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Risk factors for relapse among methamphetamine users receiving a joint legal-medical treatment program as a diversion intervention: A one-year follow-up study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023:208955. [PMID: 36804075 DOI: 10.1016/j.josat.2023.208955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/26/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Methamphetamine (METH) is a Schedule II illicit drug in Taiwan. A 12-month legal-medical joint intervention program has been developed for first-time METH offenders during deferred prosecution. Risk factors associated with METH relapse use among these individuals were unknown. METHODS We enrolled a total of 449 METH offenders referred by the Taipei District Prosecutor's Office to Taipei City Psychiatric Center. The study defines relapse as having any positive urine toxicology result or self-report of METH use during 12-month treatment. We compared demographic and clinical variables between a relapse group and nonrelapse group and used a Cox proportional hazards model to determine variables associated with time to relapse. RESULTS Of all participants, 37.8 % relapsed to use METH and 23.2 % were noncompleters in the one-year follow-up. Compared to the nonrelapse group, the relapse group had lower educational attainment, more severe psychological symptoms, longer duration of METH use, higher odds of polysubstance use, higher craving severity, and higher odds of positive baseline urine. The Cox analysis revealed individuals with positive urine results and higher craving severity at baseline were at higher risks of METH relapse (hazard ratio [95 % CI]: 3.85 [2.61-5.68] and 1.71 [1.19-2.46], respectively, p < 0.001). Baseline positive urine results and high craving could also predict a shorter length of time to relapse than their respective counterparts. CONCLUSIONS Positive urine screening for METH at baseline and high craving severity are two indicators of an increased risk of drug relapse. Tailored treatment plans incorporating these findings to prevent relapse are warranted in our joint intervention program.
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Bright DA, Martire KA. Does Coerced Treatment of Substance‐Using Offenders Lead to Improvements in Substance Use and Recidivism? A Review of the Treatment Efficacy Literature. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/j.1742-9544.2012.00072.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David A Bright
- School of Social Sciences, University of New South Wales
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Krebs E, Urada D, Evans E, Huang D, Hser YI, Nosyk B. The costs of crime during and after publicly funded treatment for opioid use disorders: a population-level study for the state of California. Addiction 2017; 112:838-851. [PMID: 27981691 PMCID: PMC5382102 DOI: 10.1111/add.13729] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/19/2016] [Accepted: 12/12/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND AND AIMS Treatment for opioid use disorders (OUD) reduces the risk of mortality and infectious disease transmission; however, opportunities to quantify the potential economic benefits of associated decreases in drug-related crime are scarce. This paper aimed to estimate the costs of crime during and after periods of engagement in publicly funded treatment for OUD to compare total costs of crime during a hypothetical 6-month period following initiation of opioid agonist treatment (OAT) versus detoxification. DESIGN Retrospective, administrative data-based cohort study with comprehensive information on drug treatment and criminal justice systems interactions. SETTING Publicly funded drug treatment facilities in California, USA (2006-10). PARTICIPANTS A total of 31 659 individuals admitted for the first time to treatment for OUD, and who were linked with criminal justice and mortality data, were followed during a median 2.3 years. Median age at first treatment admission was 32, 35.8% were women and 37.1% primarily used prescription opioids. MEASUREMENTS Daily costs of crime (US$2014) were calculated from a societal perspective and were composed of the costs of policing, court, corrections and criminal victimization. We estimated the average marginal effect of treatment engagement in OAT or detoxification adjusting for potential fixed and time-varying confounders, including drug use and criminal justice system involvement prior to treatment initiation. FINDINGS Daily costs of crime during treatment compared with after treatment were $126 lower for OAT [95% confidence interval (CI) = $116, $136] and $144 lower for detoxification (95% CI = $135, $154). Summing the costs of crime during and after treatment over a hypothetical 6-month period using the observed median durations of OAT (161 days) and detoxification (19 days), we estimated that enrolling an individual in OAT as opposed to detoxification would save $17 550 ($16 840, $18 383). CONCLUSIONS In publicly funded drug treatment facilities in California, USA, engagement in treatment for opioid use disorders is associated with lower costs of crime in the 6 months following initiation of treatment, and the economic benefits were far greater for individuals receiving time-unlimited treatment.
