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Schroeder, Epstein, Umbricht, and Preston (2006) randomly assigned 81 outpatients dually diagnosed with heroin and cocaine dependence and engaging in HIV risk behaviors to one of four conditions. While all study participants received methadone maintenance, this treatment was augmented with cognitive-behavioral therapy (CBT), contingency management (CM), both (CBT + CM), or neither. The CBT administered in this study "included relapse-prevention techniques along with methods for coping, behavioral reinforcement, and generalizing skills to the environment, and this intervention was given in a group format in twelve weekly 90-min sessions. Furthermore, the CBT intervention ... included an HIV prevention component with hands-on demonstration and group practice of HIV risk reduction skills (e.g., putting a condom on a banana, cleaning a syringe)" (pp. 876-877).
The most noteworthy findings from this study are the frequencies of cessation of self-reported drug-related and sexual risk behaviors, even among participants receiving the control treatment. Over half of participants reporting injection drug use [IDU] at intake reported no [IDU] at study exit, and over 90% of participants who reported sharing needles at intake reported no needle sharing at study exit. ... [In addition,] 88% of those reporting unprotected sexual intercourse at intake reported no unprotected sex at study exit, and 91% of those trading sex for money or drugs at intake reported no longer doing so at study exit. These reported cessations in risk behavior were independent of gender and psychiatric comorbidity and were largely independent of behavioral treatment modality. ... The apparent cessation rates of sexual as well as drug-related risk behavior observed in this study suggest that additional benefit may be derived from augmentation [of methadone maintenance] with behavioral treatment, regardless of the behavioral treatment modality. The reported behavior change may be attributable to some feature common to all treatment in this study – perhaps the increased contact with clinic staff, or the social benefits of engaging in group therapy. (p. 876)
Schroeder and colleagues stress caution in interpreting these data, which are based entirely on self-report and the exclusion of 112 of 193 participants who were randomized but for whom HIV risk behavior data were missing. Despite these limitations, the investigators indicate that
this study offers preliminary evidence that dually dependent substance abusers maintained on methadone can achieve reductions in sexual as well as drug-related risk behaviors when treatment is augmented with group behavioral therapy aimed at reducing cocaine use. That these reductions were observed in the control group implies that intensive behavioral treatment may not be necessary; perhaps the effectiveness of methadone maintenance for reduction of HIV risk could be improved by the addition of a weekly support group with incentives for regular attendance. Due to the tentative nature of these findings, further research is necessary to replicate them in larger samples, preferably using outcome assessments that include collateral reports of participants' HIV risk behaviors. (p. 877)
To identify psychological motivations and psychosocial states associated with different levels of methamphetamine (meth) use, Halkitis and Shrem (2006) analyzed survey data from a convenience sample of 49 gay and bisexual men in New York City who used meth. Men were categorized as "Binge" users if they used meth between 1 and 12 days over the previous 3-month period. Men were categorized as "Chronic" users if they used meth for any amount of time greater than 12 days over the previous 3-month period.
Findings suggest that “Chronic” users report higher levels of avoidant coping and are more likely to use [meth] to avoid unpleasant emotions, to avoid physical pain, and to engage in pleasant times with others than those who are “Binge” users. While previous research demonstrates the value of treatment approaches that consider the synergy of mental health, drug use, and sexual-risk taking, ... [these] findings suggest the importance of identifying the frequency and current progression of [meth] use when addressing the psychological meanings it has for the individual user. (p. 549)
Theall, Elifson, and Sterk (2006) interviewed 268 young adult men and women with diverse self-identified sexual orientations to examine HIV risk behavior associated with the use of MDMA (3,4-methylenedioxymethamphetamine), better known as ecstasy. For readers unfamiliar with this substance, "[t]ouch, both sensual and sexual, ... [i]s a significant part of the ecstasy experience" (p. 169).
In general, the findings suggest that HIV sexual risk behaviors occur among young adult ecstasy users, with higher levels of HIV risk-taking among heavy ecstasy users [i.e., those using ecstasy on more than 10 days during the 90 days preceding the interview]. After controlling for various enabling factors and poly-drug use, having a drug-using partner, believing that ecstasy makes one want to touch people in a sexual way and more frequent alcohol consumption were some of the strongest predictors of overall HIV sexual risk among the respondents in this sample. It is important to incorporate these predictors in HIV risk reduction messages. For instance, information on touch, and the associated sexual desire, will enable ecstasy users to recognize the link between use, touch, and the potential for unsafe sex. (p. 177)
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Summer 2006 Newsletter / Volume 7, Issue 4 
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