AIDS and Behavior

, Volume 21, Issue 4, pp 1138–1148 | Cite as

Prevalence and Predictors of Substance Use Disorders Among HIV Care Enrollees in the United States

  • Bryan Hartzler
  • Julia C. Dombrowski
  • Heidi M. Crane
  • Joseph J. Eron
  • Elvin H. Geng
  • W. Christopher Mathews
  • Kenneth H. Mayer
  • Richard D. Moore
  • Michael J. Mugavero
  • Sonia Napravnik
  • Benigno Rodriguez
  • Dennis M. Donovan
Original Paper

Abstract

Prior efforts to estimate U.S. prevalence of substance use disorders (SUDs) in HIV care have been undermined by caveats common to single-site trials. The current work reports on a cohort of 10,652 HIV-positive adults linked to care at seven sites, with available patient data including geography, demography, and risk factor indices, and with substance-specific SUDs identified via self-report instruments with validated diagnostic thresholds. Generalized estimating equations also tested patient indices as SUD predictors. Findings were: (1) a 48 % SUD prevalence rate (between-site range of 21–71 %), with 20 % of the sample evidencing polysubstance use disorder; (2) substance-specific SUD rates of 31 % for marijuana, 19 % alcohol, 13 % methamphetamine, 11 % cocaine, and 4 % opiate; and (3) emergence of younger age and male gender as robust SUD predictors. Findings suggest high rates at which SUDs occur among patients at these urban HIV care sites, detail substance-specific SUD rates, and identify at-risk patient subgroups.

Keywords

HIV care settings Substance use disorders Patient demography United States 

Resumen

Los esfuerzos previos para estimar la prevalencia de los trastornos por uso de sustancias (TUS) de Estados Unidos en la atención del VIH han sido socavados por los problemas comunes de la investigación realizada en un solo sitio. Este documento informa sobre un estudio de una cohorte de 10,652 adultos con VIH que reciben atención en siete sitios, con los datos del paciente disponibles sobre la geografía, la demografía y los índices de factores de riesgo, y con trastornos por uso de sustancias para sustancias específicas identificadas con los instrumentos de autoinforme con umbrales de diagnóstico que han sido validado. Ecuaciones de estimación generalizadas también evaluaron los índices de pacientes como predictores de TUS. Los resultados fueron: 1) una tasa de prevalencia de TUS de 47 % (entre-ubicación gama de 21 a 71 %), con 20 % de la muestra que demuestra un trastorno que implica múltiples sustancias; 2) las tasas SUD por sustancia específica de 31 % para la marihuana, 19 % para el alcohol, 13 % de la metanfetamina, 11 % de la cocaína, y 4 % de los opiáceos; y 3) el surgimiento de menor edad y el sexo masculino como predictores robustos de los trastornos por uso de sustancias. Los resultados sugieren que los pacientes en las clínicas urbanas VIH tienen altas tasas de TUS, describen las tasas de sustancias específicas, e identifican subgrupos de pacientes en situación de riesgo.

