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The impact of depression on drug users is extensive, serving as a trigger for high-risk injection practices and continued drug use. Yet the ability to retain active drug users in mental health treatment has never been tested clinically. We recruited injection drug users (IDU) for a randomized study of combined psychotherapy and pharmacotherapy for the treatment of depression. Among the 53 SCID-diagnosed depressed subjects assigned to the combined treatment group, 43.4% were 'fully adherent' to treatment (75% or greater attendance at cognitive-behavioral therapy (CBT) sessions or 75% or greater adherence to the pharmacotherapy regimen). The correlation of CBT attendance and pharmacotherapy use was high ([r.sub.s] = .74). Persons with double depression (major depression plus dysthymia) were most likely to be fully adherent (p = .01); frequency of heroin use was inversely associated with adherence. Developing public health treatment interventions to engage out-of-treatment, dually-diagnosed IDUs is possible. Keywords: Depression; Injection drug use; Heroin; Adherence; Psychotherapy

The dominant image of an intravenous (IV) drug user in U.S. society is that of the unbridled 'dope fiend'. It is common in treatment literature to refer to users as diseased and pathologically unable to control their lives. Female IV drug users, as the bearers of children, even more than males, are faced with the paradox posed by conflicting social messages labeling them as irresponsible, dirty 'dope fiends' while approaching them as responsible citizens who need to 'clean up their act' for their children. The paradox of these messages creates a profound moral dilemma involving agency - the ability to develop a flow of conduct by reflexively monitoring intention, purpose, and accountability of actions in the pursuit of a goal - and the social identity of 'junkie'. This article examines this social condition and how it affects the life and options of a woman diagnosed HIV positive. Using narrative discourse and analyzing it through the study of voice I show how an IV drug using woman uses her diagnosis to redefine her life and her social identity, as she changes a negative 'deviant' image into a positive one.

In this study, we examined the relationship between depressive symptoms and needle-sharing behavior in a community sample of intravenous drug users (N = 499) in Baltimore, Maryland. Based on the polytomous logistic regression, higher depressive symptoms were positively associated both with needle sharing after cleaning with bleach and with needle sharing without first cleaning with bleach at the bivariate analyses. This relationship remained significant (OR = 1.66) even after adjusting for demographic characteristics, life events, drug use patterns, and social and drug networks. A significant synergistic effect of depressive symptoms and drug network on needle sharing after cleaning with bleach and needle sharing without cleaning was observed. More depressed intravenous drug users who also had a larger drug network were found to be at higher risk of needle sharing after cleaning with bleach, as well as needle sharing without cleaning (OR = 2.59). Depression status is discussed as a predisposing factor and drug network size as a precipitating factor for needle-sharing behavior. Implications for preventing needle-sharing behavior by reducing depressive symptoms are discussed. Key Words. Depression; Drug network; Interaction; Needle sharing; Social network, INTRODUCTION Although most injection drug users (IDUs) demonstrate basic knowledge of modes of human immunodeficiency virus (HIV) transmission, many continue to share needles and to become infected with HIV (1). [...]