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Objective: Explore demographic characteristics, patterns of drug use and psychological distress among regular injecting drug users (IDUs) in Australia, as a function of recent criminal activity. Methods: Structured, face-to-face interviews with 909 regular IDUs recruited from every capital city in Australia, between June and August 2007, as part of the annual Illicit Drug Reporting System (IDRS). Criminal activity in the past month was assessed using the Opiate Treatment Index (OTI); psychological distress was assessed using the Kessler psychological distress scale (K10). Results: Forty-three per cent of IDUs reported recent (past month) criminal activity. Those who had committed crime recently were younger, exhibited riskier patterns of drug use, reported more drug-related problems and were more likely to exhibit significant psychological distress. In a multivariate model the most important correlates of recent criminal activity were use of more than three drug types recently (OR=2.66, 95% CI 1.96-3.61), initiation to injecting before age 18 (OR=1.93, 95% CI 1.42-2.61) and daily drug injection (OR=1.55, 95% CI 1.13-2.13). Conclusions and Implications: Criminal activity among regular IDUs in Australia is not restricted to a particular demographic group, and is a marker for riskier patterns of drug use, greater drug-related harm and psychological distress. Contact between IDUs and the criminal justice system provides opportunities for the delivery of targeted harm reduction messages, and for screening and diversion into appropriate treatment services. Key words: crime, substance abuse, intravenous, mental health, harm reduction. doi: 10.1111/j.1753-6405.2009.00379.x

Examination of childhood risk factors for injection drug use may provide clues as to why people progress to injection drug use and it can promote identification of at-risk youth. We surveyed current injection drug users (IDUs) and individuals who never injected drugs (non-IDUs), recruited through street outreach and snowball sampling in Denver, CO. Between March 2000 and October 2003, 601 subjects (339 IDUs and 262 non-IDUs) participated in structured interviews. We examined self-reported factors in childhood that may have been influential in whether one progressed to drug injection later in life. These indicators included age at drug and alcohol initiation, childhood risk behavior, parental monitoring, family stability, and other family problems. Differences between IDUs and non-IDUs were assessed using unadjusted tests and logistic regression. Results of the data analysis indicated that IDUs were significantly younger when they first used both alcohol and marijuana, they reported higher childhood risk behavior scores, and they had less parental monitoring and less family stability as children than non-IDUs. This research may assist clinicians in defining factors that put youth at risk for problems associated with injection drug use. Keywords Injection drug use * Risk behavior * Parental influence * Prevention * Family

The prevalence is determined and correlates of HIV-1 infection among community-based injecting drug users (IDUs) in Tehran, Iran are presented. Results reveal that the prevalence of HIV-1 infection has reached an alarming level among IDUs in Tehran, with incarceration-related exposures revealed to be the main correlates of HIV-1 infection.

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.

Two short scales, the TCU Depression Scale and the TCU Decision-making Scale, were psychometrically evaluated in a sample of 145 intravenous drug users. Coefficient alpha reliabilities were .78 for the 6-item TCU Depression Scale and .77 for the 9-item TCU Decision-making Scale. Concurrent validity of the former scale was assessed by correlating scores with those on the Beck Depression Inventory, r=.75. Based on the Beck Depression Inventory Clinical cutoff scores, 83% of the sample showed some depression, with 23% severely depressed, 39% moderately depressed, and 21% mildly depressed. Individuals scoring higher on depression on both tests tended to score lower on decision-making. Significant demographic associations of age, gender, education, and race-ethnicity were found for the depression and decision-making scales. More depression was noted for women, those younger, white, and having less education. Older and more educated intravenous drug users tended to score higher on decision-making. Validity for the depression and decision-making scales was assessed by examining correlations with behaviors. Significant positive correlations were found between depression scores and intravenous use of cocaine only, heroin and cocaine combined, and heroin only. Also, intravenous use of cocaine only and of cocaine and heroin combined were negatively related to decision-making. AIDS sex-risky behavior was positively correlated with depression and negatively correlated with decision-making.

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). [...]