Alcohol, drugs, and condom use among drug offenders: An event-based analysis

https://doi.org/10.1016/j.drugalcdep.2007.08.012Get rights and content

Abstract

Background

Studies of the association between substance use and condom use in specific sexual encounters often do not separate the effects of alcohol and different types of drugs. Because the pharmacological effects and social settings of various substances differ, their effects on unprotected intercourse may vary as well.

Goal

This study examined the relationship between alcohol and drug use and the use of condoms in sexual encounters with casual partners in a high-risk population of drug offenders.

Design

Participants in court-ordered drug diversion programs (n = 536; 26% female) completed a questionnaire in which they reported on the circumstances of their most recent sexual encounter with a casual partner.

Results

In multivariate logistic models, alcohol use in conjunction with sex was not related to decreased condom use in either men or women. Amphetamines (smoked or injected) were associated with decreased condom use, while cocaine, marijuana, and orally-administered amphetamines were not significantly associated with condom use.

Conclusions

In this high-risk sample, links between substance use and unprotected sex differ with type of drug used.

Introduction

Although sexual risk taking is frequently linked to alcohol and other substance use, the nature of this relationship and the influence of confounding variables are not clearly understood (Leigh and Stall, 1993, Leigh, 2002), and research on this link has shown inconsistent findings (for reviews, see Dingle and Oei, 1997, Donovan and McEwan, 1995, Halpern-Felsher et al., 1996, Leigh, 2002, Leigh and Stall, 1993, Rhodes and Stimson, 1994, Weinhardt and Carey, 2000). In many studies on this topic, general substance use measures (for example, quantity or frequency of use) are simply correlated with general measures of risky sexual behavior (for example, frequency of unprotected intercourse). A more targeted approach uses information about substance use and unprotected sex in a specific sexual encounter. This event-specific method ensures that substance use and unprotected sex occurred on the same occasion, thus strengthening (but not guaranteeing) causal inferences.

Studies on substance use and unprotected sex in discrete events often incorporate measures of alcohol use, but measures of drug use (particularly of specific drugs) are less common (for review, see Leigh, 2002). Several studies have found that substance use (including alcohol or other drugs) at the time of a sexual encounter is not significantly associated with condom use in that encounter in such varied samples as drug users (Rosengard et al., 2006, Watkins et al., 1993), teenagers (Palen et al., 2006, Rosenthal et al., 1997), college students (Senf and Price, 1994, Freimuth et al., 1992), young adults (Santelli et al., 1997, Leonard and Ross, 1997), and female clients at a sexually transmitted diseases (STD) clinic (Weinstock et al., 1993). However, substance use was associated with non-use of condoms in several male samples, including a national sample of young men (Ku et al., 1993) and male clients of an STD clinic (Weinstock et al., 1993). In a study of men who have sex with men (MSM), substance use was associated with unprotected receptive anal intercourse with a non-main partner, but not with penetrative intercourse or with unprotected sex with a main partner (Stueve et al., 2002). In these studies, information about which substances were used in the sexual encounter is not reported; and all substances, including alcohol, are combined in a single predictor variable.

Several event-level studies have distinguished between types of substances when investigating the association between substance use and condom use in sexual encounters. Using data from a national survey, Schafer et al. (1994) found that people who used any drug (not including alcohol) at the most recent sexual encounter with a new sexual partner were less likely to use condoms than were non-users. Street youth who used marijuana in a recent sexual encounter were less likely to use condoms, but those who used crack were more likely to use condoms (Bailey et al., 1998). Marijuana use with sex was also associated with decreased condom use at a recent sexual encounter among adolescents in detention (Kingree and Betz, 2003, Kingree et al., 2000, Kingree and Phan, 2002) and among MSM (Clutterbuck et al., 2001), but was unrelated to condom use among young heterosexual adults (Brodbeck et al., 2006). In a sample of female drug users, condom use at a recent sexual encounter was not significantly associated with use of alcohol, injection drugs, crack, or non-injection drugs before sex (Tortu et al., 2000), while a study of drug injectors suggested decreased condom use when both sexual partners were using crack with sex (Friedman et al., 1999). Event-level studies of MSM have found more unprotected receptive anal intercourse among men who used stimulants before sex (Colfax et al., 2004, Mansergh et al., 2006), as well as no effects for drugs other than alcohol (Vanable et al., 2004).

The objective of this paper is to examine the associations between substance use and unprotected intercourse in a sample of drug offenders. Because of the varied drug experience in this sample, there is a significant amount of drug use reported before sexual activity, and we can examine the role of drugs of different classes.

Section snippets

Participants

Individuals who were enrolled in eight court-ordered drug diversion programs in the Los Angeles metropolitan area participated in the study between 1999 and 2002 (n = 536, 26% female). These individuals were referred to education and treatment programs in lieu of prosecution for drug offenses including minor possession and driving under the influence. Drug diversion education classes were randomly chosen from a list of classes provided by program administrators who agreed to provide recruitment

Results

Condom use and substance use at the most recent sexual encounter with a casual partner are shown in Table 1. Combining alcohol with other drugs was common: 73% of men who reported using drugs in this event also drank alcohol, and 62% of men who drank also used drugs. Sixty-seven percent of women who used drugs also drank alcohol, and 46% of women who drank also used drugs. The most common combinations were alcohol and marijuana (21%), alcohol and cocaine (11%), alcohol and amphetamine (13%),

Discussion

In this sample of drug offenders, men and women who drank alcohol in conjunction with a recent sexual encounter with a casual partner were no less likely to use condoms than were those who did not drink during the encounter. This finding is consistent with a recent meta-analysis of the association between drinking and condom use in sexual encounters, which reported that drinking was linked to decreased condom use only in first sexual encounters in adolescents, not in recent encounters among

Acknowledgement

Supported by R01 DA12101 from the National Institute on Drug Abuse.

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