Implementing an Updated "Break the Cycle" Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US "opioid epidemic" Setting

AIDS Behav. 2019 Sep;23(9):2304-2314. doi: 10.1007/s10461-019-02467-y.


We tested the hypothesis that an updated "Break the Cycle" (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.

Keywords: Break the cycle; First injection; HIV; Initiation; Injecting drug use; Opioid epidemic.

MeSH terms

  • Adult
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Drug Users / psychology*
  • Epidemics*
  • Estonia / epidemiology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Motivational Interviewing
  • New York City / epidemiology
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / psychology*
  • Risk-Taking
  • Substance Abuse, Intravenous / epidemiology
  • Substance Abuse, Intravenous / prevention & control
  • Substance Abuse, Intravenous / psychology


  • Analgesics, Opioid