References

  1. 1.
    Moore RD, Bartlett JG. Dramatic decline in the HIV-1 RNA level over calendar time in a large urban HIV practice. Clin Infect Dis. 2011;53:600–4.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Althoff KN, Buchacz K, Hall HI, et al. U.S. trends in antiretroviral therapy use, HIV RNA plasma viral loads, and CD4 T-lymphocyte cell counts among HIV-infected persons. Ann Intern Med. 2012;157:325–35.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Gardner EM, McLees MP, Steiner JF, del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52(6):793–800.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mugavero MJ, Amico KR, Horn T, Thompson MA. The state of engagement in HIV care in the United States: from cascade to continuum to control. Clin Infect Dis. 2013;57(8):1164–71.CrossRefPubMedGoogle Scholar
  5. 5.
    McLellan AT, Woodworth AM. The affordable care act and treatment for ‘substance use disorders’: implications of ending segregated behavioral healthcare. J Subst Abuse Treat. 2014;46:541–5.CrossRefPubMedGoogle Scholar
  6. 6.
    McCance-Katz EF, Rabiner CA, Rivers JLA. The affordable care act: implementation and implications for addiction specialty care. The American Journal on Addictions. 2014;23:429–30.CrossRefPubMedGoogle Scholar
  7. 7.
    Denis CM, Gelernter J, Hart AB, Kranzler HR. Inter-observer reliability of DSM-5 substance use disorders. Drug Alcohol Depend. 2015;153:229–35.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17:1632–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Dieffenbach WW, Fauci AS. Universal voluntary testing and treatment for prevention of HIV transmission. JAMA. 2009;301:2380–2.CrossRefPubMedGoogle Scholar
  10. 10.
    Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: A mathematical model. Lancet. 2009;373:48–57.CrossRefPubMedGoogle Scholar
  11. 11.
    Giordano TP, Visnegarwala F, White ACJ, Troisi CL, Frankowski RF, Hartman CM, et al. Patients referred to an urban HIV clinic frequently fail to establish care: Factors predicting failure. AIDS Care. 2005;17(6):773–83.CrossRefPubMedGoogle Scholar
  12. 12.
    Meyer JP, Althoff AL, Altice FL. Optimizing care for HIV-infected people who use drugs: evidcence-based approaches to overcoming healthcare disparities. Clin Infect Dis. 2013;57(9):1309–17.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    DeLorenze GN, Weisner C, Tsai AL, Satre DD, Quesenberry CP Jr. Excess mortality among HIV-infected patients diagnosed with substance use dependence or abuse receiving care in a fully integrated medical care program. Alcohol Clin Exp Res. 2011;35(2):203–10.CrossRefPubMedGoogle Scholar
  14. 14.
    Arnsten JH, Demas PA, Grant RW, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17(5):377–81.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Chander G, Lau B, Moore RD. Hazardous alcohol use: a risk factor for non-adherence and lack of suppression in HIV infection. J Acquir Immune Defic Syndr. 2006;43(4):411–7.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Reback CJ, Larkins S, Shoptaw S. Methamphetamine abuse as a barrier to HIV medication adherence among gay and bisexual men. AIDS Care. 2003;15(6):775–85.CrossRefPubMedGoogle Scholar
  17. 17.
    Pence BW, Miller WC, Gaynes BN, Eron JJ Jr. Psychiatric illness and virologic response in patients initiating highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2007;44(2):159–66.CrossRefPubMedGoogle Scholar
  18. 18.
    King WD, Larkins S, Hucks-Ortiz C, et al. Factors associated with HIV viral load in a respondent driven sample in Los Angelos. AIDS Behav. 2009;13(1):145–53.CrossRefPubMedGoogle Scholar
  19. 19.
