Drug Choice, Impulsivity, and Risky Sexual Behavior

描述（由申请人提供）：危险性行为（RSB）是全球艾滋病毒的主要原因。有证据表明，药物使用与参与RSB有关，这种关系在所选择的药物之间存在差异。事实上，一些研究人员已经证明，与使用快克/可卡因的海洛因使用者相比，使用快克/可卡因的海洛因使用者中RSB的发生率明显更高。这些研究已被解释为表明，快克/可卡因的使用是RSB的一个风险因素。然而，一个局限性是，同时使用快克/可卡因的海洛因使用者使用两种药物，而不使用快克/可卡因的海洛因使用者只使用一种药物。因此，这些研究中较高水平的快克/可卡因使用也可被概念化为另一种药物的一般叠加效应，而不一定是快克/可卡因的特定效应。事实上，对药物选择作用的真正测试需要独立的群体（例如，依赖快克/可卡因而非海洛因的个体对依赖海洛因而非快克/可卡因的个体对依赖快克/可卡因和海洛因两者的个体），以更清楚地分离所产生的差异。作为这一研究路线的第二个限制，很少有研究提供了一个明确的理论框架来解释为什么RSB水平的增加与可卡因/可卡因的使用有关。目前的应用程序将比较以下三组开始住院药物使用治疗的个人的RSB水平：a）100名依赖快克/可卡因和每月使用海洛因不超过一次的个人（涵盖治疗前6个月的时期）;和B）100名海洛因依赖者，每月使用快克/可卡因不超过一次c）100名同时依赖快克/可卡因和海洛因的人（涵盖治疗前6个月的时期）。此外，目前的研究将包括从社会行动理论和冲动性中提取的变量的理论驱动组合的调节和中介效应的检查，这些变量跨该结构的几个领域（例如，延迟折扣、行为抑制、冲动冒险），以开始发展一个更大的框架来理解药物选择和RSB。这些结果将为未来的纵向研究奠定基础，进一步评估因果关系问题，并将开始提供有关通过更好地了解RSB的风险因素来预防HIV感染的有用信息。

DESCRIPTION (provided by applicant): Risky sexual behavior (RSB) is the leading cause of HIV worldwide. Evidence suggests that drug use is related to engagement in RSB, with this relationship differing across drug of choice. Indeed, several researchers have documented that RSB is significantly more frequent in heroin users who use crack/cocaine compared to heroin users who do use crack/cocaine. These studies have been interpreted to suggest that crack/cocaine use is a risk-factor for RSB. One limitation, however, is that heroin users also using crack/cocaine are using two drugs whereas heroin users not using crack/cocaine are using only one drug. Thus, greater levels of crack/cocaine use in these studies also could be conceptualized as the additive effects of another drug in general, and not necessarily the specific effects of crack/cocaine. Indeed, a true test of the role of drug choice requires independent groups (e.g., individuals dependent on crack/cocaine and not heroin vs. individuals dependent on heroin and not crack/cocaine vs. individuals dependent on both crack/cocaine and heroin) to more clearly isolate resulting differences. As a second limitation of this line of research, few studies have provided a clearly developed theoretical framework to explain why increased levels of RSB are related to crack/cocaine use. The current application will compare level of RSB across the following three groups of individuals beginning residential drug use treatment: a) 100 individuals dependent on crack/cocaine and using heroin no more than once monthly (covering a period 6 months prior to treatment); and b) 100 individuals dependent on heroin and using crack/cocaine no more than once monthly (covering a period 6 months prior to treatment); and c) 100 individuals dependent on both crack/cocaine and heroin (covering a period 6 months prior to treatment). Further, the current study will include an examination of the moderating and mediating effects of theory-driven combinations of variables taken from Social Action Theory and impulsivity across several domains of this construct (e.g., delay discounting, behavioral inhibition, impulsive risk taking) to begin to develop a larger framework to understand drug choice and RSB. The results will set the stage for future longitudinal research further assessing issues of causality and will begin to provide useful information regarding the prevention of HIV infection through better understanding risk factors for RSB.