Psychiatric Comorbidity Is Associated With Drug Use and HIV Risk in Syringe Exchange Participants

Abstract

The present study evaluated the effects of psychiatric comorbidity on substance use disorder prevalence, HIV risk behavior, and other problem severity in male and female out-of-treatment injection drug users newly registered at a syringe exchange program. Participants (N = 338) were administered the Structured Clinical Interview for the DSM-IV, the Addiction Severity Index, and the Risk Assessment Battery, and classified into one of four diagnostic groups: (1) no antisocial personality disorder (APD) or Axis I psychiatric disorder (N = 162), (2) APD only (N = 74), (3) Axis I psychiatric disorder only (N = 55), or (4) APD plus Axis I psychiatric disorder (N = 47). Psychiatric comorbidity was associated with higher rates of substance use disorder and more HIV risk and other problem severity. In general, participants with both APD and an Axis I disorder exhibited the most problem severity. APD was uniquely associated with higher prevalence for each substance use disorder assessed in this study and with elevated HIV risk. These results support and extend studies conducted with opioid-dependent individuals recruited from treatment and community settings, and reinforce the need to develop interventions to encourage syringe exchange program participants to enroll in treatment.

Psychosocial and psychopathological predictors of HIV-risk injecting behavior among drug users in Portugal

“…The majority were single, unemployed, and reported a chronic use of illicit substances starting in adolescence. Corroborating other authors findings on HIV risk behaviors among IDUs (Disney et al, 2006;Kirdorf et al, 2004;Mackesy-Amiti et al, 2012), our results showed a pattern of multiple substance abuse (e.g., tobacco, alcohol, cocaine, heroin, etc. ), loss of control of drug use and deviant behaviors -half of the sample had an overdose, some individuals had been arrested and most of these shared materials while in prison.…”

“…More risk behaviors for acquiring HIV/AIDS, such as more sharing of syringes and needles in IDUs, were found among individuals with a history of suicide attempt (Sarin, Singh, Samson, & Sweat, 2013), antisocial personality disorder (Comptom, Cottler, Ben-Abdallah, Cunningham-Williams, & Spitznagel, 2000;Disney et al, 2006) and major depression (Disney et al, 2006;Kidorf et al, 2004;Wisniewski et al, 2005), these higher on women than in men, and more evident on women who inject drugs and are infected with HIV/AIDS (Wisniewski et al, 2005). Other complications, such as more somatic complaints, as fatigue symptoms and worse quality of life were also found among IDUs, and even more in those infected with HIV and HCV (Tavakkoli, Ferrando, Rabkin, Marks, & Talal, 2013).…”

“…Furthermore, some evidence pointed out that among IDUs, those with psychiatric morbidity have greater HIV risk behaviors (Compton et al, 1995;Disney et al, 2006;Kirdorf et al, 2004). More risk behaviors for acquiring HIV/AIDS, such as more sharing of syringes and needles in IDUs, were found among individuals with a history of suicide attempt (Sarin, Singh, Samson, & Sweat, 2013), antisocial personality disorder (Comptom, Cottler, Ben-Abdallah, Cunningham-Williams, & Spitznagel, 2000;Disney et al, 2006) and major depression (Disney et al, 2006;Kidorf et al, 2004;Wisniewski et al, 2005), these higher on women than in men, and more evident on women who inject drugs and are infected with HIV/AIDS (Wisniewski et al, 2005).…”

“…Psychiatric disorders including other substance abuse, major depression disorder, anxiety, posttraumatic stress disorder, antisocial personality disorder, borderline personality disorder, and psychosis are commonly found comorbid with drug addiction (Braitstein et al, 2005;Buckley, 2006;Compton, Cottler, Shillington, & Price, 1995;Disney et al, 2006;Kirdorf et al, 2004;Mackesy-Amiti, Donenberg, & Ouellet, 2012).…”

Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

“…ASPD has been associated with poorer treatment outcomes, including worse psychosocial functioning, more legal problems, and more problematic substance use in many (Basu et al, 2004;Cacciola et al, 1996;Compton et al, 2003;Fridell et al, 2006;Grella et al, 2003;King et al, 2001;Leal et al, 1994) but not all (Brooner et al, 1998;Crits-Cristoph et al, 1999;McKay et al, 2000;Messina et al, 2002Messina et al, , 2003 studies. Among patients with DUDs, comorbid ASPD is associated with higher levels of drug and sexual HIV risk behaviors Disney et al, 2006;Fals-Stewart et al, 2003;Kelley and Petry, 2000;Ladd and Petry, 2003;Woody et al, 1997). However, ASPD has been an inconsistent predictor of response to HIV risk reduction interventions (Compton et al, , 2000bMcCusker et al, 1995;Woody et al, 2003).…”