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Behavioral Treatment + Naltrexone Reduces Drug Use and Legal Problems in the Republic of Georgia
The American Journal of Drug and Alcohol Abuse
Abstract
Known drug users in the Republic of Georgia are 99% male. Georgian social context includes close family social structure, intense police scrutiny over daily life, and minimal social service infrastructure. Drug use is dangerous and individuals rely on family support to address socially stigmatizing problems.
The aim was to examine the changes in problem severity over time experienced by 40 adult opioid-injecting men with drug-free female partners in the Republic of Georgia who participated in a randomized clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone.
This secondary data analysis study examined the results from a project that had randomized participants to either a comprehensive intervention that paired behavioral treatment with naltrexone or usual care (UC) and examined changes in Addiction Severity Index (ASI) composite scores.
The comprehensive intervention showed three times the decline in ASI drug use and legal composite scores than did the UC condition in males in the Republic of Georgia, both p < .009.
The results suggest that the use of a comprehensive behavioral intervention paired with naltrexone leads to significant reductions in drug use and legal problems in opioid-injecting males in the Republic of Georgia.
A comprehensive intervention that paired behavioral treatment with naltrexone provides a promising approach to protect drug users against relapse and legal risks.
... However, Subutex can also be used recreationally and abused. The abuse of Subutex has been most notable in major urban areas like Tbilisi, (Kirtadze, Otiashvili, O'Grady, & Jones, 2012;Otiashvili et al., 2014). Journalist Gaeme Wood described Tbilisi in 2006 this way "…it had all the wrecked majesty of an ex-beauty queen with 6 years of track-marks down her arms. ...
This chapter focuses on the emerging epidemic of opiate abuse in relation to increased availability and use of prescription opioids for both medical and recreational purposes. Abuse of prescription opioids, including synthetic opioids such as fentanyl, Vicodin, Subutex, Oxycontin, methadone, pethidine, and desomorphine, has been increasing in certain areas of the world. The prescribing and availability of these prescription opioids vary greatly from one country to another. For example, within the United Kingdom 1.7% of the population in Scotland abuses opioids, whereas only 0.13% of the population of Northern Ireland and 0.76% of people in England and Wales abuse opioids. These percentages are dwarfed by the United States, which leads the world in percentage of population (6%) abusing opioid drugs. In response to opiate abuse and addiction there has been an increase in the distribution of addiction-replacement medications, such as Subutex, which presents yet another public health risk. When Subutex inundated the Republic of Georgia in response to their escalating heroin addiction, street diversion of this prescription opioid resulted in a Subutex abuse epidemic. In countries where the prevalence of prescription opioid abuse is greater than 1% of the population, the rate of opioid abuse exceeds the rate of heroin use, with the exception of Afghanistan, which produces 90% of the world's illicit heroin.
... It was an iterative process with many partners who all offered important additions that helped create a more comprehensive and culturally congruent intervention. One vitally important lesson that we had learned in our previous pilot study delivering treatment services to males [32,33] was that potential participants were largely unaware of the purposes and goals of research. In the United States, large segments of the population have either participated in or been exposed to behavioral and/or medical research. ...
Women who inject drugs (WID) are highly marginalized and stigmatized and experience ongoing discrimination in Georgia. Few opportunities exist for WID to receive publicly funded treatment for substance use disorders. The IMEDI (Investigating Methods for EnhancingDevelopment in Individuals) project was developed in response to the need for women-specific and women-centered treatment services.This paper described our approach to understanding the Georgian culture—andWID within that culture—so that we could integrate two interventions for substance use found effective in otherWestern and non-Western cultures and to outline
how we refined and adapted our integrated intervention to yield a comprehensive women-centered intervention for substance use.
Reinforcement Based Treatment (RBT) and theWomen’s CoOp (WC) were adapted and refined based on in-depth interviews with WID (𝑁 = 55) and providers of health services (𝑁 = 34) to such women and focus groups [2 withWID (𝑁 = 15) and 2 with health service providers (𝑁 = 12)]. The resulting comprehensive women-centered intervention, RBT+WC, was then pretested and
further refined in a sample of 20WID. Results indicated positive pre-post changes in urine screening results and perceived needs for both RBT+WC and a case management control condition. The approach to treatment adaptation and the revised elements of RBT+WC are presented and discussed.
