The effect of antisocial personality disorder on drug treatment entry and subsequent needle exchange utilization among injection drug users from the Baltimore needle exchange program

• Main Author: Havens, Jennifer Rochussen
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2004
• Subjects: Antisocial personality disorder; Drug therapy; Drug use; Injections; Mental health; Needle exchange programs; Public health; United States > US; Baltimore Maryland
• ISBN: 9780496779413; 0496779419

Background and objectives. The prevalence of antisocial personality disorder (ASPD) among injection drug users (IDUs) is several times that of the general population. A significantly higher proportion of IDUs with comorbid ASPD and opiate use have been shown to engage in high-risk injection and sexual practices. However, little prospective research on the influence of ASPD on pre-treatment outcomes has been conducted. Through this longitudinal study, a number of specific hypotheses surrounding ASPD and outcomes associated with drug abuse treatment were explored. Methods. Subjects were participants in the Treatment Retention Intervention (TRI), a randomized behavioral trial examining the influence of a Strengths-Based Case Management (SBCM) intervention versus the standard (passive) referral on facilitating treatment entry and retention among IDUs receiving treatment referrals to opiate-agonist therapy from the Baltimore NEP. Multiple logistic regression, the Kappa statistic and negative binomial regression were utilized to examine predictors of treatment entry, validity of self-reported drug use and predictors of NEP utilization, respectively. Results. Of 141 IDUs referred from NEP to drug treatment, 67.4% were male, 76.6% Black and the median age was 38 (Interquartile Range (IQR): 34–43). One in five participants (19.1%) tested HIV-positive and the prevalence of ASPD was 24.8%. ASPD was not associated with treatment entry, and among Black participants, those with both ASPD and depressive symptoms, those who were injecting speedball and those who were selling needles were significantly less likely to return to the NEP post-treatment. Good to excellent validity was found when comparing self-reported drug use with NEP utilization. Conclusions. While few associations were found between ASPD and various outcomes, this does not underscore the importance of this high-risk group and suggests that IDUs with ASPD should be able to attain similar success in drug abuse treatment programs provided that comorbid conditions such as stimulant dependence are addressed. Finally, drug treatment programs should provide expanded access to job skills training and employment opportunities in order to lessen the number of IDUs relying on illicit employment, such as needle selling, for income.