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Affiliation(s)
| | | | | | | | | | - Bohdan Nosyk
- British Columbia Centre for Excellence in HIV/AIDS
- UCLA Integrated Substance Abuse Programs
- Faculty of Health Sciences, Simon Fraser University
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Hayhurst KP, Leitner M, Davies L, Flentje R, Millar T, Jones A, King C, Donmall M, Farrell M, Fazel S, Harris R, Hickman M, Lennox C, Mayet S, Senior J, Shaw J. The effectiveness and cost-effectiveness of diversion and aftercare programmes for offenders using class A drugs: a systematic review and economic evaluation. Health Technol Assess 2015; 19:1-168, vii-viii. [PMID: 25619533 DOI: 10.3310/hta19060] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The societal costs of problematic class A drug use in England and Wales exceed £15B; drug-related crime accounts for almost 90% of costs. Diversion plus treatment and/or aftercare programmes may reduce drug-related crime and costs. OBJECTIVES To assess the effectiveness and cost-effectiveness of diversion and aftercare for class A drug-using offenders, compared with no diversion. POPULATION Adult class A drug-using offenders diverted to treatment or an aftercare programme for their drug use. INTERVENTIONS Programmes to identify and divert problematic drug users to treatment (voluntary, court mandated or monitored services) at any point within the criminal justice system (CJS). Aftercare follows diversion and treatment, excluding care following prison or non-diversionary drug treatment. DATA SOURCES Thirty-three electronic databases and government online resources were searched for studies published between January 1985 and January 2012, including MEDLINE, PsycINFO and ISI Web of Science. Bibliographies of identified studies were screened. The UK Drug Data Warehouse, the UK Drug Treatment Outcomes Research Study and published statistics and reports provided data for the economic evaluation. METHODS Included studies evaluated diversion in adult class A drug-using offenders, in contact with the CJS. The main outcomes were drug use and offending behaviour, and these were pooled using meta-analysis. The economic review included full economic evaluations for adult opiate and/or crack, or powder, cocaine users. An economic decision analytic model, estimated incremental costs per unit of outcome gained by diversion and aftercare, over a 12-month time horizon. The perspectives included the CJS, NHS, social care providers and offenders. Probabilistic sensitivity analysis and one-way sensitivity analysis explored variance in parameter estimates, longer time horizons and structural uncertainty. RESULTS Sixteen studies met the effectiveness review inclusion criteria, characterised by poor methodological quality, with modest sample sizes, high attrition rates, retrospective data collection, limited follow-up, no random allocation and publication bias. Most study samples comprised US methamphetamine users. Limited meta-analysis was possible, indicating a potential small impact of diversion interventions on reducing drug use [odds ratio (OR) 1.68, 95% confidence interval (CI) 1.12 to 2.53 for reduced primary drug use, and OR 2.60, 95% CI 1.70 to 3.98 for reduced use of other drugs]. The cost-effectiveness review did not identify any relevant studies. The economic evaluation indicated high uncertainty because of variance in data estimates and limitations in the model design. The primary analysis was unclear whether or not diversion was cost-effective. The sensitivity analyses indicated some scenarios where diversion may be cost-effective. LIMITATIONS Nearly all participants (99.6%) in the effectiveness review were American (Californian) methamphetamine users, limiting transfer of conclusions to the UK. Data and methodological limitations mean it is unclear whether or not diversion is effective or cost-effective. CONCLUSIONS High-quality evidence for the effectiveness and cost-effectiveness of diversion schemes is sparse and does not relate to the UK. Importantly this research identified a range of methodological limitations in existing evidence. These highlight the need for research to conceptualise, define and develop models of diversion programmes and identify a core outcome set. A programme of feasibility, pilot and definitive trials, combined with process evaluation and qualitative research is recommended to assess the effectiveness and cost-effectiveness of diversionary interventions in class A drug-using offenders. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Karen P Hayhurst
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Maria Leitner
- School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Linda Davies
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
| | | | - Tim Millar
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Jones
- National Drug Evidence Centre, Institute of Population Health, University of Manchester, Manchester, UK
| | - Carlene King
- Offender Health Research Network, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Michael Donmall
