PROCESSES OF RECOVERY IN METHAMPHETAMINE-USING MEN WHO HAVE SEX WITH MEN

Purpose: This longitudinal study examined theory-based processes of recovery among methamphetamine-using men who have sex with men (MSM) enrolled in outpatient substance abuse treatment.  Processes of recovery included: self-efficacy for managing methamphetamine triggers; perceived social support for reducing methamphetamine use; and stages of change (e.g., pre-contemplation, contemplation, action, and maintenance).  Processes of recovery were examined as predictors of number of anal sex partners while high on methamphetamine and decreased self-reported methamphetamine use over 6-months.   

Background: Methamphetamine-using MSM experience human immunodeficiency virus (HIV) health disparities including higher HIV seroconversion rates and accelerated disease progression.  Studies are needed to identify processes of recovery that predict better substance abuse treatment outcomes among methamphetamine-using MSM.  Results would support the development of treatment approaches and nursing interventions to optimize HIV/AIDS prevention efforts in MSM.

Methods: In total, 88 methamphetamine-using MSM seeking substance abuse treatment in San Francisco were enrolled in a treatment outcome study.  At baseline, 3- and 6-months follow-up, participants completed a computer-based assessment.  Predictors included: self-efficacy for managing methamphetamine triggers measured by the Drug Taking Confidence Questionnaire (a=.97); perceived social support for reducing methamphetamine use measured by an adapted Processes of Change measure (a=.86); and the University of Rhode Island Change Assessment (a=.79) measured stages of change.  Outcomes included: number of anal sex partners while high on methamphetamine in last 3 months; and self-reported days of methamphetamine use in last 30 days.  Generalized estimating equations were used to assess whether changes in processes of recovery were associated with these outcomes.

Results:  Self-efficacy for managing methamphetamine triggers (incidence rate ratio [IRR]= 1.8, 1.04-1.11) and perceived social support for reducing methamphetamine use (IRR=1.04, 1.01-10.6) increased over 6 months.  Of the stages of change, contemplation (IRR=0.98, 0.97-0.99) and maintenance (IRR=0.98, 0.96-0.99) decreased over 6 months. In a multivariate model controlling for age, race and HIV-status, perceived social support for reducing methamphetamine use was independently associated with decreased number of anal sex partners while high on methamphetamine (adjusted incidence rate ratio [aIRR]=0.92, 0.96-0.99).  Conversely, contemplation was independently associated with increased number of anal sex partners while high on methamphetamine (aIRR=1.08, 1.01-1.16). Greater perceived social support for reducing methamphetamine use (aIRR=0.92, 0.89-0.95) and self-efficacy for managing methamphetamine triggers (aIRR=0.97, 0.96-0.97) were independently associated with decreased self-reported methamphetamine use.

Implications: Results suggest that methamphetamine-using MSM may have better substance abuse treatment outcomes if they build social relationships that support efforts to reduce methamphetamine use and engage in activities that increase self-efficacy for managing triggers. Nurses on the forefront of HIV prevention and care efforts can encourage linkage to support groups. Interestingly, contemplation was associated with increased number of anal sex partners while high on methamphetamine, suggesting it may be a marker of ambivalence.  Nurses are uniquely positioned to identify and assist with resolution of ambivalence toward reducing methamphetamine use through stages of change processes and motivational enhancement strategies that support treatment goals. These results will assist in the development of novel interventions to target methamphetamine use as a key driver of the HIV/AIDS epidemic among MSM.