July 2008

Grant Results

SUMMARY

Researchers at the Boston University School of Social Work interviewed IV-drug users and analyzed treatment and outcome data to explore whether drug treatment and other services can help IV-drug users reduce their drug use and other behaviors that increase their risk of HIV infection.

Key Findings

  • Treatment for IV-drug use varies significantly between different racial and ethnic groups. Hispanic IV-drug users were a third less likely than whites to enter residential drug treatment and African Americans were half as likely as whites to enter methadone maintenance.
  • IV-drug users who received psychiatric medications for their mental or emotional problems were less likely to share needles.
  • Treatment with psychiatric medications, however, did not curtail drug use.

Funding
The Robert Wood Johnson Foundation (RWJF) provided $339,247 to conduct the study from September 2000 through August 2004.

The federal Center for Substance Abuse Treatment (CSAT) provided $500,000 to increase the sample size of the study.

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THE PROBLEM

Previous research has shown that IV drug users who receive treatment stop or limit their drug use and reduce "risky" behavior, such as needle-sharing and unprotected sex that increases their chances of infection with HIV. IV drug users, however, frequently do not seek treatment, and those in treatment are likely to drop out. More information is needed on the factors that influence drug users to seek treatment and complete it.

In earlier work, researchers at the Boston University School of Social Work assessed the health and other social service needs of urban IV drug users in Massachusetts in a longitudinal study funded by CSAT. According to the project director, the study was limited in that it did not examine the link between IV drug users' utilization of health services and changes in drug use and HIV/AIDS behavior over time.

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THE PROJECT

Under this grant, researchers conducted interviews with IV drug users and analyzed treatment and outcome data to explore whether those who receive drug treatment and health and social services reduce their drug use and other behavior that puts them at risk of HIV infection. The project was designed to build on the earlier CSAT-funded study. Its goals were to:

  • Track changes in substance use and high-risk behavior over a period of three years among rural and urban IV drug users in Massachusetts.
  • Examine whether the kinds of health and social services IV drug users received led to reductions in substance use and high-risk behavior.

Project staff subcontracted with two groups — Tapestry Health Systems in Western Massachusetts and Cambridge Cares About AIDS, in Cambridge, Mass. — to recruit outreach workers to conduct in-person interviews with more than 1,200 IV drug users. They then created a database that merged information from the interviews with treatment and outcome data contained in a state database that has information on more than 50,000 people who had received treatment between 1996 and 2002. The final merged database included interview and treatment information on 507 IV drug users.

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FINDINGS

The researchers reported their findings in a series of papers published in peer-reviewed journals including the American Journal of Drug and Alcohol Abuse and the Journal of Substance Abuse Treatment (see the Bibliography). Among the key findings:

  • Women were significantly more likely than men to practice risky behavior. Three-quarters (76 percent) of women shared needles or practiced sexually risky behavior, compared with 49 percent of men.
  • Mental health treatment appears to help curb needle-sharing. IV drug users who received psychiatric medications for their mental or emotional problems were less likely to share needles. Treatment with psychiatric medications, however, did not curtail drug use.
  • IV drug users who were high-level drug treatment users, and may have dropped-out of a number of treatment episodes, were more likely to share needles. The researchers suggest that high treatment users should be identified and offered HIV prevention counseling and mental health services.
  • IV drug users remain high users of emergency room and other hospital services. Those with the highest level of psychiatric symptoms were seven times more likely to use the emergency room than were those with fewer psychiatric symptoms. The researchers suggest that more mental health services should be provided with drug treatment services.
  • Drug users who had health insurance were at least three times more likely to receive methadone treatment during the study period than were those without insurance.
  • Mothers who lived with their children and were employed were more likely to receive methadone maintenance than were mothers who did not reside with their children.
  • Treatment for IV drug use varies significantly between different racial and ethnic groups. Hispanic IV drug users were a third less likely than whites to enter residential drug treatment, and African Americans were half as likely as whites to enter methadone maintenance.

Limitations

According to the principal investigator, the limitations of the study are:

  • The findings may not generalize to all IV drug users nationally. The sample included Massachusetts drug users only, did not include those who used self-help or 12-step programs and did not include drug users who had never sought treatment.
  • The study did not address total length of time in drug treatment, which may be related to changes in risky behavior, such as needle-sharing.

