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Nicotine dependence and HIV risk behaviors among illicit drug users
Addictive Behaviors 29 (2004) 623 – 625
Short communication
Nicotine dependence and HIV risk behaviors among illicit drug users Scott L. Hershberger*, Dennis G. Fisher, Grace L. Reynolds, Jennifer A. Klahn, Michele M. Wood Department of Psychology, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA
Abstract This study was concerned with examining the relation between nicotine dependence and HIV risk behaviors in a sample of 297 out-of-treatment drug users. A number of significant relationships were found between nicotine dependence and HIV risk behaviors. Crack-smoking injectors were found to have a higher degree of nicotine dependence when compared with exclusive injectors or exclusive crack smokers. Participants’ impulsivity may be one possible reason why nicotine dependence is related to HIV risk behaviors. The results also suggest that drug abuse programs make available smoking cessation programs. D 2003 Elsevier Ltd. All rights reserved. Keywords: HIV; Nicotine dependence; Smoking
1. Introduction Cigarette smoking and the use of illicit drugs appear to go hand in hand. Analysis of data from the 1994 National Household Survey on Drug Abuse showed that individuals who reported having smoked cigarettes were more likely to use cocaine, heroin, crack, and marijuana than those who had not smoked, thus suggesting a gateway relationship between cigarettes and illicit drugs (Lai, Lai, Page, & McCoy, 2000). Among individuals in drug treatment, a majority smoke cigarettes (Boyd & Pohl, 1996; Campbell, Wander, Stark, & * Corresponding author. Tel.: +1-562-985-5001. E-mail address: [email protected] (S.L. Hershberger). 0306-4603/$ – see front matter D 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2003.08.016
624
S.L. Hershberger et al. / Addictive Behaviors 29 (2004) 623–625
Holbert, 1995; DiFranza & Guerrera, 1990). Despite the potential usefulness of providing smoking cessation programs to illicit drug users, treatment providers are often reluctant to offer these programs to these clients. Myths that have prevented treatment providers from offering nicotine cessation treatment in conjunction with drug treatment include the following: (a) substance abusers in recovery are unwilling to stop smoking; (b) substance abusers in recovery are unable to stop smoking, and (c) substance abusers in recovery may put themselves at greater risk for drug relapse should they stop smoking (Campbell et al., 1995). Illicit drug use is only one of a number of behaviors that place an individual at risk for HIV infection (Anteghini, Fonseca, Ireland, & Blum, 2001). Hence, the purpose of this study is twofold. First, the relationship between nicotine dependence and HIV risk behaviors is examined to see whether those individuals who are more dependent on nicotine engage in a greater number of HIV risk behaviors, and second, different drug users are compared to evaluate whether they differ on nicotine dependence.
2. Method 2.1. Participants Out-of-treatment drug users (N = 297; 210 males, 87 females) enrolled in the Center for Behavioral Research and Services’ (CBRS) Counseling and Food Program (CFP) were asked to participate in a pilot study of smoking and tobacco. The mean age of participants was 43.75 years (S.D. = 9.37, Range = 18–74). Of the participants, 59% were Black (not of Hispanic origin; n = 171), 24% White (not of Hispanic origin; n = 70), 12% Hispanic/Latino (n = 35), 2% Native American/American Indian or Alaskan Native (n = 7), 1% Asian or Pacific Islander (n = 2), and 1% ‘‘Other’’ (n = 3). Sixty-six percent of the sample was exclusively crack-cocaine users, 16% was exclusively injectors, and 18% was both crackcocaine smokers and injectors. 2.2. Materials The Risk Behavior Assessment (RBA; National Institute on Drug Abuse, 1993) measures sexual and drug risk behaviors, medical history and attitudes about AIDS, and general demographic information. The Fagerstrom Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991) is a six-item, self-report measure of dependency on nicotine.
3. Results Scores on the FTND were significantly (all P < .05) and positively related to the number of times respondents injected, the number of days respondents smoked crack-cocaine, and the percent of times respondents used condoms during sex. In addition, scores on the FTND
S.L. Hershberger et al. / Addictive Behaviors 29 (2004) 623–625
625
differed significantly among the three drug groups: smoking injectors had the highest level of nicotine dependence, injectors were somewhat less nicotine dependent, and crack users were the least nicotine dependent.