... A total of 74 men between May 2006 and January 2009 were screened. Of these men, 19 failed to show for their initial intake appointment , while 55 were evaluated for eligibility on the following criteria: 18 years or older, having a current illicit-drug-free intimate female partner with whom they had regular contact, lack of current suicidal ideation, meeting DSM-IV criteria for current opioid dependence, not meeting DSM-IV criteria for thought disorder and free of cognitive impairment that prevent them from completing the study [19,20]). Men who indicated current physical abuse of their female partner to an extent that might be life threatening were excluded from the study. ...
Background
HIV and Hepatitis C virus (HCV) infections are strongly related to injection drug use in the Republic of Georgia. Little information is available about HIV and HCV status, sexual risk, support for their partner, and risk for physical violence among the female partners of opioid-injecting men in the Republic of Georgia, many of whom may not be using drugs, yet may be at high risk of being infected with HIV and HCV from their drug-using partners.
Methods
In order to better understand the risks for females whose partners are injecting drugs, the present study conducted an initial investigation of the non-substance-using female partners of 40 opioid-injecting men who were participating in a clinical trial examining the feasibility and efficacy of a 22-week comprehensive intervention that paired behavioral treatment with naltrexone. The 40 female partners were assessed at their male partners’ study intake.
Results
The female sample was 32.3 years old (SD=6.7), 37 (93%) were married, with 15.5 years of education. A majority reported at least partial employment the majority of the time during the past 3 years, with only one woman reported being unemployed most of the time during the past 3 years. They self-reported they were 3% HIV-positive and 8% HCV-positive. Their HIV sex risk scores indicated a relatively low risk. However, only 4 (10%) women reported using a condom most of the time while having sex and 15 (38%) report not having had sex during the last 30 days. Experiences of interpersonal violence were common, with 42% reporting physical abuse by their partner during the last year and 48% reporting feeling unsafe in their current relationship.
Conclusions
The alarmingly high rate of failure to use barrier protection methods, together with the high percentage who did not know their HIV and HCV status, suggest that it may be beneficial to include non-substance-using female partners in prevention programs along with their partners to reduce the risk of HIV and HCV spreading from the population of injection-drug–using males into the general population. [This secondary analysis study was funded by an international supplement to the parent randomized clinical trial “Treating the Partners of Drug Using Pregnant Women: Stage II (HOPE)”. ClinicalTrials.gov Identifier: NCT00496990.]
The report reflects findings of Services Monitoring Survey and Economic Analysis of Harm Reduction Programs in Georgia and depicts main areas to be advanced for the sustainability of the evidence based, cost-effective Harm Reduction programs in Georgia including aligning approaches of HIV policy and drug policy and establish implementation of a unified, coherent and consistent approach and allocating national funding for needs based Harm Reduction Services.
Background: This study aimed at assessment of retention and compliance to naltrexone for long-term management among patients with opioid dependence syndrome over a follow-up period of 15 months. Additionally, it aimed to identify predictors of retention in naltrexone treatment.
Methods: The study was conducted at a tertiary care drug dependence treatment centre. The study involved patients with opioid dependence syndrome who were prescribed naltrexone for long-term management. Information was collected for socio-demographic variables, drug use history, diagnosis, retention and compliance to naltrexone treatment. Data were analysed using SPSS ver 21 (IBM Inc., New York, NY).
Results: One hundred fifty-three patients were enrolled in naltrexone maintenance treatment following an initial detoxification phase. Duration of retention was longer among those who did not report concurrent use of cannabis (z = 2.06, p = 0.03) or benzodiazepines (z = 2.04, p = 0.04) at the time of presentation to treatment centre. Marital status (OR 3.61, 95% CI 0.96–8.22), employment status (OR 8.18, 95% CI 1.68–16.53), age at onset of opioid use (OR 13.17, 95% CI 1.08–1.31), duration of opioid use (OR 11.56, 95% CI 0.97–0.99) and number of abstinence attempts in past (OR 7.49, CI 1.20–3.07) as predictors of retention at 90 days (Table 4). Similarly, marital status (OR 4.80, 95% CI 1.13–10.22), employment status (OR 4.90, 95% CI 1.20–21.61), duration of opioid use (OR 8.11, 95% CI 0.96–0.99) and number of abstinence attempts in past (OR 8.18, 95% CI 1.23–3.05) were predictors of retention at 180 days.
Conclusions: Certain socio-demographic and drug use related variables are predictors of longer retention in naltrexone treatment. These factors can guide the selection process for the patients suited for long-term maintenance with naltrexone for opioid dependence.