Communications

The researchers published their findings in AIDS: Education and Prevention, the American Journal of Drug and Alcohol Abuse, the Journal of Substance Abuse Treatment and seven other journals and two book chapters. They also presented their findings at meetings of the American Public Health Association, the Society for Social Work and Research, the International Conference on Urban Health and the International Conference on Evaluation for Practice (see the Bibliography for more details on publications).

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AFTER THE GRANT

A grant from the Substance Abuse and Mental Health Services Administration allowed investigators to expand the scope of the research. In their 2008 article in the Journal of Substance Abuse Treatment, (Schlosser A, Abdallah A, Callahan C, Bradford S, Cottler L. "Does Readiness To Change Predict Reduced Crack Use In Human Immunodeficiency Virus Prevention?" 35[1]:28–35) the researchers published the results of a study evaluating the efficacy of peer-delivered Human Immunodeficiency Virus (HIV) preventive education, as opposed to standard (healthcare provider-delivered) HIV preventive education, in reducing crack cocaine use among users in St. Louis. In the article, investigators noted that:

  • Some 70 percent of participants who received peer-delivered intervention had reduced or stopped crack cocaine use after three months, compared to some 61 percent of participants who had received standard intervention.
  • Older participants were more likely to reduce crack cocaine use than were younger participants.

Project staff members also helped Tapestry Health Systems receive more than $5 million over seven years from the federal Center for Substance Abuse Treatment to conduct HIV outreach and case management for intravenous drug users.

The project staff members also expanded their work to include collaboration with Casa Esperanza, a residential substance abuse treatment agency for Latino families. In 2007, Community-Campus Partnerships for Health recognized this interagency collaboration with an Honorable Mention for the "Partnerships for Health Annual Award".

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GRANT DETAILS & CONTACT INFORMATION

Project

Researching the Service and Treatment Needs of Injection Drug Users

Grantee

Boston University School of Social Work (Boston,  MA)

  • Amount: $ 339,247
    Dates: September 2000 to August 2004
    ID#:  038634

Contact

Lena M. Lundgren, Ph.D.
(617) 353-1634
llundgre@bu.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Book Chapters

Fitzgerald T, Purington T, David K, Ferguson F and Lundgren L. "Utilization of Needle Exchange and Substance Abuse Treatment Services by Injection Drug Users: Social Work Practice Implications of a Harm Reduction Model." In Practice Issues in HIV/AIDS Services: Empowerment-Based Models and Practice Applications. Mancoske RJ and Smith JD (eds.). Binghamton, N.Y.: Haworth Press, 2004.

Lundgren LM, Capalla L, and Ben-Ami L. "Alcohol Use Among Puerto Rican Active Injection Drug Users." In Latinos and Alcohol Use/Abuse Revisited: Advances and Challenges for Prevention and Treatment Programs. Delgado M (ed.). Binghamton, N.Y.: Haworth Press, 2005.

Articles

Amodeo M, Chassler D, Ferguson T and Lundgren L. "Use of Mental Health and Substance Abuse Treatment Services by Female Injection Drug Users." American Journal of Drug and Alcohol Abuse, 30(1): 101–120, 2004. Available online.

Fitzgerald T, Lundgren L and Chassler D. "Partnership Status and Sustained HIV/AIDS High-Risk Behaviors among Female Injection Drug Users." Unpublished.

Lundgren LM, Amaro H and Ben-Ami L. "Factors Associated with Drug Treatment Entry Patterns among Hispanic Women Injection Drug Users Seeking Treatment." Journal of Social Work Practice in the Addictions, 5(1/2): 157–174, 2005.

Lundgren LM, Amodeo M and Chassler D "Mental Health Status, Drug Treatment Use, and Needle-sharing among Injection Drug Users." AIDS: Education and Prevention, 17(6): 525–539, 2005. Abstract available online.

Lundgren LM, Amodeo M, Ferguson F and Davis K. "Racial and Ethnic Differences in Drug Treatment Entry of Injection Drug Users in Massachusetts, 1996–1999." Journal of Substance Abuse Treatment, 21(3): 145–153, 2001. Abstract available online.

