Faculty Bibliography

This paper documents patterns and sequence of initiation of club drug use in a sample of 450 gay and bisexual men in New York City. Quantitative and qualitative baseline data from a year-long longitudinal investigation conducted between 2001 and 2005 were analyzed. The study focused on the use of five club drugs-cocaine, GHB, ketamine, ecstasy, and methamphetamine-using self-reported indications of use for a period of 4 months prior to assessment. Patterns of club drug use among gay and bisexual demonstrated that poly-club-drug use is common, and that patterns of use can be differentiated along the lines of age, race/ethnicity, and sexual orientation, with those who are older, Black, and bisexual, reporting less club drug use. The majority of the men initiated use of the five club drugs as follows: (a) cocaine, (b) ecstasy, (c) ketamine, (d) methamphetamine, and (e) GHB. Variations in patterns were related to both age and level of poly-club-drug use. The sequencing and/or patterns of club drug use may be better explained by socialization processes in the gay community than by Gateway Theory, which has been traditionally used to explain patterns of drug use in the population. Future research should more closely examine the synergy of drug use combinations with an emphasis on measuring the extent to which the drugs are taken in synchronicity

The purpose of this investigation was to consider person characteristics, treatment level variables, and illicit drug use to help explain the HIV antiviral adherence patterns of a community-based, non-drug-treatment-seeking sample of men who have sex with men (MSM). Adherence data were gathered for 300 MSM eight times over the course of 1 year using electronic monitoring. Treatment and person level characteristics were assessed at baseline assessment using computer-administered surveys, and drug usage was established via a diagnostic inventory. These longitudinal data were analyzed via Hierarchical Linear Modeling. The sample was diverse in terms of age and race/ethnicity. Across the span of the year in which the participants were assessed, adherence rates were relatively stable and high (means: 82% to 90%) at each time point and remained relatively stable across the yearlong investigation. Lower adherence rates were evident among those who were drug users, black identified (in terms of race), older, and by pill burden. Individuals on HIV antiretroviral therapy demonstrated consistent although not optimal adherence rates when assessed during the course of a year. The significance of numerous person level factors such as age, race, and drug use suggest that adherence to treatment may in part be impacted by the circumstances that the individual brings to the treatment behavior, and suggests interventions that delve beyond the behavioral to consider and address life social and intrapersonal circumstances that may interfere with adherence behaviors

OBJECTIVE: Few studies have analyzed the use of powder cocaine over time and its relation to psychosocial states. The purpose of the present analysis was to examine trajectories of powder cocaine use among club-drug using gay and bisexual men in New York City. METHOD: A purposive sample of 355 powder cocaine using men was surveyed four times over a period of 12 months. We analyzed natural trajectories of cocaine use and examined use in relation to demographic and psychosocial variables. Hierarchical linear modeling was used to examine associations of use at baseline and over time. RESULTS: Frequency of use at baseline was negatively related to sexual sensation seeking and positively related to triggers of unpleasant emotions, physical discomfort, and the desire for pleasant times with others. Men who reported using cocaine to avoid physical discomfort or to enhance pleasant times with others were also more likely to decrease their frequency of use during the year long investigation. CONCLUSIONS: The antecedents that explained cocaine use in this sample indicate the need for treatment and prevention programs that consider the interplay between emotions and behaviors related to use of this drug

RATIONALE: Clinical studies have shown that topiramate, an anticonvulsant medication, may be effective as a treatment for smoking cessation. However, less is known about topiramate effects on nicotine withdrawal and craving and its interactions with a smoked cigarette. OBJECTIVES: The objective of this study was to investigate the effects of topiramate treatment on abstinence-related nicotine withdrawal, cue-induced cigarette craving, and the acute effects of a smoked cigarette. MATERIALS AND METHODS: Fifteen female and 25 male cigarette smokers were randomly assigned to 9-day treatment with topiramate (final titration dose, 75 mg/day) or placebo. On the last day of treatment, after a 3-h smoke-free abstinence period, participants were evaluated for symptoms of nicotine withdrawal and then underwent cigarette and neutral cue reactivity testing. Thirty minutes after completing cue exposure testing, participants were then evaluated for the acute effects of a smoked cigarette. Cue reactivity and acute smoking measures included subjective ratings of cigarette craving and withdrawal and physiological measures of skin conductance and temperature, heart rate, and blood pressure. In addition, smoking topography was measured using a puff volume apparatus. RESULTS: Topiramate treatment enhanced subjective ratings of withdrawal after the 3-h abstinence period and reduced pre-cue skin conductance levels. Cigarette cue exposure resulted in a moderate increase in craving, which was unaffected by treatment. Topiramate treatment enhanced the rewarding effects of a smoked cigarette, even while participants smoked less per puff and achieved lower plasma nicotine levels. CONCLUSION: Results suggest that topiramate enhances both nicotine withdrawal and reward. These findings question the utility of topiramate treatment for smoking cessation.

