which did not provide social support were more likely to inject in commercial settings. The findings suggest that social support from drug network members has differential effects on injecting HIV-risk behaviors among IDUs. HIV prevention efforts should be expanded to reach drug-sharing networks and should take into account their social support relationships.

Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users.

In this study, we examined the relationship between depressive symptoms and needle-sharing behavior in a community sample of intravenous drug users (N = 499) in Baltimore, Maryland. Based on the polytomous logistic regression, higher depressive symptoms were positively associated both with needle sharing after cleaning with bleach and with needle sharing without first cleaning with bleach at the bivariate analyses. This relationship remained significant (OR = 1.66) even after adjusting for demographic characteristics, life events, drug use patterns, and social and drug networks. A significant synergistic effect of depressive symptoms and drug network on needle sharing after cleaning with bleach and needle sharing without cleaning was observed. More depressed intravenous drug users who also had a larger drug network were found to be at higher risk of needle sharing after cleaning with bleach, as well as needle sharing without cleaning (OR = 2.59). Depression status is discussed as a predisposing factor and drug network size as a precipitating factor for needle-sharing behavior. Implications for preventing needle-sharing behavior by reducing depressive symptoms are discussed.

Depression as an antecedent of frequency of intravenous drug use in an urban, nontreatment sample

The present study examined the relationship between depressive symptoms and frequency of drug use in 91 low income nontreatment intravenous drug users in Baltimore, Maryland. The majority of participants were injecting both heroin and cocaine. Scores on the depression scale at both waves were correlated with frequency of injection at wave two. Depression at wave one had a higher correlation with frequency of injections at wave two than did concurrent depression at wave two. Even after accounting for several confounds between depression and frequency of injection, depression at wave one remained highly correlated with frequency of injection at wave two.

The relationships between sexual behavior, alcohol use, and personal network characteristics among injecting drug users in Baltimore, Maryland.

Background and Objectives: Studies on the relationship between alcohol consumption and HIV-related risk behaviors report inconclusive and contradictory results. Goal of this Study: This study sought to examine the relationship between drug and alcohol use, personal network characteristics, and sexual risk behaviors. Study Design: A sample of 290 injecting drug users in Baltimore, Maryland, were interviewed. Results: More than half the males and 28% of the females reported multiple partners within the prior 6 months, and 33% of the males reported exchanging money or drugs for sex. For males, heavy drinking was significantly associated with multiple partners, exchanging money or drugs for sex, and casual sex. The personal network characteristics of size and density, as measured by the percentage of network members who knew each other, were associated with sexual risk behaviors. Conclusion: These results indicate that among injecting drug users in Baltimore, heavy drinkers, and those with larger, lower density personal networks have increased levels of sexual risk behaviors.

Risk factors for depressive symptomatology in a drug using population.

This study employs a prospective design to examine possible personality, drug use, stressful life event, and social support-related variables associated with the onset of a depressive episode in a cohort of psychoactive drug using young adults. Two waves of data, collected one year apart, were available on 942 individuals. Cases (n = 62) were free of depressive symptoms at time 1 but reported significant symptomatology at time 2 as measured by the depression subscale of the Brief Symptom Inventory. Controls (n = 490) were those free of depressive symptoms at both time points. In multivariate analyses, users of the central nervous system depressant methaqualone had a nearly four-fold elevated risk for depressed mood as compared to nonusers. Additional risk factors significant after multivariate adjustment included lower self-esteem at time 1 and negative life events. These results highlight the multifactorial nature of depressive symptomatology.

Do dimensions of therapeutic community treatment predict retention and outcomes

First-week Dimensions of Change Instrument (DCI) assessments from a cohort of 519 adults entering six therapeutic communities (TCs) were used to predict treatment retention and outcomes. A more positive first-week response to TC social processes (Community Responsibility; Resident Sharing, Support, and Enthusiasm; Group Process; and Clarity and Safety) and to one TC personal-development process (Positive Self-Attitude and Commitment to Abstinence) predicted retention for the first month. Improvement in Clarity and Safety and Resident Sharing, Support, and Enthusiasm scores at 30 days predicted retention in treatment for 3, 6, and 9 months. In multivariate analyses available to a subset of the entry cohort, a longer tenure in treatment was a robust predictor of posttreatment outcomes. First-week DCI scores on the community process scales predicted posttreatment alcohol-and-other-drug abstinence and functioning.