substance use and abuse

Hello gentlemen (and not-so-gentle men),

In a few weeks, I will be attending the annual meeting of the American Public Health Association.  While there, I will be presenting the first paper generated by the work that I did on the Bareback Project, focusing on substance use and abuse.  Although the poster that I will be presenting hasn't been finalized yet, I thought that I would take this opportunity to share with you some of the main findings.

Let me know your thoughts and reactions, when you've had a chance to read the following project update.

Hugh



Part 1 – Drug Use Prevalence Information


During their lifetimes, a large majority of the men taking part in the Bareback Project (85.2%) reported having used an illegal drug at least once. This is considerably greater than the comparable figure for adult men in the U.S. general population (51.3%), making participants in this study more than 5x as likely as their general population counterparts to report lifetime use of an illegal drug.

If marijuana is taken out of this equation, approximately two-thirds (68.3%) of the men participating in the Bareback Project reported lifetime use of another illegal drug. This compares with 33.6% of the men in the population-at-large.

On all major types of illegal drugs studied, the men participating in the Bareback Project were substantially more likely to report having tried the drug during their lifetimes when compared to the “typical” American male adult. Particularly noteworthy is the difference in methamphetamine use, which was nearly 12x more common among men in this study than in the general population.


Also noteworthy are the large differences in the proportion of Bareback Project men who reported recently using illegal drugs, when compared to men in the adult population. Study participants were more than 12x as likely as men in the general population to say that they used marijuana during the month prior to interview. Bareback Project men were nearly 14x as likely as the “typical” American male adult to report any illegal drug use during that time period. The differential decreased to 7x if marijuana use is taken out of the equation, but that still means that the Bareback Project men were considerably more likely to report recent drug use than their general population counterparts were.

Part 2 – Differentiating Between Men Who Did and Men Who Did Not Use Illegal Drugs


From a prevention and intervention standpoint, it is important to identify the factors that differentiate who uses illegal drugs from those who do not. For the Bareback Project, multivariate analysis identified eight characteristics that contribute uniquely and significantly to this differentiation. They are:


1. Race -- Caucasian men were 37% less likely than men belonging to other racial groups to be users of illegal drugs (p<.02).


2. Relationship status -- Men who were involved in a marital-type relationship were a little more than twice as likely as those who were not comparably "involved” to be illegal drug users (p<.03).


3. Knowing someone who had died from AIDS -- Men who knew someone who had died from AIDS-related causes were about half as likely as those who knew no such person to be a user of illegal drugs (p<.04).


4. Body mass index -- The more heavy-set a guy was, the less likely he was to be an illegal drug user (p<.002). (I’m not quite sure what to make of this particular finding, and may re-run the analysis leaving this characteristic out of the equation just to make/keep it “cleaner” intellectually.)


5. Preferred length of sexual session -- The longer guys liked their sex sessions to last, the more likely they were to be users of illegal drugs (p<.05).


6. Liking sex in public venues -- The more that men reported liking to have sex in public places, such as parks, restrooms, or bookstores, the more likely they were to be an illegal drug user (p<.04).


7. Attitudes toward condom use -- The more opposed men were to the use of condoms, the more likely they were to be illegal drug users (p<.04). (This makes sense, as it is probably indicative of a pattern of involvement in risky behaviors.)


8. Physical abuse when growing up -- The more physical abuse men experienced during their formative years, the less likely they were to become illegal drug users in adulthood (p<.02). (Most of the published studies show this to be the other way around.)





Part 3 – Understanding Greater Versus Lesser Drug Use among Illegal Drug Users


Also worthwhile from a prevention and intervention standpoint is developing an understanding of the factors that are associated with greater/lesser drug use among people who do use illegal drugs. For the Bareback Project, multivariate analysis identified six characteristics that contribute uniquely and significantly to this differentiation. They are:


1. Relationship status -- Drug users who were “involved” with someone used about half as many illegal drugs as their counterparts who were not “involved” (p<.04). (Ordinarily, we would expect this to be the other way around. But it is possible that the men who took part in this study used drugs without their partner’s knowledge, in which case the relationship would be expected to have an inhibiting effect on substance use.)


