Intervention Description
Intervention Package Information
Evaluation Study and Results
References and Contact Information

Intervention Description

Target Population
Intranasal heroin users

Goals of Intervention

• Eliminate or reduce non-injection drug use
• Prevent transition to injecting drugs

Theoretic Basis

• Social Learning Theory

Intervention Duration
Four 60-90 minute sessions delivered over 2 weeks, plus HIV pre- and post-test counseling

Intervention Settings
Community store-front

Deliverer
Two group facilitators

Delivery Methods

• Counseling
• Exercises
• Group discussion
• Lecture
• Role play
• Risk reduction supplies (condoms)
• Video

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Intervention Package Information

An intervention package is currently available from Sociometrics, Inc..

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Evaluation Study and Results

The original evaluation was conducted in New York City between 1986 and 1988.

Key Intervention Effectss

• Reduced initiation of injection drug use

Study Sample
The baseline study sample of 104 intranasal heroin users is characterized by the following:

• 51% White, 26% African American, 23% Hispanic
• 70% Male, 30% Female
• 75% heterosexual, 11% homosexual, 13% bisexual
• Mean age of 27 years, range 16-48 years
• Mean education of 13 years, range 7-16 years

Recruitment Settings
Community (through newspaper ads and referrals)

Eligibility Criteria
Subjects were eligible if their primary route for using heroin in the previous 6 months was intranasal (“sniffing”), if they had not injected more than 60 times in the previous 2 years, and if they were HIV-negative or hepatitis B antibody negative (if refused HIV testing)

Assignment Method
Participants (N = 104) were randomly assigned to 1 of 2 groups: SNIFFER (n not reported) or comparison (n not reported).

Comparison Group
The comparison group participants only received a Hepatitis B test and HIV pre-test counseling, along with post-test counseling if they elected to take an HIV test.

Relevant Outcomes Measured and Follow-up Time
Injection drug use and condom use during past 6 months were measured on average 8.9 months (range from 5 to 21 months) after the intervention.

Participant Retention

• Overall study sample:

  n = 83 at follow-up
  80% retained at follow-up

• SNIFFER intervention (baseline n not reported, but if all lost-to-follow-up participants came from this group, retention rate would be 66%):

  n = 40 at follow-up
  ≥ 66% retained at follow-up

• Control (baseline n not reported, but if all lost-to-follow-up participants came from this group, retention rate would be 67%):

  n = 43 at follow-up
  ≥ 67% retained at follow-up

Significant Findings
At follow-up, the intervention participants were significantly less likely to report injecting any drugs than control participants (p < .05, one-tailed test).

Considerations

• This intervention fails to meet the best-evidence criteria due to small analytical sample sizes, low retention rates, and using a one-tailed test.
• As part of intake procedures, all study participants were given HIV pre-test counseling and offered HIV antibody testing. Post-test counseling was provided to all who accepted HIV testing (87%). Hepatitis B testing was required for those not electing to take the HIV antibody test to be used as a surrogate measure for HIV sero-status.
• The total baseline (n = 104) and follow-up (n = 83) sample sizes were reported, but baseline sample sizes and retention rates by group were not reported and are not available. The sample sizes were reported at follow-up, so lowest possible retention rates were calculated by subtracting all baseline subjects that were not retained (n = 21) from each group in turn. Since the actual retention rates would have been as good or better than the worst-case calculated rates, this study meets the promising-evidence criteria.
• The intervention targets heroin “sniffers” at high risk of transitioning into injection drug use. At baseline, 45% had injected in the past and 12% reported injecting in the past 6 months.

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References and Contact Information

• Des Jarlais, D. C., Casriel, C., Friedman, S. R., & Rosenblum, A. (1992). AIDS and the transition to illicit drug injection – results of a randomized trial prevention program. British Journal of Addiction, 87, 493-498.

  Researcher: Dr. Don C. Des Jarlais, NDRI, 11 Beach Street, New York, NY 10013. email: dcdesjarlais@aol.com

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