Alcohol, the ‘forgotten drug,’ leads to unsafe sex among drug users

New findings link alcohol use and risky sex among injection drug users. The results appear in a Brown-led study published in the journal Alcoholism: Clinical & Experimental Research.

PROVIDENCE, R.I. — A new study uncovers an intimate bond between drinking and unsafe sex among injection drug users.

“Among individuals who use drugs and the people who treat them, alcohol is overlooked,” said lead author Michael Stein, M.D. “It is a forgotten drug. But drinking appears to be one of several risky behaviors engaged in by injection drug users (IDUs).”

More than one third of reported AIDS cases are directly associated with injection drug use. Unprotected sexual contact with IDUs is the predominant cause of heterosexual transmission of HIV.

Among IDUs, “alcohol may not be considered an important drug, or even a drug at all, yet it is likely to reduce certain inhibitions and lead to unsafe sex,” Stein said. Alcohol consumption may be a little-known link between injection drug use and heterosexual transmission of the HIV virus that causes AIDS, he said.

Stein and colleagues interviewed a “high-risk group” of injection drug users – individuals not receiving formal substance abuse treatment – recruited from a syringe exchange program in Providence, R.I.

Of the 5,610 days analyzed, 1,054 (18.8 percent) were considered days of unprotected sexual contact. Drinking also occurred on 549 (52 percent) of those days.

The findings indicate that drinking days were 1.76 times more likely to involve risky sexual behavior than days on which alcohol was not consumed, said Stein. The study appears in the October issue of the journal Alcoholism: Clinical & Experimental Research.

Little attention is paid to alcohol use or disorders among drug injectors who are in medical or drug-treatment settings, he said.

“This situation needs to change dramatically,” said Stein, who is an associate professor of medicine at Brown Medical School. He is based in the Division of General Medicine at Rhode Island Hospital.

“Given the high rates of alcohol abuse and dependence in this sample, referrals to alcohol treatment should be available at needle exchanges,” Stein said. “Health care providers need to pay attention to alcohol use when they are addressing the complications of drug use, as well as the behaviors of drug users.”

Stein noted another reason for concern. “Because so many drug injectors carry the hepatitis C virus and because alcohol worsens the disease course of hepatitis C, attention to alcohol is particularly important for injectors.”

He and colleagues recently devised and tested an intervention program to treat alcohol use among IDUs. Results are forthcoming.

Although it seems intuitive that people who drink may have risky sex, data must support the association before preventive measures can be developed, the researchers said.

“Many, many people have pointed out over the last 20 years that without a cure or vaccine for AIDS, the only way of protecting ourselves and our country is through prevention,” said Ron Stall, chief of the Behavioral Interventions Research Branch at the Centers for Disease Control and Prevention.

“Fewer people have remarked upon the fact that prevention works,” he said. “One of the necessary conditions for HIV prevention to work, however, is for rigorous data to be collected regarding the conditions under which risk-taking behaviors occur.”

Study co-authors include statistician Bradley Anderson, Rhode Island Hospital; fourth-year Brown medical student Anthony Charuvastra; and assistant professor Peter D. Friedmann, M.D., Brown Medical School and Rhode Island Hospital.

The National Institute on Alcohol Abuse and Alcoholism funded the study.

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