This paper is the thirty-fifth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2012 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
Background:
In the Republic of Georgia, women comprise under 2% of patients in substance use treatment and to date there has been no empirical research to investigate what factors may facilitate or hinder their help-seeking behaviour or access to treatment services.
Methods:
This study included secondary analysis of in-depth interviews with 55 substance-using women and 34 providers of health-related services.
Results:
The roles and norms of women in Georgian society were identified as major factors influencing their help-seeking behaviour. Factors that had a negative impact on use of drug treatment services included an absence of gender-specific services, judgmental attitudes of service providers, the cost of treatment and a punitive legal position in regard to substance use. Having a substance-using partner served as an additional factor inhibiting a woman's willingness to seek assistance.
Conclusion:
Within the context of orthodox Georgian society, low self-esteem, combined with severe family and social stigma play a critical role in creating barriers to the use of both general health and substance-use-treatment services for women. Education of the public, including policy makers and health care providers is urgently needed to focus on addiction as a treatable medical illness. The need for more women centred services is also critical to the provision of effective treatment for substance-using women.
Compared to the previous decade, the year 2005 was much more active in terms of the development of drug policy
for Georgia. In particular, it was marked with the two following simultaneous strategic initiatives: on the initiative of
the Georgian Ministry of Labour, Health and Social Security a state council, determining the countryís drug policy,
was set up; it started the elaboration of the anti drug strategic document for the country. On the other hand, on the
initiative of the ìOpen Society ñ Georgiaî Foundation, the project ìDrug Policy Reform in Georgiaî was launched
to develop and implement the countryís new drug policy. It is not coincidental that both state and non-government
sectors started simultaneously to work on the national strategy for the solution of the drug problem, the reasons
being the deficit of strategic and tactical solutions, non-existence of a large scale, coordinated, planned, strategically
sound measures subject to regular coordination and monitoring.
Resulting from these two initiatives, two different drug strategy documents were prepared with a package of
corresponding legal amendments attached to each of them. At present, the Georgian Parliamentary Committee on
Health and Social Affairs is reviewing both proposals, aiming to improve the legislation in a balanced way so that
it improves the effectiveness of the fight against drug suppliers and distributors, ensures the safety of the
implementation of harm reduction programmes in different contexts (community, penitentiary system, etc), and,
finally, limits the spread of drug use in the general population. This review process should culminate in parliamentary
recommendations for steps in development of a comprehensive drug strategy for the country.
Nowadays drug demand reduction measures in the country are funded mainly by international organizations, with
the focus on harm reduction as a top priority. During the last 10 years, the governmental funding provided for the
governmental/state measures aimed at drug demand reduction (prevention, treatment and rehabilitation, harm
reduction, epidemiological research), was cut by a factor of ten. By 2006, it decreased to 50 000 GEL (22 400 )
ñ a sum that would allow to pay for detoxification (without any additional treatment) of 35 people suffering with
addiction only.
Recognizing the inseparability of the interventions and its financial coverage, the Chairman of the Committee on
Heath and Social Affairs of the Georgian Parliament proposed to present the budget of the strategic implementation
plan for the next parliamentary hearing that should discuss the two drug strategy proposals.
Besides described above, the year 2005 is marked by the following developments in the drug situation: rise of
Subutex import from Europe and correspondingly its use by addicts (mainly via injections); rise by a factor of two
of the number of patients treated at the existed treatment centres in the country (603 patients in 2005 versus 300
in 2004); forming of the long queues of the patients awaiting for treatment at the existing treatment centres;
identified 63.9% of IDUs among HIV infected patients registered at the AIDS Centre by the end of 2005; identifying
the fact that prevalence of HIV among prisoners of the penitentiary system of Georgia exceeding more than 11
times prevalence of HIV in the general population of the country (1.76 versus 0.15).
As for development in the field of demand reduction responses, the following should be mentioned here: at the end
of 2005 the first Methadone Substitution Programme was launched in Georgia, planning to serve 200 patients by
the end of 2006, in the framework of Global Fundís programme ìStrengthening national response in Georgia to
implement the effective prevention and control of HIV/AIDS, tuberculosis and malariaî. Another novelty is the
first post-detoxification rehabilitation centre for addicts, founded by the initiative of the Patriarchy of Georgia on
the base of a number of functional monasteries in the country.
The given report – „Drug Situation in Georgia, 2004"- is the second edition of the project aiming to create
information system on drugs, initiated by the Southern Caucasus Anti Drug Programme.
