HIV/AIDS risk reduction through treatment of cocaine-dependent methadone patients: A multiaxial intervention

Peter Andrew Courtnage (1991)

In the United States methadone maintained patients with concomitant cocaine dependence represent a major vector of human immunodeficiency virus (HIV)-contagion transmission, HIV-seroconversion, and/or acquired immune deficiency syndrome (AIDS). The present study utilized 40 cocaine dependent military veterans, on an average dosage of 49 milligrams of methadone, who were being treated in an urban outpatient clinic. All subjects were male, with a mean age of 42; 42 percent of whom were Afro-Americans; 33 percent of whom were HIV-seropositive and/or diagnosed with AIDS. In order to test the effectiveness of cocaine-use reduction, subjects were randomly assigned to one of four groups: Detox Acupuncture-alone, Detox Acupuncture and Psychoeducation-combined, Psychoeducation-alone, or to a no-treatment Control Group. Behavioral indices and changes were monitored at the inception of the study, and at three month and six month intervals. Instruments utilized were the Addiction Severity Index (ASI), the Cocaine Experience Inventory (CEI), and the HIV/AIDS-Risk Inventory (HARI). In addition, enzyme multiplied immunology tests (EMIT) and thin-layered chromotography (TLC) analyses of urine samples were employed as biological monitoring measures. Utilizing chi-square analyses, levels of significance were noted in the experimental groups' complete cessation of cocaine use (p $\le$.05). Utilizing Tukey and Scheffe multimean comparison tests, levels of significance were also noted between the rates at which subjects in the Detox Acupuncture-alone Group and the Detox Acupuncture and Psychoeducation-combined Group reduced their mean days of cocaine use versus the cocaine reduction rate of the Control Group (p $\le$.01). Qualitative differences were also noted between groups, with subjects assigned to the Detox Acupuncture and Psychoeducation-combined Group making the most extensive use of detox acupuncture and independently practicing and developing skills acquired in the psychoeducation curriculum. This study calls into question the effectiveness of psychological interventions, by themselves, while demonstrating the effectiveness of detox acupuncture alone and/or in conjunction with psychoeducation, in reducing the cocaine dependence of methadone-maintained subjects. Further studies, utilizing larger samples, longer follow-up, and periodic booster sessions, are needed to confirm the results of this study.