4. Discussion This study found significant relationships between tobacco dependency and risky behaviors. Crack-smoking injectors tended to be more nicotine dependent compared to crack-smokers and injectors. The relation between tobacco dependency and HIV risk behaviors within a sample of drug users is not surprising, given the well-replicated finding that adults who smoke cigarettes also engage in numerous other behaviors that place them at risk in general (e.g., Anteghini et al., 2001). High levels of impulsivity provide one explanation for this clustering of risk behaviors; individuals who are highly impulsive tend to smoke more, consume more alcohol, not use condoms, and use illicit drugs (Zuckerman & Kuhn, 2002). The findings of our study suggest that treatment programs concerned with illicit drug use should assist with smoking cessation. Recent research has confirmed the effectiveness of smoking cessation programs. If we are correct in hypothesizing that nicotine dependence and risk behaviors are related not through one influencing the other, but instead through impulsivity acting as a common influence on both, the beneficial effects of smoking cessation programs will not generalize to the reduction of risk behaviors. For generalization to occur, the participant’s impulsivity would somehow have to be lessened. In lieu of altering impulsivity, a difficult task at best, individuals should have access to both smoking cessation and HIV risk behavior reduction programs.
References Anteghini, M., Fonseca, H., Ireland, M., & Blum, R. W. (2001). Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil. Society for Adolescent Medicine, 28, 295 – 302. Boyd, C. J., & Pohl, J. (1996). Nicotine and alcohol abuse in African American women who smoke crack cocaine. Journal of Substance Abuse, 8, 463 – 469. Campbell, B. K., Wander, N., Stark, M. J., & Holbert, T. (1995). Treating cigarette smoking in drug-abusing clients. Journal of Substance Abuse Treatment, 12, 89 – 94. DiFranza, J. R., & Guerrera, M. P. (1990). Alcoholism and smoking. Journal of Studies on Alcohol, 51, 130 – 135. Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O. (1991). The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86, 1119 – 1127. Lai, S., Lai, H., Page, J. B., & McCoy, C. B. (2000). The association between cigarette smoking and drug abuse in the United States. Journal of Addictive Diseases, 19(4), 11 – 24. National Institute on Drug Abuse (1993). Risk behavior assessment questionnaire. Rockville, MD: Author. Zuckerman, M., & Kuhn, D. M. (2002). Personality and risk-taking: Common biosocial factors. Journal of Personality, 68, 999 – 1029.
Short communication
Nicotine dependence and HIV risk behaviors among illicit drug users Scott L. Hershberger*, Dennis G. Fisher, Grace L. Reynolds, Jennifer A. Klahn, Michele M. Wood Department of Psychology, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA
Abstract This study was concerned with examining the relation between nicotine dependence and HIV risk behaviors in a sample of 297 out-of-treatment drug users. A number of significant relationships were found between nicotine dependence and HIV risk behaviors. Crack-smoking injectors were found to have a higher degree of nicotine dependence when compared with exclusive injectors or exclusive crack smokers. Participants’ impulsivity may be one possible reason why nicotine dependence is related to HIV risk behaviors. The results also suggest that drug abuse programs make available smoking cessation programs. D 2003 Elsevier Ltd. All rights reserved. Keywords: HIV; Nicotine dependence; Smoking
1. Introduction Cigarette smoking and the use of illicit drugs appear to go hand in hand. Analysis of data from the 1994 National Household Survey on Drug Abuse showed that individuals who reported having smoked cigarettes were more likely to use cocaine, heroin, crack, and marijuana than those who had not smoked, thus suggesting a gateway relationship between cigarettes and illicit drugs (Lai, Lai, Page, & McCoy, 2000). Among individuals in drug treatment, a majority smoke cigarettes (Boyd & Pohl, 1996; Campbell, Wander, Stark, & * Corresponding author. Tel.: +1-562-985-5001. E-mail address: [email protected] (S.L. Hershberger). 0306-4603/$ – see front matter D 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2003.08.016
624
S.L. Hershberger et al. / Addictive Behaviors 29 (2004) 623–625
Holbert, 1995; DiFranza & Guerrera, 1990). Despite the potential usefulness of providing smoking cessation programs to illicit drug users, treatment providers are often reluctant to offer these programs to these clients. Myths that have prevented treatment providers from offering nicotine cessation treatment in conjunction with drug treatment include the following: (a) substance abusers in recovery are unwilling to stop smoking; (b) substance abusers in recovery are unable to stop smoking, and (c) substance abusers in recovery may put themselves at greater risk for drug relapse should they stop smoking (Campbell et al., 1995). Illicit drug use is only one of a number of behaviors that place an individual at risk for HIV infection (Anteghini, Fonseca, Ireland, & Blum, 2001). Hence, the purpose of this study is twofold. First, the relationship between nicotine dependence and HIV risk behaviors is examined to see whether those individuals who are more dependent on nicotine engage in a greater number of HIV risk behaviors, and second, different drug users are compared to evaluate whether they differ on nicotine dependence.