    Giordano TP, Gifford AL, White ACJ, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44:1493–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Torian LV, Wiewel EW. Continuity of HIV-related medical care, New York City, 2005–2009: do patients who initiate care stay in care? AIDS, Patient Care, STDs. 2011;25:79–88.CrossRefGoogle Scholar
  21. 21.
    Hall HI, Gray KM, Tang T, Li J, Shouse L, Mermin J. Retention in care of adults and adolescents living with HIV in 13 U.S. areas. J Acquir Immune Defic Syndr. 2012;60:77–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Rebeiro P, Althoff KN, Buchacz K, Gill J, Horberg M, Krentz H, et al. Retention among North American HIV-infected persons in clinical care, 2000–20008. J Acquir Immune Defic Syndr. 2013;62(3):356–62.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Werb D, Mills EJ, Montaner JS, Wood E. Risk of resistance to highly active antiretroviral therapy among HIV-positive injecting drug users: a meta-analysis. Lancet Infect Dis. 2010;10:464–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Malta M, Strathdee SA, Magnanini MM, Bastos FI. Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction. 2008;103:1242–57.CrossRefPubMedGoogle Scholar
  25. 25.
    Roux P, Carrieri MP, Cohen J, Ravaux I, Poizot-Martin I, Dellamonica P, et al. Retention in opioid substitution treatment: a major predictor of long-term virological success for HIV-infected injection drug users receiving antiretroviral treatment. Clin Infect Dis. 2009;49(9):1433–40.CrossRefPubMedGoogle Scholar
  26. 26.
    Malee KM, Mellins CA, Huo Y, Tassiopoulos K, Smith R, Sirois PA, et al. Prevalence, incidence, and persistence of psychiatric and substance use disorders among mothers living with HIV. J Acquir Immune Defic Syndr. 2014;65(5):526–34.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Rabkin JG, McElhinney MC, Ferrando SJ. Mood and substance use disorders in older adults with HIV/AIDS: Methodological issues and preliminary evidence. AIDS. 2004;18(Supplement #1):S43–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Rosenberg SD, Drake RE, Brunette MF, Wolford GL, Marsh BJ. Hepatitis C virus and HIV co-infection in people with severe mental illness and substance use disorders. AIDS. 2005;19(Supplement #3):S26–33.CrossRefPubMedGoogle Scholar
  29. 29.
    Gaynes BN, Pence BW, Erron JJ, Miller WC. Prevalence and comorbidity of psychiatric diagnoses based on reference standard in an HIV+ patient population. Psychosom Med. 2008;70(4):505–11.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Pence BW, Miller WC, Whetten K, Erron JJ, Gaynes BN. Prevalence of DSM-IV-defined mood, anxiety, and substance use disorders in an HIV clinic in the southeastern United Staes. J Acquir Immune Defic Syndr. 2006;42(3):298–306.CrossRefPubMedGoogle Scholar
  31. 31.
    Atkinson JH, Grant I, Kennedy CJ, Richman DD, Spector SA, McCutchan JA. Prevalence of psychiatric disorders among men infected with human immunodeficiency virus: a controlled study. Arch Gen Psychiatry. 1988;45:859–64.CrossRefPubMedGoogle Scholar
  32. 32.
    Dew MA, Becker JT, Sanchez J, Caldararo R, Lopez OL, Wess J, et al. Prevalence and predictors of depressive, anxiety, and substance use disorders in HIV-infected and uninfected men: a longitudinal evaluation. Psychol Med. 1997;27:395–409.CrossRefPubMedGoogle Scholar
  33. 33.
    Perry S, Jacobsberg LB, Fishman B, Frances A, Bobo J, Jacobsberg BK. Psychiatric diagnosis before serological testing for the human immunodeficiency virus. Am J Psychiatry. 1990;147:89–93.CrossRefPubMedGoogle Scholar
  34. 34.
    Catalan J, Klimes I, Bond A, Day A, Garrod A, Rizza C. The psychosocial impact of HIV infection in men with haemophilia: controlled investigation and factors associated with psychiatric morbidity. J Psychosom Res. 1992;36:409–16.CrossRefPubMedGoogle Scholar
  35. 35.
