Nicotine dependence and HIV risk behaviors among illicit drug users

doi:10.1016/j.addbeh.2003.08.016

Addictive Behaviors

Volume 29, Issue 3, May 2004, Pages 623-625

https://doi.org/10.1016/j.addbeh.2003.08.016 Get rights and content

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.

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 et al., 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.

Section snippets

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),

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 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.

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

References (8)

M. Anteghini et al.
Health risk behaviors and associated risk and protective factors among Brazilian adolescents in Santos, Brazil
Society for Adolescent Medicine
(2001)
C.J. Boyd et al.
Nicotine and alcohol abuse in African American women who smoke crack cocaine
Journal of Substance Abuse
(1996)
B.K. Campbell et al.
Treating cigarette smoking in drug-abusing clients
Journal of Substance Abuse Treatment
(1995)
J.R. DiFranza et al.
Alcoholism and smoking
Journal of Studies on Alcohol
(1990)

There are more references available in the full text version of this article.

Cited by (16)

HIV-Infected Subjects and Tobacco Smoking: A Focus on Nicotine Effects in the Brain
2019, Neuroscience of Nicotine: Mechanisms and Treatment
Despite the numerous diseases known to be associated with the smoking habit, tobacco consumption has persisted, largely owing to nicotine's addictive properties. Notably, nicotine targets nicotinic acetylcholine receptors in the central nervous system, resulting in upregulation of these receptors, a response linked to nicotine addiction. HIV-infected individuals smoke more than the normal population. For HIV-infected individuals whose health is compromised, smoking and nicotine consumption cause even more harm by accelerating neurocognitive deterioration and further depressing the central nervous system. Moreover, the presence of virotoxins and nicotine permeabilizes the blood-brain barrier, thus facilitating infected macrophages to trespass and subsequently release HIV and proinflammatory cytokines. Together, these alterations significantly contribute to HIV-associated neurocognitive disorders. Smoking cessation studies demonstrate little adherence to the therapy, low abstinence, and scarce adherence to antiretroviral therapy, which is highlighted by risk behaviors that worsen the infection.
Smoking-Cessation Interventions in People Living With HIV Infection: A Systematic Review
2014, Journal of the Association of Nurses in AIDS Care
Citation Excerpt :
Furthermore, interventions that were most successful also asked patients about previous or current drug use and history of mental illness (e.g., depression and anxiety; Moadel et al., 2012) and tailored interventions to those needs. Studies have suggested that a history of intravenous drug addiction is associated with a higher rate of smoking addiction (Hershberger, Fisher, Reynolds, Klahn, & Wood, 2004); therefore, addressing cigarette smoking in isolation without considering other addictive behaviors may result in suboptimal outcomes. Successful interventions in this review also provided an individualized smoking-cessation plan that included a support buddy, addressed social issues, and offered feasible smoking-cessation programs (i.e., choice of attending a day or night program, or cell-phone delivery; Moadel et al., 2012; Vidrine et al., 2006).
Tobacco smoking remains a prevalent behavior in people living with HIV infection (PLWHs) and is associated with impaired immune functioning, increased cardiovascular risk, and decreased response to antiretroviral therapy. This review presents a critique and synthesis of evidence on effective smoking-cessation interventions for PLWHs. A comprehensive search identified nine peer-reviewed intervention studies published between 1989 and 2012. The highest likelihood of smoking cessation (range of odds ratios 4.33–5.6) were in two randomized controlled trial interventions using cell phone technology. Clinically significant reductions in systolic blood pressure, weight gain, and increased CD⁴⁺ T-cell count were reported in participants who ceased smoking in three of the nine studies. Overall, multistrategy smoking-cessation interventions, delivered over multiple sessions, were effective. However, the most effective interventions were tailored to the unique individual needs of PLWHs, including assessment of and intervention for polysubstance abuse and mental health issues, as well as the inclusion of access-promoting elements.
Genetically expressed HIV-1 viral proteins attenuate nicotine-induced behavioral sensitization and alter mesocorticolimbic ERK and CREB signaling in rats
2011, Pharmacology Biochemistry and Behavior
Citation Excerpt :
Tobacco smoking prevalence among HIV-1 positive population is 3-fold greater than that in HIV-1 negative population (Burkhalter et al., 2005; CDC, 2007; Gritz et al., 2004; Nahvi and Cooperman, 2009; Niaura et al., 2000). HIV-1 infected patients are more likely to become dependent on nicotine, and less likely to quit than HIV-1 negative individuals (Fuster et al., 2009; Hershberger et al., 2004; Nahvi and Cooperman, 2009). There is an increasing body of clinical and experimental evidence that tobacco smoking is associated with a more rapid progression to AIDS (Crothers et al., 2005; Furber et al., 2007; Nieman et al., 1993; Zhao et al., 2010) and HIV-1 associated dementia (Burns et al., 1996; Manda et al., 2010).
The prevalence of tobacco smoking in HIV-1 positive individuals is 3-fold greater than that in the HIV-1 negative population; however, whether HIV-1 viral proteins and nicotine together produce molecular changes in mesolimbic structures that mediate psychomotor behavior has not been studied. This study determined whether HIV-1 viral proteins changed nicotine-induced behavioral sensitization in HIV-1 transgenic (HIV-1Tg) rats. Further, we examined cAMP response element binding protein (CREB) and extracellular regulated kinase (ERK1/2) signaling in the prefrontal cortex (PFC), nucleus accumbens (NAc) and ventral tegmental area (VTA). HIV-1Tg rats exhibited a transient decrease of activity during habituation, but showed attenuated nicotine (0.35 mg/kg, s.c.)-induced behavioral sensitization compared to Fisher 344 (F344) rats. The basal levels of phosphorylated CREB and ERK2 were lower in the PFC of HIV-1Tg rats, but not in the NAc and VTA, relative to the controls. In the nicotine-treated groups, the levels of phosphorylated CREB and ERK2 in the PFC were increased in HIV-1Tg rats, but decreased in F344 animals. Moreover, repeated nicotine administration reduced phosphorylated ERK2 in the VTA of HIV-1Tg rats and in the NAc of F344 rats, but had no effect on phosphorylated CREB, indicating a region-specific change of intracellular signaling. These results demonstrate that HIV-1 viral proteins produce differences in basal and nicotine-induced alterations in CREB and ERK signaling that may contribute to the alteration in psychomotor sensitization. Thus, HIV-1 positive smokers are possibly more vulnerable to alterations in CREB and ERK signaling and this has implications for motivated behavior, including tobacco smoking, in HIV-1 positive individuals who self-administer nicotine.
Tobacco and HIV
2006, Clinics in Occupational and Environmental Medicine
The interrelationship of smoking, CD4<sup>+</sup>cell count, viral load and cancer in persons living with HIV
2021, AIDS
Risky Decision Making in Psychological Disorders
2020, Risky Decision Making in Psychological Disorders

View all citing articles on Scopus

View full text

Short communicationNicotine dependence and HIV risk behaviors among illicit drug users

Abstract

Introduction

Section snippets

Participants

Results

Discussion

Society for Adolescent Medicine

Journal of Substance Abuse

Journal of Substance Abuse Treatment

Alcoholism and smoking

Journal of Studies on Alcohol

Short communication
Nicotine dependence and HIV risk behaviors among illicit drug users