- National Drug Evidence Centre, Institute of Population Health, University of Manchester, Manchester, UK
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Charlotte Lennox
- Offender Health Research Network, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Soraya Mayet
- Tees, Esk and Wear Valleys NHS Foundation Trust, County Durham, UK
| | - Jane Senior
- Offender Health Research Network, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Jennifer Shaw
- Offender Health Research Network, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Brecht ML, Herbeck D. Time to relapse following treatment for methamphetamine use: a long-term perspective on patterns and predictors. Drug Alcohol Depend 2014; 139:18-25. [PMID: 24685563 PMCID: PMC4550209 DOI: 10.1016/j.drugalcdep.2014.02.702] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/12/2014] [Accepted: 02/18/2014] [Indexed: 11/20/2022]
Abstract
INTRODUCTION This paper describes methamphetamine (MA) use patterns, specifically the duration of continuing abstinence ("time to relapse") for periods averaging 5 years post-discharge from treatment for MA use, and the relationship with selected user and treatment characteristics. METHODS A sample of 350 treatment admissions from a large county substance use disorder (SUD) treatment system was randomly selected (within gender, race/ethnicity, treatment modality strata). Retrospective self-report data are from natural history interviews (NHI) conducted approximately 3 years after treatment and a follow-up of 2-3 years later. Relapse is defined as any use of MA with time as the number of months of continuous MA abstinence after treatment discharge until relapse. This outcome was constructed from a monthly MA use timeline using NHI data. A Cox model was used to examine time to relapse and predictors. RESULTS Sixty-one percent of the sample relapsed to MA use within 1 year after treatment discharge and 14% during years 2-5. Significant protective factors predicting longer time to relapse included having experienced serious MA-related psychiatric/behavioral problems (hazard ratio [HR]=0.75, p=0.027), longer duration of the index treatment episode (HR=0.93, p=0.001), and participating in self-help or other treatment during the post-treatment abstinence period (HR=0.29, p<0.001); risk factors for shorter time to relapse included having a parent with alcohol and/or drug use problems (HR=1.35, p=0.020) and involvement in MA sales (HR=1.48, p=0.002). CONCLUSIONS Results contribute a long-term perspective on patterns of MA use following treatment and support a need for early post-treatment and long-term continuing care and relapse-prevention services.
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Affiliation(s)
- Mary-Lynn Brecht
- Integrated Substance Abuse Programs, Department of Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025, United States; School of Nursing, University of California, Los Angeles, Factor 5-151, 700 Tiverton Ave., Los Angeles, CA 90095, United States.
| | - Diane Herbeck
- Integrated Substance Abuse Programs, Department of Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 100, Los Angeles, CA 90025, United States
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Riley DE, Liu L, Cohen B, Robinson S, Groessl EJ, Ho SB. Characteristics and impact of methamphetamine use in patients with chronic hepatitis C. J Addict Med 2014; 8:25-32. [PMID: 24343127 PMCID: PMC4339184 DOI: 10.1097/adm.0000000000000001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk factor for hepatitis C virus(HCV) infection. The purpose of this study was to determine the characteristics and HCV infection outcomes of patients with a history of MA use. METHODS Subjects consisted of newly entered patients in the Veterans Affairs (VA) HCV registry at a single VA medical center from January 1, 2004, to June 30, 2004, and from January 1, 2007, to June 30, 2007. Univariate and multivariate analyses related to HCV infection antiviral treatment outcomes through 2010 was performed. RESULTS A total of 198 consecutive eligible HCV registry patients were analyzed, and 40% had a history of MA use. Of patients with MA use history, 46% (36/79) had active use (within 6 months) at initial contact. Active MA users were significantly younger (mean age, 45.5 years), with more concomitant drug use (86%), compared with patients without MA use (mean age, 53.5 years; 42% minority; 29% other drug use). Overall, 71% of the 198 patients reported a history of problematic alcohol use, and 47% of those reported active abuse. Logistic regression analyses indicated that MA use did not significantly adversely affect antiviral treatment initiation, completion, or sustained virological response rates compared with that in patients without MA use. Active alcohol users had lower treatment initiation than patients without alcohol use. CONCLUSIONS MA use is common in recent US veterans with HCV infection and occurs in younger patients with polysubstance use. Prior history or active MA use does not seem to adversely affect HCV infection clinic treatment compared with that in HCV-infected patients without MA use.
