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Objective: This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors., Methods: Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors., Results: Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program., Conclusions: No overall benefit of extending treatment beyond 6 months was found.

This study examined test-retest reliabilities of self-reported human immunodeficiency virus (HIV) sexual and drug injection behaviors among 246 prior drug users admitted to either of two residential drug treatment programs in Westborough, Massachusetts, and Providence, Rhode Island, between June 1990 and September 1992. Participants, selected by their date of admission, were administered admission and reliability questionnaires pertaining to HIV risk behaviors, the latter at approximately 2 weeks after admission. Estimated reliabilities (kappa coefficients) of the sexual behaviors ranged from 0.72 to 0.91; those for the drug injection variables ranged from 0.63 to 0.98. These results were consistent across groups defined by sex and injection of drugs. The consistently good reliabilities are significant to the design of independent studies of drug treatment populations utilizing self-report measures of sexual and drug behaviors.

We investigated the associations of psychiatric symptoms and diagnoses with HIV risk behaviors among 405 clients of two United States residential drug abuse treatment programs at admission and at follow-up. Measures of psychiatric status included the Beck Depression Inventory (BDI), selected diagnoses assessed with the Diagnostic Interview Schedule (DIS-III-R) and the Addiction Severity Index psychiatric composite score (ASI-P). Measures of risk behaviors included: drug injection risk (including sharing and bleaching of needles and syringes), multiple sexual partners and condom use. In multivariate analyses, the BDI at baseline and change in the BDI to follow-up were strongly associated with drug use at follow-up (both injection and non-injection), but not with other risk behaviors. In contrast, psychiatric diagnoses were not statistically associated with risk behaviors at follow-up when baseline behavior was controlled.

The validity of drug and sexual behavior data collected by drug user treatment staff using a short clinical risk assessment among 387 injection drug users is evaluated using in-depth, confidential interview process. Moderate to high agreement levels were found for most, but not all, variables. Participants consistently reported less risky behaviors on the clinical risk assessment than on the in-depth interview. More easily recalled information can be accurately gathered through a short clinical risk assessment. However, in-depth, confidential interviewing is important when gathering self-reports of the frequency of drug and sexual behaviors.

We investigated the outcomes of a 21-day inpatient drug detoxification and rehabilitation program including length of stay, transfer to further treatment, and HIV risky behavior. Clients (n = 567) were predominantly White, male, currently unemployed, and their treatment was not covered by third party payment. 78% were detoxified with methadone. The median length of stay was 18 days. Higher education, not living with spouse or children, English as primary language, admission during fall or winter months, and greater knowledge of HIV transmission were independent predictors of greater length of stay. Among those with follow-up (n = 450), 19% were transferred to residential drug-free programs and 7% to outpatient programs. Taking into account loss to follow-up, the overall rate of treatment transfer could be as low as 21%. Greater length of stay was associated with higher rates of transfer to residential treatment. Relapse rates to either any drug use or injection drug use were lower among subjects transferred to residential treatment than either clients transferred to outpatient programs or those with no further treatment. Among subjects who continued to inject drugs at follow-up, no reduction in HIV risky behaviors was found regardless of further treatment. We conclude that detoxification programs have the potential for reducing relapse to drug use when followed by residential drug-free treatment.

This study aimed to identify factors which predict participation of drug users in HIV-1 antibody testing. The study was part of a randomized controlled trial of three small group AIDS educational programs, in a 21-day in-patient drug detoxification and rehabilitation program. Subjects (n = 497) were clients admitted to the program who consented to participate in the evaluation and who completed baseline data collection. All subjects received pre-test counseling. Testing was offered after 1 week in treatment; 52% decided to be tested. Factors which predicted participation in testing included: no previously reported positive result, a longer stay in treatment, a greater frequency of injection, a greater perceived probability of being infected, and the type of AIDS education. Both actual and perceived level of risk, and the type of AIDS education provided can affect participation in testing programs.

We investigated the associations of self-reported HIV status and risky injection practices with dependent variables measuring readiness and motivation for treatment and depression among 550 clients at two residential drug abuse treatment programs. The results suggest that a positive HIV status may be associated with motivation for treatment independently of and more strongly than risky behavior. In multivariable analyses, HIV status was associated with a scale measuring cons of drug use (P = 0.006). Risky behavior was associated with the dependent variables only in univariate analyses. The univariate association between risky behavior and depression was confounded by social desirability bias. Further research is needed to determine whether HIV-related variables predict retention or outcome of treatment.