A clinical trial contrasted 2 interventions designed to link opioid-dependent hospital patients to drug abuse treatment. The 126 out-of-treatment participants were randomly assigned to (a) case management, (b) voucher for free methadone maintenance treatment (MMT), (c) case management plus voucher, or (d) usual care. Services were provided for 6 months. MMT enrollment at 3 months was 47% (case management), 89% (voucher), 93% (case management plus voucher), and 11% (usual care); at 6 months enrollment was 48%, 68%, 79%, and 21%, respectively. Case management and vouchers can be valuable in health settings to link substance abusers with medical problems to drug abuse treatment.

Cigarette smoking is a significant problem among substance users and is common in heroin users. Rates of concurrent smoking and opioid use are estimated to be between 85-98%, 1 at least four times higher than the general U.S. population.2 Not surprisingly, these differences in prevalence translate to differences in success rates in smoking cessation programs as well.Rates of smoking cessation among heroin users are several times lower than rates for the general U.S. population.

Men exposed to a condom skills practice exercise were hypothesized to perform better on condom skills measures than those exposed only to a demonstration or to no intervention. As part of a larger NIDA Clinical Trials Network HIV Prevention protocol men in substance abuse treatment were administered male and female condom use skills measures (MCUS, FCUS) at preintervention, two weeks, 3 months and 6 months post-intervention. The MCUS and FCUS scores were compared for three intervention exposure groups (demonstration only [DO, n=149], demonstration plus practice [D+P; n=112], attended no sessions [NS, n=139]) across the 4 assessment time points using a mixed effects linear regression model. There is a statistically significant intervention group-by-time effect (p<.0001) for both the MCUS and FCUS. Post hoc, pairwise linear trends across time indicated that for both the MCUS and the FCUS the D+P group is significantly superior to the DO group and the NS group.

This study identified predictors of condom use and developed a model of condom use in a sample of men (n=324) enrolled in drug treatment. Utilizing a series of logistic regression analyses reported condom use was predicted by possession of condoms, future intention to use condoms, future intention to increase condom use, having a high-risk partner, low Condom Barriers Scale scores, being unmarried and ethnic minority status. A probit path analysis revealed the following model of condom use among men in drug treatment: Taking condoms from clinic stocks was the best predictor of condom possession, which in turn was the best predictor of condom use. These study findings identify condom availability in treatment programs as an important risk reduction intervention. Treatment programs can apply these predictors of condom use to better identify individuals at risk for HIV and sexually transmitted infections to better target prevention interventions.