2. Overall health practices -- The better a person’s general health behaviors were (e.g., eating properly, getting a full night’s sleep, not smoking, etc.), the less he tended to use drugs (p<.02).


3. Age of first drug use -- The younger men were when they first began using drugs, the more drug use they tended to report as adults (p<.02). (This is a common research finding reported in the scientific literature.)


4. Optimism about the future -- The more optimistic drug-using men were regarding their future, the more drug use they tended to report (p<.002). (Although many people might have predicted this relationship to be in the other direction, some studies have shown optimism about the future to be predictive of greater involvement in risk. This seems to be attributable to people’s denial of potential risks/harms when they perceive a positive future to await them.)


5. Experiencing moderate or severe childhood maltreatment -- Men who had been moderately or severely maltreated during their formative years reported about half as much drug use as those who had not been maltreated or whose maltreatment was less consequential (p<.02). (This is contrary to expectations and requires careful thought to explain and interpret.)


6. HIV/AIDS knowledge -- The more knowledgeable drug users were with regard to HIV/AIDS and HIV transmission, the less drug use they typically reported (p<.04).




Part 4 – Sex while “Under the Influence”


A little more than half of the men participating in the Bareback Project (55.6%) said that, given their choice, they would prefer to have sex while under the influence of some substance(s) rather than completely sober. The large majority of these men (85.8% of them, or 47.7% of the total sample) said that they would prefer this to be an illegal drug, and the large majority of these men (94.5% of them, or 45.1% of the total sample) said that they would prefer this to be a drug “harder” than marijuana. One-quarter of the men in the study (25.1%) ranked marijuana as their first- or second-choice substance to combine with sex. This was followed by methamphetamine (15.7%), alcohol (13.9%), and ecstasy or other club drugs (12.1%).


In terms of their actual behaviors, nearly half of the men (47.1%) said that, during the month prior to interview, they had engaged in sex while under the influence of some substance at least once. Most of these men (73.7% of them, or 34.7% of the total sample) said that they recently had engaged in sex while high on an illegal drug, with a little more than half of these men (53.0% of them, or 18.4% of the total sample) indicating that this had been a drug “harder” than marijuana. During the month prior to interview, the three substances most frequently combined with sex by the men in the study were alcohol (26.9%), marijuana (23.6%), and methamphetamine (15.4%).


Coinciding with the preceding, a substantial number of the men who participated in the Bareback Project said that they preferred to have sex with other men who were “under the influence” of something (45.1%), with the overwhelming majority of these men (97.8% of them, or 44.1% of the total sample) specifying a preference for their partner to be high on some type of illegal drug. Indeed, nearly half of the men in the study (41.1%) said that their preference would be for both they themselves and their sex partner(s) to be high during sex. Most of these men (72.7% of them, or 29.9% of the total sample) said that their preference would be for both they themselves and their sex partner(s) to be high on some type of illegal drug during sex.

Multivariate analysis revealed five factors that are related significantly and uniquely to the determination of whether or not men recently engaged in sex while under the influence of some type(s) of drug(s). These were:


1. Body mass index -- The more heavy-set sexually active men were, the less likely they were to have sex while high on alcohol and/or other drugs (p<.0006).


2. Preference for “wild” or “uninhibited” sex -- The more that men said that they preferred their sexual sessions to be “wild” or “uninhibited,” the more likely they were to report having sex while under the influence (p<.0001).


3. Perceived accuracy of HIV information provided in discussion -- The more accurate men perceived their partners to be when discussing their HIV serostatus with them, the more likely they were to engage in sexual relations while under the influence of alcohol and/or other drugs (p<.008).


4. Impulsivity -- The more impulsive men were in general, the more likely they were to report recently having had sex while drunk and/or high (p<.0002).


5. Emotional neglect during formative years -- The more emotional neglect men experienced during their formative years, the less likely they were to report having recently had sex while under the influence of alcohol and/or other drugs (p<.02). (Most of the published studies report this elationship to be in the other direction. Further thought is needed to explain this finding and to put it into its proper context.)