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We examined the effect on depressive symptoms of a peer network-oriented intervention effective in reducing sexual risk behavior and methamphetamine (MA) use. Current Thai MA users aged 18-25 years and their drug and/or sex network members enrolled in a randomized controlled trial with 4 follow-ups over 12 months. A total of 415 index participants recruited 568 network members. Linear repeated measures models were fit with depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) as the outcome. Among indexes in the intervention condition, mean CES-D decreased from 20.0 to 15.7 (p less than 0.0001) over follow-up. Controlling for covariates and changes in MA and alcohol use, CES-D in this group decreased by 0.35 points per month (95% confidence interval, 0.45, -0.25). All other groups showed minimal changes in CES-D score. The peer-oriented, community-based intervention designed to reduce MA use and sexual risk behavior also resulted in substantial reduction in depressive symptoms, independent of changes in MA use. (Contains 3 tables and 1 figure.)

Background: Despite Thailand's war on drugs, methamphetamine ("yaba" in Thai) use and the drug economy both thrive. This analysis identifies predictors of incident and recurrent involvement in the sale or delivery of drugs for profit amongst young Thai yaba users., Methods: Between April 2005 and June 2006, 983 yaba users, ages 18-25, were enrolled in a randomized behavioural intervention in Chiang Mai Province (415 index and 568 of their drug network members). Questionnaires administered at baseline, 3-, 6-, 9-, and 12-month follow-up visits assessed socio-demographic factors, current and prior drug use, social network characteristics, sexual risk behaviours and drug use norms. Exposures were lagged by three months (prior visit). Outcomes included incident and recurrent drug economy involvement. Generalized linear mixed models were fit using GLIMMIX (SASv9.1)., Results: Incident drug economy involvement was predicted by yaba use frequency (adjusted odds ratio [AOR]: 1.05; 95% confidence interval [CI]: 1.01, 1.10), recent incarceration (AOR: 2.37; 95% CI: 1.07, 5.25) and the proportion of yaba-using networks who quit recently (AOR: .34; 95% CI: .15, .78). Recurrent drug economy involvement was predicted by age (AOR: 0.81; 95% CI: 0.68, 0.96), frequency of yaba use (AOR: 1.06; 95% CI: 1.02, 1.09), drug economy involvement at the previous visit (AOR: 2.61; CI: 1.59, 4.28), incarceration in the prior three months (AOR: 2.29; 95% CI: 1.07, 4.86), and the proportion of yaba-users in his/her network who quit recently (AOR: .38; 95% CI: .20, .71)., Conclusion: Individual drug use, drug use in social networks and recent incarceration were predictors of incident and recurrent involvement in the drug economy. These results suggest that interrupting drug use and/or minimizing the influence of drug-using networks may help prevent further involvement in the drug economy. The emergence of recent incarceration as a predictor for both models highlights the need for more appropriate drug rehabilitation programmes and demonstrates that continued criminalization of drug users may fuel Thailand's yaba epidemic., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Introduction and Aims: Our study examined the incidence of arrest and incarceration, investigated predictors of incarceration and explored the persistence of depression, alcohol use and drug use after incarceration among young methamphetamine users from Thailand., Design and Methods: Participants were aged 18-25 years old and were a part of a 12 month randomised social network trial that aimed to reduce sexual risk and methamphetamine use. Estimates of the incidence of arrest and incarceration over 12 months were calculated. A matched case-control study (n = 73 cases; n = 223 controls) was performed to examine incarceration risk factors using conditional logistic regression. Persistence of drug-risk behaviours were explored after incarceration., Results: Study participants (n = 950) were 72% male, with a median age of 19 years and a median of 9 years of schooling. Frequent drug and alcohol use were reported at baseline. In total, 35% of the sample reported ever having been arrested and 22% reported ever having been incarcerated at baseline. During the 12 month follow up, 16% of the sample was arrested. In univariate analyses, risk factors for incarceration included frequent drug and alcohol use, being less educated, and a history of arrest and incarceration. A high prevalence of drug and alcohol use and involvement in the drug economy persisted after arrest., Discussion and Conclusions: The study indicates a high prevalence of recidivism among this young sample, with continued involvement in drug-risk behaviours after incarceration. Appropriate interventions are needed to address root causes of arrest, largely related to substance use.