OBJECTIVE: We sought to delineate patterns of poly-club-drug use among gay and bisexual men. Data were drawn from a large-scale 12-month longitudinal investigation of club drug use and sexual behavior among 450 racially, ethnically, and geographically diverse sample of gay and bisexual men in New York City. METHODS: Using community-based sampling, we recruited the sample from numerous venues and assessed the self-reported use of five drugs and their relation to one another: cocaine, ecstasy, GHB, ketamine, and methamphetamine. Multivariate hierarchical linear modeling (HLM) was utilized to examine associations of usage over the 12-month data collection period. RESULTS: Use of the five club drugs was highly related as noted by both parametric and non-parametric analyses of the cross-sectional data. Patterns of use over time also indicated significant longitudinal associations. Specifically, the use of methamphetamine over time was related to both the use of ecstasy and GHB. CONCLUSIONS: The analyses suggest that usage patterns of individual club drugs such as methamphetamine, ecstasy, and GHB among gay and bisexual men are highly related across time. These findings hold implications for the treatment approaches that are utilized to address substance abuse in this segment of the population, and suggest that practitioners focus on the totality of the substance abuse behaviors and not necessarily individual drugs which are administered

AIM: The popularity of methamphetamine among gay men has been documented; however, few studies have examined the complex behavioral and psychological motivations behind methamphetamine use, particularly over time. This study aimed to (i) identify the trajectories for methamphetamine use; (ii) explore factors related to methamphetamine use; and (iii) determine factors which predict changes in usage over a year. DESIGN: This analysis utilized hierarchical linear modeling to identify the trajectories for methamphetamine use and explore factors related to patterns of methamphetamine use. PARTICIPANTS: A sample of 293 gay and bisexual men who indicated methamphetamine use at baseline were drawn from Project BUMPS (Boys Using Multiple Party Substances), which was a longitudinal, mixed-methodologies study of 450 club drug-using gay and bisexual men. MEASUREMENTS: Participants were assessed via quantitative measures in four waves of data collection over the course of a year (baseline, 4, 8 and 12 months post-baseline). FINDINGS: Frequency of methamphetamine use is related to reliance on the drug to avoid unpleasant emotions and physical discomfort, outcome expectancies for use and combining the drug with Viagra. Those with higher levels of drug-related sensation-seeking and those who combine use with Viagra show more consistent use over time, although a decrease in use is noted for most of the sample. CONCLUSIONS: Longitudinal analyses support the idea that methamphetamine is used by gay men to mask feelings of discomfort and to enhance sensations as well as sexual pleasure. Longitudinal non-intervention studies of drug use may have intervention-like effects

This paper examines the use of gamma-hydroxybutyrate (GHB) among a sample of gay men in New York City, who identify GHB as their most frequently used club drug. The sample was drawn from a larger longitudinal investigation of club drug using men. Thematic analysis yielded findings regarding perceived stigma for GHB use, tolerance of potential adverse side effects, and reasons for why some prefer this substance to other club drugs. Specifically, our findings suggest that GHB is viewed unfavorably in many social circles, that side effects are tolerated by frequent GHB users, and that the drug is chosen over other substances because the short duration of action, energy boost, sleep assistance, increase in libido, and limited after-effects. Examining the reasons why men use this substance will lead to the development of GHB specific prevention strategies, which accurately address the consequences of use as well as the motivations that individuals possess for using the substance.

36 alcoholic patients, recruited from a treatment program, and 20 non-alcohol abusing control subjects were tested for their reactions to alcohol and non-alcohol cues. The cue exposure paradigm included audio-visual (video), tactile, olfactory, and guided imagery cue components related to alcohol and non-alcohol beverages. Response measures were analyzed for significant difference based on alcohol and non-alcohol cue and patient type. Among the subjective ratings, alcohol cue specific increases in alcohol craving, desire to drink, alcohol-like high, positive drinking expectancies and alcohol-like withdrawal were seen in alcoholic subjects. Among the physiological measures, alcohol cue specific increases in salivation were seen in alcoholic subjects. Changes in heart rate, skin conductance and temperature were not specific to alcohol cues, or to alcoholic patients. The smelling of alcohol had the greatest impact on alcohol craving and skin conductance in alcoholic subjects. These findings demonstrate robust subjective effects, and weak physiological effects, in response to a multidimensional alcohol cue exposure paradigm. The response profile indicates cue reactivity in alcoholics as an appetitive based form of alcohol craving

The recreational use of gamma-hydroxybutyrate (GHB) has been relatively understudied, despite its popularity in gay communities. We examined the use of GHB in a sample of 450 club drug using gay and bisexual men. Of these, 29% indicated use of the substance in the recent past. GHB users were similar to those in the sample who reported no use along key demographic factors, although GHB users were more likely to identify as gay than bisexual and were slightly older. Poly-drug use was common, with close to half of GHB users combining with methamphetamine, MDMA, or ketamine; approximately one quarter also used GHB with alcohol. Participants reported that GHB was often used at nightclubs, circuit parties, sex parties, and sex clubs, with HIV-positive men more likely to use the substance in sexual contexts. Use of GHB is common among a certain subset of gay men despite warnings within the community about the potentially fatal effects of the substance, suggesting that more effort be given to educate drug using gay men about GHB