Among this sample of opioid-dependent adults, there were high rates of global and domain-specific neurocognitive impairment, with severe impairment in learning and memory. Lifetime alcohol and cocaine dependence were associated with greater neurocognitive impairment, particularly in executive functioning. Because executive functioning is critical for decision-making and learning/memory dysfunction may interfere with information encoding, these findings suggest that opioid-dependent adults may require enhanced support for medical decision-making.
Active drug use among HIV-infected persons is associated with poor adherence to highly active antiretroviral therapy (HAART) and sub-optimal treatment outcomes. To understand adherence experiences among HIV-infected drug users, we conducted semi-structured interviews with 15 participants in a randomized controlled trial evaluating the efficacy of directly observed HAART delivered in methadone maintenance clinics. Interviews were recorded, transcribed, and thematically analyzed. We identified negative and positive psychological themes associated with both drug use and adherence. Participants described tension between negative feelings (denial, shame, and perceived isolation) and positive feelings (acceptance, motivation, empowerment, and perceived connectedness), and they associated this tension with their own drug using and adherence behaviors. Sustained antiretroviral therapy adherence may require increased emphasis on understanding the psychological experience of HIV-infected drug users.
Objectives
Provision of smoking cessation treatment is limited in office-based buprenorphine maintenance treatment (BMT) settings. This study describes smoking and smoking cessation behaviors among patients receiving office-based BMT.
Methods
Cross-sectional study of patients receiving office-based BMT at a community health center in the Bronx, NY. We interviewed patients assessing sociodemographic, substance use and tobacco use characteristics, including methods used for smoking cessation. We report simple frequencies and explored associations of BMT characteristics with smoking behaviors.
Results
Of 68 patients, 87.7% were current cigarette smokers, 7.9% were former smokers and 4.4% had never smoked. Of lifetime smokers, 83.1% reported at least one prior quit attempt; 78.5% had used medication (75.4% used nicotine replacement therapy, 29.2% varenicline, and 9.2% bupropion). Ten patients (15.4%) reported using electronic cigarettes to try to quit smoking. Stopping “cold turkey” (40.0%) and gradually decreasing the number of cigarettes smoked (32.3%) were non-pharmacological methods of quitting tried most often. Use of behavioral support, including stop smoking programs and counseling, was low. Higher dose and longer duration of BMT was associated with greater smoking frequency.
Conclusions
Patients receiving BMT have a high prevalence of cigarette smoking, though most have tried to quit, and have prior experience with pharmacotherapy for smoking cessation. Efforts to optimize smoking cessation treatments among BMT patients are needed.
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