Substance use predictors of poor medication adherence: the role of substance use coping among HIV-infected patients in opioid dependence treatment

AIDS Behav. 2013 Jan;17(1):168-73. doi: 10.1007/s10461-012-0319-6.


Many HIV-infected injection drug users (IDUs) continue to use illicit substances despite being in substance use treatment. Substance use is associated with non-adherence to HIV medications; however underlying mechanisms regarding this relation are understudied. The current investigation examined the role of substance use coping in terms of the relation between substance use and HIV medication adherence. Participants were 121 HIV-infected IDUs (41 % female, M age = 47, SD = 7.1) in opioid dependence treatment. Participants completed self-report questionnaires, were administered clinical interviews and oral toxicology screens, and used a medication-event-monitoring-system cap to assess 2 week HIV medication adherence. The use of cocaine and multiple substances were significantly related to decreased medication adherence. Substance use coping mediated these associations. Findings highlight the importance of assessing, monitoring, and targeting ongoing substance use, and ways to increase positive coping for HIV-infected IDUs in substance use treatment to aid in HIV medication adherence.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adaptation, Psychological*
  • Adolescent
  • Adult
  • Antiretroviral Therapy, Highly Active
  • CD4 Lymphocyte Count
  • Drug Users / psychology*
  • Female
  • Follow-Up Studies
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • HIV Infections / psychology
  • Humans
  • Interviews as Topic
  • Male
  • Massachusetts
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data
  • Methadone / therapeutic use
  • Middle Aged
  • Narcotics / therapeutic use
  • Opiate Substitution Treatment
  • Opioid-Related Disorders / complications*
  • Opioid-Related Disorders / drug therapy
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / psychology
  • Regression Analysis
  • Severity of Illness Index
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / drug therapy
  • Substance Abuse, Intravenous / epidemiology
  • Substance Abuse, Intravenous / psychology
  • Surveys and Questionnaires
  • Viral Load
  • Young Adult


  • Narcotics
  • Methadone