Drug Use-Related Normative Misperceptions and Behaviors Among Persons Seeking Heroin Withdrawal Management.

Abstract

Normative perceptions about substance use are well-established predictors of substance use risk behaviors, yet no research to date has examined how people who use heroin perceive the drug use behaviors and their association with personal behaviors. In a sample of persons seeking heroin withdrawal, we compared normative beliefs (descriptive norms) about others' drug use behaviors, and examined the association between normative beliefs and behaviors. Participants (n = 241) were patients undergoing short-term inpatient heroin withdrawal management in Massachusetts. t-Tests were used to compare participants' perceptions about various substance use behaviors among both US adults and persons seeking heroin withdrawal at the same site. We also examined associations between participants' normative beliefs and personal substance use behaviors. Participants significantly overestimated drug-related risk behaviors of adults nationally; overall, participants estimated that 44.7% had tried heroin, 37.6% had injected drugs in the past year, and 63.2% had smoked marijuana in the past month when actual national rates are 2.0%, 0.3%, and 5.5%, respectively. Participants also held significant misperceptions about contemporaneous patients in the heroin withdrawal program; behaviors about sharing works, diverting buprenorphine or methadone, and exchanging sex for drugs or money were most substantially overestimated. Normative perceptions were associated with a range of personal drug-using behaviors (eg, injection drug use, exchanging sex for drugs or money). Consistent with existing substance use norms research, participants in the current sample tended to overestimate others' engagement in risky substance use, and these normative perceptions were associated with increased personal risk. Leveraging norms in heroin harm reduction interventions may hold substantial promise.