Lundgren LM, Capalla L and Ben-Ami L. "Alcohol Use Among Adult Puerto Rican Injection Drug Users." Alcoholism Treatment Quarterly, 23(2/3): 149–164, 2005.

Lundgren L and Chassler D. "Sustained HIV High-Risk Behavior: A 12-Month Study." Unpublished.

Lundgren L, Chassler D, Ben-Ami L, Purington T and Schilling R. "Factors Associated with Emergency Room Use among Injection Drug Users of African-American, Hispanic, and White-European Background." American Journal on Addictions, 14(3): 268–280, 2005. Abstract available online.

Lundgren L, Schilling R, Ferguson F and Amodeo M. "Examining Drug Treatment Program Entry of Injection Drug Users: Human Capital and Institutional Disaffiliation." Evaluation and Program Planning, 26(2): 123–132, 2003.

Lundgren LM, Schilling RF, Fitzgerald T, Davis K, and Amodeo M. "Parental Status Differences of Women Injection Drug Users and Entry to Methadone Maintenance." Substance Use and Misuse, 38(8): 1109–1131, 2003. Abstract available online.

Lundgren LM, Schilling RF, and Peloquin SD. "Evidenced-based Drug Treatment Practice and the Child Welfare System: The Example of Methadone." Social Work, 50(1): 53–63, 2005. Abstract available online.

Lundgren L, Sullivan L, and Amodeo M. "How Do Treatment Repeaters Use the Drug Treatment System? An Analysis of Injection Drug Users in Massachusetts." Journal of Substance Abuse Treatment, 30(2): 121–128, 2006. Abstract available online.

Shin SH, Lundgren L and Chassler D. "Examining Drug Treatment Entry Patterns among Young Injection Drug Users." American Journal on Drug and Alcohol Abuse, 33(2): 217–225, 2007. Abstract available online.

Survey Instruments

"Drug Treatment and Service Needs of African American and White Injection Drug Users." Boston University, fielded April 2001.

"Drug Treatment and Service Needs of African American and White Injection Drug Users." Boston University, fielded May 2002.

Presentations and Testimony

Lena Lundgren, Timothy Purington and N. Kuilian. HIV Prevention through a Collaborative Community Outreach Research Effort at the Annual Meeting of the International Conference on Urban Health, Boston, 2004. Proceedings are available online.

Lena Lundgren, Maryann Amodeo, Faith Ferguson and Karen Davis. "Service Gaps and Substance Abuse Treatment Needs of African American and White Injection Drug Users: a longitudinal Study," at the Annual Meeting of the American Public Health Association, November 12–16, 2000, Boston. Proceedings of the meeting are available online.

Lena Lundgren, Maryann Amodeo, Faith Ferguson and Karen Davis. "Substance Abuse Treatment and Service Needs among Injection Drug Users: A Statewide Effort to Prevent HIV/AIDS," at the Annual Meeting of the Society for Social Work and Research, 2001, Atlanta. Proceedings of the meeting are available online.

Faith Ferguson, Maryann Amodeo, Karen Davis and Lena Lundgren. "Examination of Service Use by Injection Drug Users in Needle Exchange and Drug Treatment Programs in Massachusetts: 1996–1999," poster presentation at the Annual Meeting of the Society for Social Work and Research, January 2002, San Diego. Proceedings of the meeting are available online.

Lena Lundgren, Maryann Amodeo and Robert Schilling. "Evaluating a State-Wide Substance Abuse Treatment System," at the 4th International Conference on Evaluation for Practice, July 4–6, 2002, Tampere, Finland.

Lena Lundgren, Robert Schilling, Faith Ferguson, Karen Davis and Maryann Amodeo. "A Multi-Year Assessment of Service Needs of Injection Drug Users," at the Annual Meeting of the Society for Social Work and Research, January 2003, Washington. Proceedings of the meeting are available online.

Lena Lundgren, Robert Schilling and Susan D. Peloquin. "Is the Child Welfare System Aware of Evidence Based Substance Abuse Treatment Practices: The Example of Methadone Maintenance," a poster presentation at the Annual Meeting of the Society for Social Work and Research, January 2004, New Orleans. Proceedings of the meeting are available online.

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Report prepared by: Barbara Matacera Barr
Reviewed by: Richard Camer
Reviewed by: Molly McKaughan
Program Officer: Constance M. Pechura