With the support of the Drug Information System Project, the first („Drug Situation in Georgia, 2003") as
well as the present edition were prepared and published. The both reports concerned the identification
of needs from the perspective of assessing existing drug situation in the country. At the same time, the
reports attempted to objectively and reliably describe and analyse drug situtation in the country in
correspondence with international standards.
In particular, during the preparation of the report, we were guided by the principles elaborated by the
European Monitoring Center for Drugs and Drug Addiction (EMCDDA).
Those that have read the last year’s report will see that this year’s publication includes several sections
that have already been published in the previous issue. These are chapters, which mainly cover historical
aspects of the problem and issues related to the legislation.
We considered as necessary to include the above mentioned sections in the present publication as
well, since in order to assess the drug situation in 2004 correctly, readers should be familiar with the
historical and legal background. Also, there are no more left copies of the last year’s report (it has all
been distributed) and presently, not everyone can get hold of internet publications; based on our experience,
several of the Drug Information Network member agencies do not have access to Internet. The above
mentioned are the main reasons, why we decided to cover these issues again, in the 2004 report. They
all deserve attention of readers.
The given report, as well as the last year’s publication does not claim to be exhaustive. It can be said
that it has more of a „Diagnostic” significance: it shows us where the weak link is in obtaining essential
information on drugs or to identify the lack of coordination, necessity of either methodological or institutional
development. The overall purpose of the publications is to encourage implementation of mechanisms
of obtaining objective and reliable information in compliance with international standards.
The drug-related legislation derived from the soviet period was effective in Georgia up to 2003. The state
strategy based on the soviet-type legislation was primarily focused on law enforcement measures that
were not reflective of democratic development needs of the country after it regained independence in
1990.
Independence brought about destruction of former power control mechanisms, and the problem of drug
abuse became particularly acute. As a response, the State Commission on Fighting Drug Abuse and
Illicit Drug Trafficking was established in 1994, with the task to formulate and implement policies in this
area.
The Commission developed two national programmes based on the principle of multi-agency cooperation.
However, none of these were translated into action due to lack of funds, and the Commission itself has
become a highly formalised, inactive body.
The Georgian Research Institute on Addiction was established in 1993 and has since become a leader
in the area, responsible for carrying out basic research, introduction of new technologies, expanding
relevant services and monitoring. The Institute was an administrative tool for the state to manage the
area. However, due to severe financial crisis and budgetary constraints, in 1995 the state withdrew the
status of a public service institution from the Research Institute on Addiction, along with other scientific
institutions. This in fact cut off funding by the state and undermined a potential to manage the sphere.
Based on the new drug legislation (see subchapter “Drug legislation and its development”), on June 19,
2003 the Parliament of Georgia passed a decision to transform the Georgian Research Institute on
Addiction into a public institution. Under the present circumstances there is an urgent need to work out a well-balanced, multi-disciplinary
and modern strategy based on humanistic principles and taking account of the experiences accumulated
within the framework of the previous national programmes. It is imperative to develop a national strategic
plan based on the new approach that would rely on needs’ assessment and stakeholders’ analysis. The
plan should be realistic in terms of its implementation potential and envision a capacity for monitoring,
evaluation and impact assessment
Motivational interviewing was developed in the addictions field for helping people work through ambivalence about behaviour change. This paper describes a brief form of motivational interviewing developed in a medical setting for use in brief consultations. It is based upon the assumption that most patients do not enter the consultation in a state of readiness to change their patterns of drinking, smoking, exercise, diet or drug use; therefore, straightforward advice-giving will be of limited value and will lead to the kind of non-constructive dialogue often encountered in the addictions field: the interviewer's arguments for change are met by resistance from the patient. In contrast, this method aims to help patients articulate for themselves the reasons for concern and the arguments for change. Even if a decision to change is not made in the consultation, this time will be well spent since behaviour change itself could well occur in the near future. The method is based upon the use of a menu of strategies, with the interviewer selecting a strategy to match the degree of readiness to change of the patient. Each strategy takes 5–15 minutes to complete. Information-giving, which forms a central component, is designed as a patient-centered activity which maximizes freedom of choice for the individual. This paper contains an overview of the method and includes details of three strategies taught to trainees. It concludes with a discussion of some implications for training and health care practice.
The aim of the study was to understand the prevalence and patterns of the non-medical injecting use of buprenorphine among drug injectors in Georgia.
A self-administered questionnaire was distributed among injecting drug users enrolled in Georgian needle exchange programmes. The questions covered topics related to drug use career, patterns (frequency, history, dosage) and reasons for the use of buprenorphine.