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Affiliation(s)
- Dana E Riley
- From the Departments of Medicine (DER, BC, SBH), Health Services Research and Development (LL, EJG), and Psychiatry (SR), VA San Diego Healthcare System, San Diego, CA; and Departments of Family and Preventive Medicine (LL, EJG), Medicine (BC, SBH), and Psychiatry (SR), University of California, San Diego
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Polcin DL, Buscemi R, Nayak M, Korcha R, Galloway G. Gender Differences in Psychiatric Symptoms among Methamphetamine Dependent Residents in Sober Living Houses. ADDICTIVE DISORDERS & THEIR TREATMENT 2012; 11:53-63. [PMID: 23559891 DOI: 10.1097/adt.0b013e3182213ef1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Although psychiatric symptoms among methamphetamine (MA) dependent individuals have been studied in treatment programs, they have not been examined in services designed to support sustained recovery in the community (e.g. sober living houses). In addition, some disorders more common among women, such as somatoform and bulimia, have been understudied among MA dependent individuals. This study aimed to examine psychiatric symptom differences between MA dependent men and women who we entering sober living houses (SLHs). METHODS Two hundred forty five individuals were interviewed within one week of entering SLHs. Instruments included a DSM IV based measure for MA dependence, a psychiatric screen (the Psychiatric Diagnostic Screening Questionnaire), demographics, recent substance use and recent use of services. RESULTS Of the 245 participants, 103 men and 25 women met criteria for MA dependence. Womenwith MA dependence reported more psychiatric symptoms than men. They also trended toward reporting more psychiatric symptoms than non-MA dependent women. For men, psychiatric symptoms did not vary between those with and without MA dependence. Some understudied disorders (e.g., somatoform) had large proportions of women meeting the screening criteria. CONCLUSIONS Additional research is needed on understudied psychiatric disorders that are common among MA dependent women. SLH's should consider ways to address psychiatric symptoms among MA dependent individuals, especially women. Strategies could include increasing linkages with professional mental health services as well as developing peer oriented strategies for managing symptoms.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group Public Health Institute 6475 Christie Avenue, Suite 400 Emeryville, CA 94608-1010 Phone (510) 597-3440 Fax (510) 985-6459
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Jaffe A, Du J, Huang D, Hser YI. Drug-abusing offenders with comorbid mental disorders: problem severity, treatment participation, and recidivism. J Subst Abuse Treat 2012; 43:244-50. [PMID: 22305234 DOI: 10.1016/j.jsat.2011.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 11/30/2011] [Accepted: 12/12/2011] [Indexed: 11/24/2022]
Abstract
This study examined problem severity, treatment participation, and recidivism among 1,016 offenders with co-occurring mental disorders who participated in California's Proposition 36. Participants were assessed using the Addiction Severity Index (ASI) at baseline, and their records on mental health diagnoses, drug treatment participation, and arrests were also obtained. Participants' co-occurring disorder (COD) severity was classified as mild or severe based on specific mental health diagnoses. Predictors of recidivism were examined among mild-COD and severe-COD participants separately using ordinal logistic regression. Results indicate that although previous arrests, education, and treatment retention length are predictors of recidivism generally, gender, age, primary drug, ASI drug severity score, and treatment modality are differentially important depending on COD status. These results underscore the need for COD-focused intervention strategies among offenders, taking into consideration the severity of their COD status.
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Affiliation(s)
- Adi Jaffe
- University of California, Los Angeles, Integrated Substance Abuse Program, Los Angeles, CA 90025, USA.
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Brecht ML, Urada D. Treatment outcomes for methamphetamine users: California Proposition 36 and comparison clients. J Psychoactive Drugs 2012; Suppl 7:68-76. [PMID: 22185041 DOI: 10.1080/02791072.2011.602279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Methamphetamine (meth) is a major drug of abuse in California and several other states, particularly among criminal offender populations. Over the past decade, substance abuse treatment systems have had to adapt to and accommodate the increasing needs of meth users and, in California, deal with the impact of Proposition 36, which has resulted in a greater number of criminal offenders entering the treatment system. This study examines selected treatment performance and outcome indicators for California Proposition 36 offenders entering substance abuse treatment for meth use and compares their performance and outcomes to other subgroups of California treatment clients differentiated by whether or not they were admitted to treatment through Proposition 36 and whether or not their primary substance was meth. Significant improvements in all outcome domains were seen across the populations, and treatment performance and outcomes were not substantively inferior for the offender or meth-using groups.
