Novel Intervention for Drug Use and HIV Risk among Anxiety Sensitive Heroin Users

超过850，000名美国人目前患有艾滋病，估计有40，000人继续感染艾滋病毒 （CDC，2004）。生活在城市和贫困地区的少数民族注射者 使用海洛因特别容易感染艾滋病毒（Chitwood等人，2000; De Rossi et al.，1988年; SAMHSA， 2003年）。这些发现表明，开发治疗方法的重要性在于帮助个人实现 戒除注射海洛因，特别是在市中心少数民族人口中。然而，内城 少数群体不太可能获得长期的物质使用治疗（伯恩斯坦等人，2005年），以及 在住院治疗中心内，注射治疗中药物使用的辍学和复发的可能性 海洛因使用者高得惊人（Manu等人，1994年）。因此，需要进行有针对性的简短干预 可作为药物使用治疗的辅助手段， 和复吸药物，减少进一步注射吸毒和艾滋病毒感染或传播的风险。 从当代心理脆弱性模型（巴洛，2002年）的建设，有概念和 探索反映对厌恶事件超敏反应的认知因素， 更好地了解导致海洛因戒毒和复吸的因素 用户（Brown等人，2005年）。其中一个有希望的认知脆弱性是焦虑敏感性（AS）。AS，a 相对稳定的个体差异特征，代表恐惧焦虑相关症状的倾向 由于相信这些症状会产生负面影响（Reiss，1991），最近已将其与 海洛因使用（Lejuez et al.，2006年），并已发现显着和独特的预测治疗脱落 在海洛因使用者中（Lejuez等人，2007年）。我们的团队随后开发了一个基于 针对患有AS-焦虑症的市中心海洛因使用者专门定制的个人干预 海洛因使用者的敏感性治疗（ASTH; Tull等人，2007年）。试验数据表明， 治疗患者证明减少AS和海洛因的渴望。此外，如果治疗成功， 通过性接触增加艾滋病毒感染风险的可能性是违反直觉的， 海洛因使用和/或焦虑。因此，我们建议采用ASTH与 健康的关系（HR; Kalichman et al.，2001年），旨在预防高风险的有针对性的干预措施 性行为目前，联合干预（ASTH+HR）的结构旨在降低艾滋病毒风险 通过（a）通过减少AS促进海洛因戒断，和（B）防止参与 危险的性行为，使用社会认知方法，旨在增加一个人的理解， 人际关系/亲密关系以及这些关系中危险性行为的可能性， 通过技能建设，帮助个人更有效地科普这些情况并保持性安全。我们 还收集了试点数据，以确定这种联合干预的安全性，可行性和可接受性。的 本提案的目的是提供一项为期两年的1b期随机对照试验，纳入60名患者 接受标准住宅物质使用治疗，比较ASTH与来自 改良的健康关系（HR;旨在减少危险性行为的简短干预; Kalichman et ，2001年）到非指导性治疗（NT+HR），重点是治疗脱落的物质使用结果 住院治疗和住院治疗后3个月内复发，以及 在此期间，参与艾滋病毒风险行为，包括注射毒品和危险的性行为。

More than 850,000 Americans are currently living with AIDS and an estimated 40,000 continue to contract HIV each year (CDC, 2004). Minority individuals living in urban and poverty-stricken areas who engage in injection heroin use are particularly at risk for HIV infection (Chitwood et aI., 2000; De Rossi et aI., 1988; SAMHSA, 2003). These findings suggest the importance of developing treatments focused on helping individuals achieve abstinence from injection heroin use, especially within inner-city minority popUlations. However, inner-city minorities are less likely to have access to longer-term substance use treatment (Bernstein et aI., 2005), and within residential treatment centers, the likelihood of drop-out and relapse to substance use among injection heroin users is strikingly high (Manu et aI., 1994). Therefore, there is a need for targeted, brief interventions that can be conducted as an adjunct to substance use treatment to reduce vulnerability for treatment drop-out and relapse to substance use, reducing risk for further injection drug use and HIV infection or transmission. Building from contemporary models of psychological vulnerability (Barlow, 2002), there is conceptual and robust empirical reason to explore cognitive factors reflecting a hypersensitivity to aversive events in order to better understand the factors that contribute to treatment dropout and relapse to substance use among heroin users (Brown et aI., 2005). One such cognitive vulnerability that holds promise is anxiety sensitivity (AS). AS, a relative stable individual difference characteristic representing the tendency to fear anxiety-related symptoms due to the belief that these symptoms will have negative consequences (Reiss, 1991), has recently been linked to heroin use (Lejuez et aI., 2006) and has been found to significantly and uniquely predict treatment drop-out among heroin users (Lejuez et aI., 2007). Our group has subsequently developed an exposure-based individual intervention specifically tailored to inner-city heroin users with heightened AS - the Anxiety Sensitivity Treatment for Heroin Users (ASTH; Tull et aI., 2007). Pilot data indicate the feasibility of the treatment with patients evidencing reduced AS and heroin cravings. Additionally, if the treatment is successful, there is a counterintuitive potential for increased HIV risk through sexual contact resulting from a reduction in heroin use and/or anxiety. Therefore, we propose to utilize an integrated treatment combining ASTH with Healthy Relationships (HR; Kalichman et aI., 2001), a targeted intervention designed to prevent high risk sexual behavior. The combined intervention (ASTH+HR) is now structured to reduce risk for HIV infection/transmission by (a) promoting heroin abstinence by reducing AS, and (b) preventing engagement in risky sexual behaviors using a social cognitive approach aimed at increasing one's understanding of interpersonal/intimate relationships and potential for risky sexual behaviors in those relationships, combined with skill building to help the individual more effectively cope and remain sexually safe in those situations. We also collected pilot data to establish the safety, feasibility, and acceptability of this combined intervention. The objective of the present proposal is to provide a two year Stage 1b randomized control trial of 60 patients receiving standard residential substance use treatment comparing ASTH combined with modules from a modified Healthy Relationships (HR; a brief intervention designed to reduce risky sex behaviors; Kalichman et aI., 2001) to nondirective therapy (NT+HR), with a focus on the substance use outcomes of treatment drop-out from the residential treatment and relapse following the residential treatment across 3 months, as well as engagement in HIV-risk behaviors including injection drug use and risky sexual behavior across this period.