Pharmaceutical buprenorphine in the form of Subutex was the most commonly injected drug in terms of lifetime (95.5%) and last-month (75%) prevalence of use. 48% of those study participants who had injected Subutex at some point reported having used it to cope with withdrawal or to give up other opioids. 90.5% of Subutex injectors used 1-2 mg as a single dose, and the mean frequency of its injection was 6 times per month. 75% of Subutex injectors had used 3 or more types of illegal drugs during the last 30 days.
While widely misused by Georgian drug injectors, Subutex is neither the principal nor the favourite drug, and it is rather used as self-treatment. The authors consider the introduction of buprenorphine maintenance treatment to be a promising effective measure to decrease its non-medical and illegal use.
Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s.
In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors.
Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change.
Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence.
All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To test the initial feasibility of a novel 22-week comprehensive intervention pairing behavioral treatment with naltrexone that aimed at engaging, retaining, and treating opioid-injecting men in the Republic of Georgia.
Forty opioid-injecting male and their drug-free female partners participated in a two-group randomized clinical trial at the field site of the Union Alternative Georgia, in Tbilisi, Republic of Georgia. The comprehensive intervention that paired behavioral treatment with naltrexone for the male participants (n=20) included counseling sessions using Motivational Interviewing for both the male participant and the couple, monetary incentives for drug abstinence, and research-supported detoxification followed by naltrexone treatment. Male participants in the usual care condition (n=20) had the opportunity to attend once-a-week individualized education sessions and upon request receive referrals to detoxification programs and aftercare that could or could not have included naltrexone. Outcome measures included entry into inpatient detoxification and naltrexone treatment, urine drug screening, reduction in illicit substance use, use of benzodiazepines, injection of buprenorphine, and needle and syringe sharing.
The comprehensive intervention condition showed significantly more weekly urine samples negative for illicit opioids during weeks 1-22 (7.0 vs. 1.4; p<.001) and reported significant declines in use of benzodiazepines and injection of buprenorphine (both ps<.004).
The first behavioral treatment randomized clinical trial in the Republic of Georgia found that the use of tailored behavioral therapy paired with naltrexone is both feasible and efficacious for treating drug use and reducing HIV drug-risk behavior in Georgian men.
Drug-dependent pregnant women with intimate partners who are also drug-dependent have been found to have compromised treatment outcomes. Thus, developing a treatment to reduce a male partner's drug use is the first step in a line of research with a distal goal of improving pregnant patient's treatment outcomes.
This study examined a novel intervention for engaging the male partner in drug treatment.
Men targeted for intervention were non-treatment-seeking opioid users. Motivational enhancement therapy (MET), an effective non-confrontational intervention approach for evoking behavioral change, was employed to encourage treatment participation. This six-session intervention was followed by a drug-abstinent contingency-based voucher incentive program. Moreover, to help maintain drug abstinence, male partners had rapid facilitation into either opioid detoxification with aftercare or methadone maintenance. Interwoven into treatment were both couple's counseling and a men's group educational program designed to strengthen the support provided by the men to their partners during pregnancy and post-delivery. Men (n = 45) received either the novel intervention package called HOPE (Helping Other Partners Excel) or a control condition (n = 17) that received weekly support and referrals for treatment.
Men in the HOPE condition, compared with the usual care condition, showed increased treatment retention, transient decreases in heroin use, increased involvement in recreational activities, less reliance on public assistance, and increased social support for their pregnant partners. CONCLUSION AND CLINICAL SIGNIFICANCE: Results suggest that treatment of male partners is feasible and efficacious in the short term but modifications to the intervention are needed to sustain results.
This paper describes the development and initial testing of the Treatment Services Review (TSR). The TSR is a 5-minute, technician-administered interview that provides a quantitative profile of the number and types of treatment services received by patients during alcohol and drug abuse rehabilitation. Test-retest studies indicated satisfactory reliability administered either in person or over the phone. Tests of concurrent validity showed the ability to discriminate different levels of treatment services and good correspondence with independent measures of treatment provided. While additional studies are still needed with this instrument, the data collected thus far suggest that the TSR may serve two types of needs. First, at the programmatic level, the TSR may prove useful in describing and comparing programs in terms of the nature and number of services actually delivered to patients. At the individual patient level, the TSR may offer a means of evaluating the "match" between a patient's needs and the services actually provided.
The aim of this study was to assess the efficacy of a behavioral treatment program for achieving initial cocaine abstinence in individuals enrolled in outpatient treatment for cocaine dependence.