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Affiliation(s)
- Mary-Lynn Brecht
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA 90025, USA.
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Evans E, Anglin MD, Urada D, Yang J. Promising practices for delivery of court-supervised substance abuse treatment: perspectives from six high-performing California counties operating Proposition 36. EVALUATION AND PROGRAM PLANNING 2011; 34:124-134. [PMID: 20965568 PMCID: PMC3025310 DOI: 10.1016/j.evalprogplan.2010.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/15/2010] [Accepted: 09/19/2010] [Indexed: 05/30/2023]
Abstract
Operative for nearly a decade, California's voter-initiated Proposition 36 program offers many offenders community-based substance abuse treatment in lieu of likely incarceration. Research has documented program successes and plans for replication have proliferated, yet very little is known about how the Proposition 36 program works or practices for achieving optimal program outcomes. In this article, we identify policies and practices that key stakeholders perceive to be most responsible for the successful delivery of court-supervised substance abuse treatment to offenders under Proposition 36. Data was collected via focus groups conducted with 59 county stakeholders in six high-performing counties during 2009. Discussion was informed by seven empirical indicators of program performance and outcomes and was focused on identifying and describing elements contributing to success. Program success was primarily attributed to four strategies, those that: (1) fostered program engagement, monitored participant progress, and sustained cooperation among participants; (2) cultivated buy-in among key stakeholders; (3) capitalized on the role of the court and the judge; and (4) created a setting which promoted a high-quality treatment system, utilization of existing resources, and broad financial and political support for the program. Goals and practices for implementing each strategy are discussed. Findings provide a "promising practices" resource for Proposition 36 program evaluation and improvement and inform the design and study of other similar types of collaborative justice treatment efforts.
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Affiliation(s)
- Elizabeth Evans
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California-Los Angeles, 1640 S. Sepulveda Blvd., Los Angeles, CA 90025, United States.
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Abstract
Significant public health problems associated with methamphetamine (MA) production and use in the United States have emerged over the past 25 years; however, there has been considerable controversy about the size of the problem. Epidemiological indicators have provided a mixed picture. National surveys of the adult U.S. population and school-based populations have consistently been used to support the position that MA use is a relatively minor concern. However, many other data sources, including law-enforcement groups, welfare agencies, substance abuse treatment program admissions, criminal justice agencies, and state/county executives indicate that MA is a very significant public health problem for many communities throughout much of the country. In this article, we describe (a) the historical underpinnings of the MA problem, (b) epidemiological trends in MA use, (c) key subgroups at risk for MA problems, (d) the health and social factors associated with MA use, (e) interventions available for addressing the MA problem, and (f) lessons learned from past efforts addressing the MA problem.
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Affiliation(s)
- Rachel Gonzales
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California 90025, USA.
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Brecht ML, Stein J, Evans E, Murphy DA, Longshore D. Predictors of intention to change HIV sexual and injection risk behaviors among heterosexual methamphetamine-using offenders in drug treatment: a test of the AIDS Risk Reduction Model. J Behav Health Serv Res 2008; 36:247-66. [PMID: 18214688 DOI: 10.1007/s11414-007-9106-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 12/17/2007] [Indexed: 11/29/2022]
Abstract
This study tested components of the acquired immunodeficiency syndrome (AIDS) Risk Reduction Model (ARRM) for a sample of methamphetamine-using offenders in drug treatment. Analyses included the first two stages of the ARRM, problem recognition and intention to reduce risk (potential precursors to later possible behavior change), assessing predictors of intentions to increase condom use, reduce other sexual risk, and disinfect needles. Path analysis results showed potential applicability of the ARRM as a basis for intervention development for this population. There was a consistent effect of self-efficacy for risk reduction strategies, as well as direct or indirect effects of problem recognition factors (AIDS knowledge, peer norms), on the three intention indicators. Prior sex risk behavior (condom use) was directly negatively related to intention to use condoms; prior needle use was indirectly negatively related to intention to disinfect. Intention to use condoms was lower for women. Results can help identify areas for intervention development.
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Affiliation(s)
- Mary-Lynn Brecht
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California-Los Angeles, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025, USA.
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