Academic journal article Journal of Drug Issues

Accessing Drug-Abuse Treatment: Perceptions of Out-of-Treatment Injectors

Academic journal article Journal of Drug Issues

Accessing Drug-Abuse Treatment: Perceptions of Out-of-Treatment Injectors

Article excerpt

The Presidential Commission on the Human Immunodeficiency Virus Epidemic (1988) developed a 10-year plan in 1987 that recommended: "Expanded drug abuse treatment programs sufficient to admit all IV drug users who desired services and, until that occurred, short-term detoxification and low-dose methadone for those on waiting lists." This study presents data collected from a sample of 2, 613 out-of-treatment and nonincarcerated injection drug users in 21 US. cities to examine their drug-- treatment access during the past year. Analyses on injectors who tried but were unable to enter treatment revealed that program-based reasons (e.g., no room, too costly,or stringent admission criteria) are the most commonly given barriers to drug treatment (72%). However, a notable number of injectors (20%) also reported that individual-based reasons are important for not accessing drug treatment. Injectors giving program- and individual-based reasons for not entering treatment are profiled using logistic regression.

Introduction

Almost one-third of all newly reported acquired AIDS cases in the United States are associated with injection drug use (Centers for Disease Control 1994). Consequently, the U.S. Public Health Service and the National Institute on Drug Abuse (NIDA) have identified this route of human HIV transmission as a research priority. Not only does the sharing of contaminated injection paraphernalia spread infection to other injection drug users (IDUs), it also serves as one of the primary vectors crossing into the heterosexual population (Magura et al., 1989).

Because AIDS is largely a behaviorally spread disease, considerable effort has been devoted to identifying factors related to its transmission and investigating the efficacy of alternative interventions designed to reduce high-risk behavior. As a means to this end, the Presidential Commission on the Human Immunodeficiency Virus Epidemic (1988) developed a 10-year plan in 1987 that included as its first recommendation: "Expanded drug abuse treatment programs sufficient to admit all IV drug users who desired services and, until that occurred, short-term detoxification and low-dose methadone for those on waiting lists" (see Inciardi, 1990 for an overview).

There is evidence to support the statement that drug-abuse treatment is effective for significant numbers of drug abusers, but at the same time drug abuse is chronic and relapsing (Leukefeld et al. 1993). Drug-abuse treatment outcomes have been examined in large treatment follow-up studies-including the Drug Abuse Reporting Program (DARP), the Treatment Outcome Prospective Study (TOPS), and the Drug Abuse Treatment Outcome Study (DATOS)-and outcomes are consistently better for those who remain in treatment longer (Gerstein and Harwood 1990; Tims et al. 1991).

Keeping drug abusers in treatment maintains positive behavioral changes related to HIV. For example, Ball et al. (1988) reported that more than 80% of patients who left methadone treatment prematurely relapsed to injection within 12 months. This finding is also supported by Metzger, et al. (1993) who reported that injectors who were not in treatment after 18 months were 5 times more likely to become infected with HIV (22%) than injectors who remained in methadone treatment (4%). Other studies have confirmed that staying in methadone treatment is associated with lower rates of seropositivity (Abdual-Quader et al. 1987; Bliz and Gronbladh 1988; Grimm et al. 1989) and significant reductions in HIV risk behaviors (Longshore et al. 1993; Novick et al. 1989).

Although there is a widely recognized need to provide AIDS prevention in conjunction with drug-abuse treatment, such an outreach strategy assumes a high degree of treatment availability. After analyzing data from 20,048 subjects in the National AIDS Demonstration Project (NADR), Liebman et al. (1993) reported that more than 40% of the injectors had not previously been in treatment for their drug abuse, and concluded that AIDS prevention efforts to injectors must be expanded to non-treatment settings. …

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