Reduced use of illicit substances, even without abstinence, is associated with improved depressive symptoms among people living with HIV

Purpose: Substance use is linked with poor outcomes among people living with HIV (PLWH) and is associated with mental health disorders. This analysis examines the impact of decreasing substance use, even without abstinence, on depressive symptoms among PLWH. Methods: Data are from PLWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Sites cohort. Participants completed longitudinal assessments of substance use (modified ASSIST) and depressive symptoms (PHQ-9). Changes in substance use frequency were categorized as abstinence, reduced use, and nondecreasing use. Adjusted linear mixed models with time-updated change in substance use frequency and depressive symptom scores were used to examine associations between changes in the use of individual substances and depressive symptoms. Analyses were repeated using joint longitudinal survival models to examine associations with a high (PHQ-9 ≥10) score. Results: Among 9905 PLWH, 728 used cocaine/crack, 1016 used amphetamine-type substances (ATS), 290 used illicit opiates, and 3277 used marijuana at baseline. Changes in ATS use were associated with the greatest improvements in depressive symptoms: stopping ATS led to a mean decrease of PHQ-9 by 2.2 points (95% CI: 1.8 to 2.7) and a 61% lower odds of PHQ-9 score ≥10 (95% CI: 0.30 to 0.52), and decreasing ATS use led to a mean decrease of 1.7 points (95% CI: 1.2 to 2.3) and a 62% lower odds of PHQ-9 score ≥10 (95% CI: 0.25 to 0.56). Stopping and reducing marijuana and stopping cocaine/crack use were also associated with improvement in depressive symptoms. Conclusions: We demonstrated that both substance use reduction and abstinence are associated with improvements in depressive symptoms over time

Assessment of community reintegration planning for sex offenders

Poor planning for reintegrating child molesters from prison to the community is a likely risk factor for sexual recidivism. The quality of reintegration planning was retrospectively measured for groups of recidivist (n = 30) and nonrecidivist (n = 30) child molesters who were individually matched on static risk level and time since release. Recidivists had significantly poorer reintegration planning scores than nonrecidivists, consistent with a previous study by the authors. Data from both studies were combined (total N = 141), and survival analyses showed that poor reintegration planning predicted an increased rate of recidivism. Accommodation, employment, and social support planning combined to predict recidivism, with predictive validity comparable to static risk models (area under the curve = .71). Summing these items yielded a scale of reintegration planning quality that differentiated well between recidivists and nonrecidivists and may have practical utility for risk assessment as an adjunct to static models.<br /

The quality of community reintegration planning for child molesters : effects on sexual recidivism

Research on the causal factors underlying sex offender recidivism has not considered the success or failure of the reintegration process by which the offender rejoins the community after prison. The authors developed a coding protocol to measure the quality and comprehensiveness of reintegration planning for sex offenders. The protocol was retrospectively applied to groups of recidivists and nonrecidivists who were matched on static risk level and follow-up time. The protocol demonstrated adequate reliability. Compared to nonrecidivists, recidivists had significantly lower scores relating to accommodation, employment, and the Good Lives Model secondary goods, as well as lower total reintegration plan scores. ANCOVAs showed that when IQ and level of sexual deviance were controlled for, accommodation (a place to live) was significantly related to sexual recidivism and the Good Lives Model&mdash;secondary goods was significantly related to any recidivism. These results suggest that poor reintegration planning may be a risk factor for recidivism.<br /