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The Interaction of Active Substance Use, Depression, and Antiretroviral Adherence in Methadone Maintenance

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Abstract

Background

Adherence to highly active antiretroviral therapy (HAART) remains crucial in successfully treating HIV. While active substance use and depression are both associated with each other and with HAART nonadherence, little is known about their interaction. An understanding of the interaction of substance use and depressive symptoms on HAART adherence can inform adherence-enhancing interventions as well as interventions that target substance use and depression.

Purpose

We tested an interaction between substance use and depression on HAART adherence among methadone maintenance patients.

Method

We assessed substance use, depressive symptoms, and HAART adherence among 100 HIV-infected individuals receiving methadone maintenance in The Bronx, New York. Regressions were performed on adherence using an interaction term comprised of substance use and depressive symptoms. MODPROBE was used to assess significant interactions.

Results

Any use of illicit substances was associated with HAART nonadherence (p = 0.043). Cannabis was the single substance of abuse most strongly associated with nonadherence (p = 0.003). Depressive symptoms approached significance in bivariate analysis (p = 0.066). In regression analysis, a significant interaction was found between illicit substance use and depressive symptoms [OR (95 % CI) 1.23 (1.06–1.44), p = 0.007], where illicit substance use was associated with nonadherence in individuals with lower depressive symptoms, but not among those with depressive symptoms at higher levels. No individual substances interacted with depressive symptoms on adherence.

Conclusion

Though substance use and depressive symptoms interacted on HAART adherence, they did not have a synergistic effect. Continued substance use (51 % of the sample) suggests an unmet need for treatment, even in methadone maintenance. Further examinations of the interplay of substance use and depression on HAART adherence are warranted.

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Acknowledgments

This work was supported by the National Institute of Drug Abuse (F32 DA032446 and P50 DA09253).

Conflict of Interest

The authors report no competing financial interests.

Disclaimer

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. The authors (Howard Newville, Karina Berg, and Jeffrey Gonzalez) declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Health, Mount Sinai St. Luke’s, New York, NY, USA

    Howard Newville

  2. University of Connecticut Health Center, Farmington, CT, USA

    Karina M. Berg

  3. Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA

    Jeffrey S. Gonzalez

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  1. Howard Newville
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  2. Karina M. Berg
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  3. Jeffrey S. Gonzalez
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Correspondence to Howard Newville.

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Newville, H., Berg, K.M. & Gonzalez, J.S. The Interaction of Active Substance Use, Depression, and Antiretroviral Adherence in Methadone Maintenance. Int.J. Behav. Med. 22, 214–222 (2015). https://doi.org/10.1007/s12529-014-9429-z

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