Drug Choice, Impulsivity, and Risky Sexual Behavior

描述（由申请人提供）：危险的性行为（RSB）是全球艾滋病毒的主要原因。有证据表明，药物使用与RSB参与有关，这种关系因药物选择而异。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更容易出现RSB。这些研究被解释为使用快克/可卡因是RSB的一个危险因素。然而，一个限制是，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，在这些研究中，高水平的快克/可卡因使用也可以被理解为一般情况下另一种药物的附加效应，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检验需要独立的群体（例如，依赖快克/可卡因而不依赖海洛因的个体vs.依赖海洛因而不依赖快克/可卡因的个体vs.既依赖快克/可卡因又依赖海洛因的个体）更清楚地分离出由此产生的差异。这一研究的第二个局限性是，很少有研究提供了一个明确的理论框架来解释为什么RSB水平的增加与快克/可卡因的使用有关。目前的申请将比较以下三组开始住院吸毒治疗的个体的RSB水平：a) 100名依赖快克/可卡因并使用海洛因不超过每月一次（治疗前6个月）的个体；b) 100名依赖海洛因和使用快克/可卡因的人每月不超过一次（治疗前6个月）；c)同时依赖快克/可卡因和海洛因的100人（治疗前6个月）。此外，目前的研究将包括对来自社会行动理论和冲动性的理论驱动的变量组合的调节和中介效应的检验，这些变量组合跨越了这个结构的几个领域（例如，延迟折扣、行为抑制、冲动性冒险），以开始建立一个更大的框架来理解药物选择和RSB。该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，并将通过更好地了解RSB的风险因素，开始提供有关预防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.