    Catalan J, Klimes I, Day A, Garrod A, Bond A, Gallwey J. The psychosocial impact of HIV infection in gay men: a controlled investigation and factors associated with psychiatric morbidity. Br J Psychiatry. 1992;161:774–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Chuang HT, Jason GW, Pajurkova EM, Gill MJ. Psychiatric morbidity in patients with HIV infection. Can J Psychiatry. 1992;37:109–15.PubMedGoogle Scholar
  37. 37.
    Williams JB, Rabkin JG, Remien RH, Gorman JM, Ehrhardt A. Multidisciplinary baseline assessment of homosexual mena with and without human immunodeficiency virus infection: standardized clinical assessment of current and lifetime psychopathology. Arch Gen Psychiatry. 1991;48:124–30.CrossRefPubMedGoogle Scholar
  38. 38.
    Brown GR, Rundell JR, McManis SE, Kendall SN, Zachary R, Temoshok L. Prevalence of psychiatric disorders in early stages of HIV infection. Psychosom Med. 1992;54:588–601.CrossRefPubMedGoogle Scholar
  39. 39.
    Lipsitz JD, Williams JB, Rabkin JG, Remien RH, Bradbury M, el Sadr W, et al. Psychopathology in male and female intravenous drug users with and without HIV infection. Am J Psychiatry. 1994;151:1662–8.CrossRefPubMedGoogle Scholar
  40. 40.
    Rosenberger PH, Bornstein RA, Nasrallah HA, Para MF, Whitacre CC, Fass RJ, et al. Psychopathology in human immunodeficiency virus infection: lifetime and current assessment. Compr Psychiatry. 1993;34:150–8.CrossRefPubMedGoogle Scholar
  41. 41.
    Maj M, Strarace F, Sartorius N. Mental disorders in HIV-I infection and AIDS. In: Sartorius N, Prilipko LL, editors. WHO expert series on biological psychiatry. Seattle: Hogrefe & Huber Publishers; 1993.Google Scholar
  42. 42.
    Lyketsos CG, McHugh PR, Hanson A, Treisman GJ, Fishman M. Screening for psychiatric morbidity in a medical outpatient clinic for HIV infection: the need for a psychiatric presence. Int J Psychiatry Med. 1994;24:103–13.CrossRefPubMedGoogle Scholar
  43. 43.
    Bix BC, Glosser G, Holmes W, Ballas C, Meritz M, Hutelmeyer C, et al. Relationship between psychiatric disease and neurological impairment in HIV seropositive individuals. J Int Neuropsychol Soc. 1995;1:581–8.CrossRefPubMedGoogle Scholar
  44. 44.
    Johnson JG, Williams JB, Rabkin JG, Goetz R, Remien RH. Axis I psychiatric symptoms associated with HIV infection and personality disorder. Am J Psychiatry. 1995;152:551–4.CrossRefPubMedGoogle Scholar
  45. 45.
    Summers J, Zisook S, Atkinson JH, Sciolla A, Whitehall W, Brown S, et al. Psychiatric morbidity associated with acquired immune deficiency syndrome-related grief resolution. J Nerv Ment Dis. 1995;183:384–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Sohler NL, Wong MD, Cunningham WE, Cabral H, Drainoni ML, Cunningham CO. Type and pattern of illicit drug use and access to health care services for HIV-infected people. AIDS Patient Care STDs. 2007;21(Supplement 1):S68–76.PubMedGoogle Scholar
  47. 47.
    Rondinelli AJ, Ouellet LJ, Strathdee SA, Latka MH, Hudson SM, Hagan H, et al. Young adult injection drug users in the United States continue to practice HIV risk behaviors. Drug Alcohol Depend. 2009;104(1–2):167–74.CrossRefPubMedGoogle Scholar
  48. 48.
    Engstrom M, Shibusawa T, El-Bassel N, Gilbert L. Age and HIV sexual risk among women in methadone treatment. AIDS Behav. 2011;15(1):103–13.CrossRefPubMedGoogle Scholar
  49. 49.