Background: Southeast Asia is experiencing an epidemic of methamphetamine use, a drug associated with risky sexual behaviors, putting a large segment of the population at increased risk for sexually transmitted infections (STIs) and HIV and in need of prevention efforts. Incidence estimates of STIs are rare in Southeast Asia, especially among newer risk groups., Study Design: We enrolled methamphetamine users aged 18 to 25 years in a 12-month randomized behavioral intervention trial in Chiang Mai, Thailand in 2005. Behavioral questionnaires were administered at visits every 3 months, and biologic specimens were collected at baseline and 12 months to test for common STIs (chlamydia, gonorrhea, HSV-2, and HIV). Poisson regression with robust variance was used to determine risk factors for incident STIs., Results: Overall, 12.7% of 519 participants acquired at least 1 STI. Chlamydia was the most common (10.6%), followed by HSV-2 (4.0%), gonorrhea (2.9%), and HIV (0.6%). Risk factors for both men and women included self-reported incarceration and having a casual sex partner during follow-up, and having a prevalent STI at baseline. Additionally, among women, having 2 or more heterosexual partners, and among men, having a greater frequency of drunkenness were risk factors for STI acquisition., Conclusions: Although HIV incidence is low in this population, incidence of other STIs is high compared with previous studies of young Thai adults. Risk factors for acquisition emphasize the need for new prevention strategies targeted toward current populations at risk.

Introduction: Depression often co-occurs with amphetamine type stimulant use and can negatively impact drug treatment outcomes. Understanding the temporal relationship between depressive symptoms and methamphetamine use can further inform both treatment and mental health options., Methods: Methamphetamine users aged 18-25 years were enrolled in a 12-month randomized behavioral trial in Thailand. Questionnaires were administered every 3 months and included information on substance use and depressive symptoms. Pattern of methamphetamine use during follow-up was characterized into four groups: early cessation, late cessation, relapse and persistent use. Multinomial logistic regression was used to determine the impact of baseline depressive symptoms (CES-D score and % > or =22) on patterns of methamphetamine use during follow-up. Linear and logistic regression was used to determine the impact of patterns of methamphetamine use on depressive symptoms at the end of the trial., Results: No association was found between baseline depressive symptoms and subsequent patterns of methamphetamine use. A significant relationship was found between patterns of methamphetamine use and ensuing depressive symptoms, with those achieving cessation experiencing lower levels of depressive symptoms., Discussion: Many symptoms of depression may resolve with cessation or reduction in methamphetamine use. Clinical and community-based efforts that facilitate drug users' attempts to stop using drugs should be supported as they may contribute to positive cessation outcomes and help to improve overall mental health.

Purpose: Methamphetamine (MA) is the leading illicit drug in Thailand among youth and young adults. Sexual risk behaviors are associated with methamphetamine use, but few data are available on the daily context of methamphetamine use. We developed an inductive behavioral typology that young Thais engage in while using methamphetamine., Methods: We conducted a cross-sectional study in Chiang Mai, Thailand, in 2005-2006 among 1,162 street-recruited methamphetamine smokers 18-25 years of age. Data collected included sociodemographic characteristics, sexual behaviors, and drug use patterns. Latent class analysis was used to describe patterns of activities in which participants reported engaging directly after using MA. Logistic regression was used to examine univariate correlates of class membership, separately by gender., Results: Participants were 75% male with a median age of 19 years. More than half of participants reported frequent alcohol use (>or=4 days/week) and half of the sample reported smoking MA >or=2 days/ week. Three classes of activities emerged for male participants (n = 863): "work" (job related); "high-risk behaviors" (motorcycle riding, fighting, sex); and "combined" (all activities). Two classes emerged for the women (n = 299): "work" (housework) and "high-risk behaviors." "High-risk behaviors" and "combined" (men only) classes were associated with more frequent alcohol and methamphetamine use compared with the "work" class., Conclusions: Our study found a distinct typology of behaviors associated with substance abuse among young adults in Thailand. Behavioral typologies allow a better understanding of the nuances of "risky" behaviors and might prove useful in targeting interventions.

