Remission of substance use disorders: gay men in the first decade of AIDS.

Abstract

Participants in a 5-year prospective study of HIV-seropositive and seronegative gay men demonstrated a significant decline in the rate (from lifetime to current) of alcohol and other DSM-III-R psychoactive substance use disorders. The goal of the current study was to identify factors associated with the cessation of problematic substance use, to observe rates of relapse over 4 years, and to describe factors associated with relapse and no relapse. A volunteer community sample of self-identified gay men (N = 56) were administered a semi-structured interview and several self-report measures by trained mental health clinicians, twice annually over a 5-year period. Retrospective and prospective data revealed a significant decline in substance use and problems associated with use in the decade of the 1980s. This change occurred, for the most part, without formal treatment. Numerous motivating factors were associated with this change, which included a fear of AIDS, a change in attitudes in the gay community, changes in other risk-taking behaviours and concerns about self-image. A variety of informal methods were employed. Most notable was "avoiding situations associated with substance use." Changes in substance abuse/dependence occurred in the context of health concerns, caring for oneself and "cleaning up one's act." Having a concern about "self-image," avoiding situations associated with drug use and not using "drug substitution" as a method of quitting were important factors for maintaining successful change.