    Strathdee SA, Sherman SG. The role of sexual transmission of HIV infection among injection and non-injection drug users. J Urban Health. 2003;80(Supplement 3):iii7–14.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Mimiaga MJ, Reisner SL, Grasso C, Crane HM, Safren SA, Kitahata MM, et al. Substance use among HIV-infected patients engaged in primary care in the United States: findings from the Centers for AIDS research network of integrated clinical systems cohort. Am J Public Health. 2013;103(8):1457–67.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Bing EG, Burnam MA, Longshore D, et al. Psychiatric disorders and drug use among human immmunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry. 2001;58(8):721–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Galvan FH, Bing EG, Fleishman JA, et al. The prevalence of alcohol consumption and heavy drinking among people with HIV in the United States: results from the HIV cost and services utilization study. J Stud Alcohol. 2002;63(2):179–86.CrossRefPubMedGoogle Scholar
  53. 53.
    Grant BF, Goldstein RB, Saha TD, Chou C, Jung J, Zhang H, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72(8):757–66.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Grant BF, Saha TD, Ruan WJ, Goldstein RB, Chou SP, Jung J, et al. Epidemiology of DSM-5 drug use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2016;73(1):39–47.CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Kitahata MM, Rodriquez B, Haubrick R, Boswell S, Mathews WC, Lederman MM, et al. Cohort profile: The Centers for AIDS Research Network of Integrated Clinical Systems. Int J Epidemiol. 2008;37:948–55.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Hughes MD. Initial treatment of HIV infection: randomized trials with clinical endpoints are still needed. J Infect Dis. 2006;194:542–4.CrossRefPubMedGoogle Scholar
  57. 57.
    Dombrowski JC, Kitahata MM, Von Rompaey SE, Crane HM, Mugavero MJ, Eron JJ Jr, et al. High levels of antiretroviral use and viral suppression among persons in HIV care in the United States, 2010. JAIDS. 2013;63(3):299–306.PubMedPubMedCentralGoogle Scholar
  58. 58.
    Humeniuk R, Ali R, Babor TF, Farrell M, Formigoni ML, Jittiwuikarn J, et al. Validation of the alcohol, smoking, and substance involvement screening test (ASSIST). Addiction. 2008;103(6):1039–47.CrossRefPubMedGoogle Scholar
  59. 59.
    Dawson DA, Smith SM, Saha TD, Rubinsky AD, Grant BF. Comparative performance of the AUDIT-C in screening for DSM-IV and DSM-5 alcohol use disorders. Drug Alcohol Depend. 2012;126:384–8.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, et al. To GEE or not to GEE: Comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology. 2010;21:467–74.CrossRefPubMedGoogle Scholar
  61. 61.
    Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering RP, Smith SM, et al. Prevalence and correlates of DSM-5 cannabis use disorder, 2012–2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Am J Psychiatry. 2016;173(6):588–99.CrossRefPubMedGoogle Scholar
  62. 62.
    Grucza RA, Agrawal A, Krauss MJ, Cavazos-Rehg PA, Bierut LJ. Recent trends in the prevalence of marijuana use and associated disorders in the United States. JAMA Psychiatry. 2016;73(3):300–1.CrossRefPubMedGoogle Scholar
  63. 63.
    Reif S, Pence BW, Hall I, Hu X, Whetten K, Wilson E. HIV diagnoses, prevalence, and outcomes in nine southern states. J Community Health. 2015;40(4):642–51.CrossRefPubMedGoogle Scholar
  64. 64.
    Cima M, Parker RD, Ahmed Y, Cook S, Dykema S, Dukes K, et al. Cause of death in HIV-infected patients in South Carolina (2005–2013). Int J STD AIDS. 2016;27(1):25–32.CrossRefPubMedGoogle Scholar
  65. 65.
    Schwarcz SK, Vu A, Hsu LC, Hessol NA. Changes in causes of death among persons with AIDS: San Francisco, California, 1996–2011. AIDS Patient Care STDs. 2014;28(10):517–23.CrossRefPubMedGoogle Scholar
  66. 66.
    Remien RH, Goetz R, Rabkin JG, Williams JB, Bradbury M, Ehrhardt A, et al. Remission of substance use disorders: gay men in the first decade of AIDS. J Stud Alcohol. 1995;56:226–32.CrossRefPubMedGoogle Scholar
  67. 67.
