“…In addition, because this was a cross-sectional design, the directionality of the associations may vary in that some of the factors may precede, be concurrent with, or pursue methamphetamine/cocaine use. Notwithstanding, the literature indicates alcohol binging is common at the time of using methamphetamine and cocaine, and jointly, promote unprotected sex, a greater number of sexual partners, and ultimately, an increased likelihood of becoming infected with HIV and other STIs (Colfax et al, 2004;Semple, Zians, Grant, & Patterson, 2005;Zule et al, 2007). Another limitation is that the drug use questions did not address intensity of use in the past 12 months.…”