Introduction and Aims: Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study explores the relationship between sexual behaviours and MA., Design and Methods: Between March 2002 and January 2003, 48 in-depth interviews with young MA users aged 15-2 years in Chiang Mai. Interviews were transcribed verbatim in Thai and translated into English. Data were analysed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management. The current analysis was stratified by gender., Results: Participants were 44% male and the median age was 20 years. At the time of the interviews, 70% were not using MA. A typology of experiences with and feelings about MA's relationship to sexual activity emerged: (1) enhanced libido--individuals who found that MA enhances their sexual experiences (n = 13); (2) decreased libido or no effect--individuals who found that MA detracted from sexual desire (n = 22); and (3) virgins (n = 13)., Discussion and Conclusions: Participants reported several distinct patterns of relationship between MA and sex. Tailored interventions are needed that address specific patterns of sexual behaviors among youth in order to promote sustainable safer sex behaviours in this population.

Purpose: Methamphetamine (MA) has become the leading drug of abuse in northern Thailand over the past several years, particularly among youth. The current qualitative study examines factors associated with initiation of MA use., Methods: Between March 2002 and January 2003, 48 in-depth interviews with young MA users were conducted in advance of a randomized, MA harm reduction, peer outreach intervention trial. The interviews were conducted in the city of Chiang Mai and the surrounding district. Data were inductively analyzed using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management., Results: Participants were 57% male and had a median age of 20 years (range 15-31 years). A culture of MA ubiquity characterized participants' initiation stories. Drug ubiquity encompassed three elements: the extent of MA use within peer networks; the availability of MA; and exposure to MA before initiation. All participants were introduced to MA by people close to them, most often by their friends. Internal reasons for trying MA were curiosity, a way to lose weight or to enhance hard work, and a way to "forget life's problems." With the prevalence of MA use among participants' peers, initiation seemed inevitable., Conclusions: Initiation was characterized as ubiquitous in terms of peer networks' use and availability. Because of the prevalent norm of MA use, these data indicate that interventions targeting social networks and young Thais before MA initiation are needed.

Aim: To understand factors influencing cessation intentions among young Thai methamphetamine (MA) users, a population with dramatically increasing rates of MA use., Design and Participants: A total of 48 in-depth interviews conducted between March 2002 and January 2003 with current and recent MA users aged 15-29 years., Setting: Chiang Mai city and surrounding district, Thailand., Measurement: Interviews addressed family history, drug use patterns and influences, cessation history, drug treatment experiences and sexual behavior. Data were analyzed inductively using the constant comparative method common to grounded theory methods. Atlas-ti was used for data management., Findings: Cessation intentions were motivated by a range of internal and external influences, including attitudes towards continued MA use shaped by recognition of negative impact on self and others; influence of family, peers, partners and community stigma; perceptions on cessation and drug treatment; and external facilitators and situational barriers, such as extensive peer pressure and drug availability. In most cases, multiple factors operated simultaneously. Some variation according to duration of use and treatment status was observed., Conclusions: Evidence-based interventions addressing MA use among Thai young people are urgently needed. These data support the continuation of evidence-based drug treatment at levels adequate to address the population need and implementation a multi-faceted approach that aims to enhance identified cessation influences in this population and minimize contextual barriers to cessation.