    Santos GM, Do T, Beck J, Makofane K, Arreola S, Pyun T, et al. Syndemic conditions associated with HIV risk in a global sample of men who have sex with men. Sex Transm Dis. 2014;90(3):250–3.CrossRefGoogle Scholar
  68. 68.
    CNICS. CFAR Network of Integrated Clinical Systems. University of Alabama-Birmingham; 2016 [cited 16 May 2016]. www.uab.edu/cnics.
  69. 69.
    Oldenburg CE, Perez-Brumer AG, Reisner SL. Poverty matters: contextualizing the syndemic condition of psychological factors and newly diagnosed HIV infection in the United States. AIDS. 2014;28(18):2763–9.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009;63:636–40.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Kalichman SC, Sikkema KJ, DiFonzo K, Luke W, Austin J. Emotional adjustment in survivors of sexual assault living with HIV-AIDS. J Trauma Stress. 2002;15(4):286–96.CrossRefGoogle Scholar
  72. 72.
    Parsons JT, Rosof E, Punzalan JC, Di Maria L. Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project. AIDS Patient Care STDs. 2005;19(1):31–9.CrossRefPubMedGoogle Scholar
  73. 73.
    Safren SA, O’Cleirigh CM, Bullis JR, Otto MW, Stein MD, Pollack MH. Cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected injection drug users: a randomized controlled trial. J Consult Clin Psychol. 2012;80(3):404–15.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Petry NM, Weinstock J, Alessi SM, Lewis MW, Dieckhaus K. Group-based randomized trial of contingencies for health and abstinence in HIV patients. J Consult Clin Psychol. 2010;78(1):89–97.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Rosen MI, Dieckhaus K, McMahon TJ, Valdes B, Petry N, Cramer JA, et al. Improved adherence with contingency management. AIDS Patient Care STDs. 2007;21(1):30–40.CrossRefPubMedGoogle Scholar
  76. 76.
    Diiorio C, McCarty F, Resnicow K, McDonnell-Holstad M, Soet J, Yeager K, et al. Using motivational interviewing to promote adherence to antiretroviral medications: a randomized controlled study. AIDS Care. 2008;20(3):273–83.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Williams AB, Fennie KP, Bova CA, Burgess JD, Danvers KA, Dieckhaus K. Home visits to improve adherence to highly active antiretroviral therapy: A randomized controlled trial. JAIDS. 2006;42(3):314–21.PubMedGoogle Scholar
  78. 78.
    NIDA. Principles of drug addiction treatment: A research-based guide (3rd ed.). Services USDoHaH, editor2012.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Bryan Hartzler
    • 1
  • Julia C. Dombrowski
    • 2
  • Heidi M. Crane
    • 2
  • Joseph J. Eron
    • 3
    • 4
  • Elvin H. Geng
    • 5
  • W. Christopher Mathews
    • 6
  • Kenneth H. Mayer
    • 7
    • 8
  • Richard D. Moore
    • 9
    • 10
    • 11
  • Michael J. Mugavero
    • 12
  • Sonia Napravnik
    • 3
  • Benigno Rodriguez
    • 13
  • Dennis M. Donovan
    • 1
    • 14
  1. 1.Alcohol & Drug Abuse InstituteUniversity of WashingtonSeattleUSA
  2. 2.Division of Allergy and Infectious DiseaseUniversity of WashingtonSeattleUSA
  3. 3.Department of MedicineUniversity of North CarolinaChapel HillUSA
  4. 4.Department of EpidemiologyUniversity of North CarolinaChapel HillUSA
  5. 5.School of MedicineUniversity of CaliforniaSan FranciscoUSA
  6. 6.Department of MedicineUniversity of CaliforniaSan DiegoUSA
  7. 7.School of MedicineHarvard UniversityBostonUSA
  8. 8.School of Public HealthHarvard UniversityBostonUSA
  9. 9.Department of MedicineJohns Hopkins UniversityBaltimoreUSA
  10. 10.Department of EpidemiologyJohns Hopkins UniversityBaltimoreUSA
  11. 11.Center for Global HealthJohns Hopkins UniversityBaltimoreUSA
  12. 12.Department of MedicineUniversity of AlabamaBirminghamUK
  13. 13.Department of MedicineCase Western Reserve UniversityClevelandUSA
  14. 14.Psychiatry and Behavioral SciencesUniversity of WashingtonSeattleUSA

Personalised recommendations