Although the cessation of substance use is the principal concern of drug treatment programs, many individuals in treatment experience co-occurring problems such as mood disruptions and sexual risk behaviors that may complicate their recovery process. This study assessed relationships among dynamic changes tracked over time in methamphetamine use, depression symptoms, and sexual risk behaviors (unprotected anal intercourse) in a sample of 145 methamphetamine-dependent gay and bisexual males enrolled in a 16-week outpatient drug treatment research program. Participants were randomly assigned into 1 of 4 conditions: contingency management (CM), cognitive behavioral therapy (CBT; the control condition), combined CM and CBT, and a tailored gay-specific version of the CBT condition. Using latent growth curve models, the authors assessed the relationship of means (intercepts) and the slopes of the 3 measures of interest over time to test whether changes in methamphetamine use predicted declining rates of depression and risky sexual behavior in tandem. Participants with the greatest downward trajectory in methamphetamine use (urine verified) reported the greatest and quickest decreases in reported depressive symptoms and sexual risk behaviors. The control group reported the most methamphetamine use over the 16 weeks; the tailored gay-specific group reported a more rapidly decreasing slope in methamphetamine use than the other participants. Findings indicate that lowering methamphetamine use itself has a concurrent and synergistic effect on depressive symptoms and risky sexual behavior patterns. This suggests that some users who respond well to treatment may show improvement in these co-occurring problems without a need for more intensive targeted interventions.

The objective of the study was to assess the reliability and validity of self-report of HIV testing questions on the Risk Behavior Assessment and Risk Behavior Follow-up Assessment. Study 1 had 219 injection drug users and crack cocaine smokers. Study 2 had 259 injection drug users and crack cocaine smokers. Study 3 had data from 17,408 injection drug users and crack cocaine smokers. When the question 'Have you ever been told that you were infected with the AIDS virus' was compared to ELISA result, the specificity was over 99% for both baseline and follow-up. The sensitivity was 32% on the Risk Behavior Assessment, but 61% on the Risk Behavior Follow-up Assessment. Those who were HIV positive at Risk Behavior Assessment (baseline) were less likely to have received their previous HIV test result. Two-thirds of the HIV test-related questions on the Risk Behavior Assessment and Risk Behavior Follow-up Assessment had acceptable reliability. The low sensitivity at Risk Behavior Assessment was probably due to the participants' failure to receive their previous test results.

Objectives We determined the costs and savings attributable to the California Substance Abuse and Crime Prevention Act (SACPA), which mandated probation or continued parole with substance abuse treatment in lieu of incarceration for adult offenders convicted of nonviolent drug offenses and probation and parole violators. Methods We used individually linked, population-level administrative data to define intervention and control cohorts of offenders meeting SACPA eligibility criteria. Using multivariate difference-in-differences analysis, we estimated the effect of SACPA implementation on the total and domain-specific costs to state and county governments, controlling for fixed individual and county characteristics and changes in crime at the county level. Results The additional costs of treatment were more than offset by savings in other domains, primarily in the costs of incarceration. We estimated the statewide policy effect as an adjusted savings of $2317 (95% confidence interval = $1905, $2730) per offender over a 30-month postconviction period. SACPA implementation resulted in greater incremental cost savings for Blacks and Hispanics, who had markedly higher rates of conviction and incarceration. Conclusions The monetary benefits to government exceeded the additional costs of SACPA implementation and provision of treatment.

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 while 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.

The University of Rhode Island Change Assessment (URICA; McConnaughty, Prochaska & Velicer, 1983), the Stage of Change Readiness and Treatment Eagerness Scale (SOCRATES; Miller & Tonigan, 1996), and the Readiness to Change Questionnaire (RCQ; Rollnick, Heather, Gold & Hall, 1992) are commonly used multi-dimensional measures of stage of change. The present study examined the convergent and discriminant validity of drug-use versions of these three measures through multi-trait multi-method analysis (MTMM) in a population of indigent out-of-treatment drug users (N = 377). Agreement in stage-of-change assignment and the relationship between stage of change and drug-use behaviors also were examined. Confirmatory Factor Analysis (CFA) suggests that the SOCRATES may have questionable convergent validity with the URICA and RCQ. There was moderate agreement in stage assignment. The analysis of behavior did provide some support for the construct validity of the measures. The results suggest that these drug-use stage-of-change measures may not be equivalent.