2. Method 2.1. Participants Out-of-treatment drug users (N = 297; 210 males, 87 females) enrolled in the Center for Behavioral Research and Services’ (CBRS) Counseling and Food Program (CFP) were asked to participate in a pilot study of smoking and tobacco. The mean age of participants was 43.75 years (S.D. = 9.37, Range = 18–74). Of the participants, 59% were Black (not of Hispanic origin; n = 171), 24% White (not of Hispanic origin; n = 70), 12% Hispanic/Latino (n = 35), 2% Native American/American Indian or Alaskan Native (n = 7), 1% Asian or Pacific Islander (n = 2), and 1% ‘‘Other’’ (n = 3). Sixty-six percent of the sample was exclusively crack-cocaine users, 16% was exclusively injectors, and 18% was both crackcocaine smokers and injectors. 2.2. Materials The Risk Behavior Assessment (RBA; National Institute on Drug Abuse, 1993) measures sexual and drug risk behaviors, medical history and attitudes about AIDS, and general demographic information. The Fagerstrom Test for Nicotine Dependence (FTND; Heatherton, Kozlowski, Frecker, & Fagerstrom, 1991) is a six-item, self-report measure of dependency on nicotine.
3. Results Scores on the FTND were significantly (all P < .05) and positively related to the number of times respondents injected, the number of days respondents smoked crack-cocaine, and the percent of times respondents used condoms during sex. In addition, scores on the FTND
S.L. Hershberger et al. / Addictive Behaviors 29 (2004) 623–625
625
differed significantly among the three drug groups: smoking injectors had the highest level of nicotine dependence, injectors were somewhat less nicotine dependent, and crack users were the least nicotine dependent.
4. Discussion This study found significant relationships between tobacco dependency and risky behaviors. Crack-smoking injectors tended to be more nicotine dependent compared to crack-smokers and injectors. The relation between tobacco dependency and HIV risk behaviors within a sample of drug users is not surprising, given the well-replicated finding that adults who smoke cigarettes also engage in numerous other behaviors that place them at risk in general (e.g., Anteghini et al., 2001). High levels of impulsivity provide one explanation for this clustering of risk behaviors; individuals who are highly impulsive tend to smoke more, consume more alcohol, not use condoms, and use illicit drugs (Zuckerman & Kuhn, 2002). The findings of our study suggest that treatment programs concerned with illicit drug use should assist with smoking cessation. Recent research has confirmed the effectiveness of smoking cessation programs. If we are correct in hypothesizing that nicotine dependence and risk behaviors are related not through one influencing the other, but instead through impulsivity acting as a common influence on both, the beneficial effects of smoking cessation programs will not generalize to the reduction of risk behaviors. For generalization to occur, the participant’s impulsivity would somehow have to be lessened. In lieu of altering impulsivity, a difficult task at best, individuals should have access to both smoking cessation and HIV risk behavior reduction programs.
References Anteghini, M., Fonseca, H., Ireland, M., & Blum, R. W. (2001). Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil. Society for Adolescent Medicine, 28, 295 – 302. Boyd, C. J., & Pohl, J. (1996). Nicotine and alcohol abuse in African American women who smoke crack cocaine. Journal of Substance Abuse, 8, 463 – 469. Campbell, B. K., Wander, N., Stark, M. J., & Holbert, T. (1995). Treating cigarette smoking in drug-abusing clients. Journal of Substance Abuse Treatment, 12, 89 – 94. DiFranza, J. R., & Guerrera, M. P. (1990). Alcoholism and smoking. Journal of Studies on Alcohol, 51, 130 – 135. Heatherton, T. F., Kozlowski, L. T., Frecker, R. C., & Fagerstrom, K. O. (1991). The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction, 86, 1119 – 1127. Lai, S., Lai, H., Page, J. B., & McCoy, C. B. (2000). The association between cigarette smoking and drug abuse in the United States. Journal of Addictive Diseases, 19(4), 11 – 24. National Institute on Drug Abuse (1993). Risk behavior assessment questionnaire. Rockville, MD: Author. Zuckerman, M., & Kuhn, D. M. (2002). Personality and risk-taking: Common biosocial factors. Journal of Personality, 68, 999 – 1029.