Thirteen consecutively admitted outpatients were offered behavioral treatment consisting of contingency management procedures and the community reinforcement approach. Fifteen consecutively admitted outpatients were offered treatment with 12-step counseling. All 13 of the patients who were offered the behavioral treatment accepted it; 12 of the patients offered 12-step counseling accepted it.
Eleven of the 13 patients in the behavioral treatment were retained for 12 weeks of treatment, compared with five of the 12 patients given 12-step counseling. Ten of the patients given behavioral therapy achieved 4 weeks of continuous cocaine abstinence, compared with only three of those given 12-step counseling. Six of the patients in the behavioral treatment group achieved 8 weeks, and three achieved 12 weeks; none of the patients in the 12-step counseling program achieved 8 weeks.
The behavioral treatment described in this paper offers promise as an effective intervention for achieving initial cocaine abstinence. A randomized trial is underway to assess the generality of these findings.
The authors compared the efficacy of a multicomponent behavioral treatment and drug abuse counseling for cocaine-dependent individuals.
The 38 patients were enrolled in outpatient treatment and were randomly assigned to the two treatments. Counseling in the behavioral treatment was based on the community reinforcement approach, while the drug abuse counseling was based on the disease model of dependence and recovery. Patients in the behavioral, but not the drug counseling, treatment also received incentives contingent on submitting cocaine-free urine specimens.
Of the 19 patients who received behavioral treatment, 58% completed 24 weeks of treatment, versus 11% of the patients who received counseling. In the behavioral treatment group 68% and 42% of the patients achieved at least 8 and 16 weeks of documented continuous cocaine abstinence, respectively, versus 11% and 5% in the drug abuse counseling group.
This multicomponent behavioral treatment appears to be an effective intervention for retaining outpatients in treatment and establishing cocaine abstinence.
Motivational interviewing has been proven to increase the motivation of individuals who need to change substance abuse and other health behaviors. This article explores a descriptive model of change and describes how motivational interviewing fits in this larger context. The theoretical assumptions of motivational interviewing are described, including controversies surrounding denial and resistance in ambivalent individuals. Specific and concrete strategies are provided for occupational medicine settings and various combinations of motivational interviewing with feedback and other treatments are described.
The first case of HIV in Georgia was diagnosed in 1989. Through December 2002, a total of 375 cases of HIV infection were reported. However, the World Health Organization estimates that the true number of infections may be closer to 1700. In all, 70% of reported cases are among injection drug users. Based on the UNAIDS classification, Georgia is a 'low-level HIV country' with an HIV prevalence of less than 1% in all groups, including drug users. However, there is a high prevalence of hepatitis B and C, suggesting a significant risk for the spread of HIV. Georgia, a newly independent republic, is experiencing an increase in injection drug use, a rise in sexually transmitted infections and commercial sex trade that create a fertile soil for the potential rapid spread of HIV. However, it is also a country with a unique window of opportunity for limiting the spread of HIV.
HIV is an emerging epidemic in Eastern Europe. Most HIV infections in this region have occurred among injection drug users (IDUs) and their sexual partners. The objective of this study was to determine the seroprevalence and risk behaviors for HIV, HBV, and HCV infection among IDUs in Georgia.
Between 2000 and 2001, we studied 583 IDUs aged 18 to 46 years from 3 cities in Georgia. Tbilist, Poti, and Batumi, Structured questionnaires were administered to measure risk behaviors, including IDU, sexual, and other risks. Blood was drawn for HIV hepatitis B (HBV), and hepatitis C (HCV) serologies.
401 (68.8%) participants were seropositive for HCV; 322 (55.2%) for HBV (HBsAg or anti-HBc): and 10 (1.7%) for HIV, Heroin (58.7%) was the most frequently used drug, followed by homemade drugs (31.6%) and opium, (9.8%). In multivariate analysis, risk factors, for HCV and HBV infection included unsafe cleaning practices for injection parapheralia. The number of drug-using partners was associated with HCV infection. Sexual risk factors (i.e., the number of sex partners, paying for sex, and a history of sexually transmitted infections [STIs] were associated with HIV but not with HCV infection. Those injecting homemade drugs and optium most frequently reported risky drug-using behavior.
Our data suggest a high prevalence of HBV and HCV infection among IDUs in Georgia associated with significant drug- and needle-sharing behaviors. HIV seroprevalence appears to be relatively low and is associated with risky sexual behaviors, rather than drug-using behaviors. Further research is needed among Georgian IDUs to develop effective prevention strategies and limit the transmission of HIV in this population.
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