Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

262 IV. SPECIAL POPULATIONSamine and alcohol are the most frequently used substances. Recent studies byMansergh and colleagues (2001), Mattison, Ross, Wolfson, Franklin, andSan Diego HIV Neurobehavioral Research Center Group (2001), and Lee,Galanter, Dermatis, and McDowell (2003) indicate high rates of simultaneousdrug use at circuit parties; the average number of substances ingested byresponders on the day of the circuit party studied by Lee and colleagues was 2.4,with a range of 0 to 7. Most people report that using drugs during a circuit partyenhances the dancing experience, relieves inhibitions, and improves sex. Othersdescribe multiple substance use as self-medication for depressed mood, anxiety,social isolation, or stress associated with living with HIV disease or AIDS.Some participants report a synergistic effect between drugs, as in the case of theMDMA and ketamine combination; some users believe that it results in a moreintense “high,” while others feel that ketamine prolongs the effect of MDMA.Multiple Substance Use and HIV RiskMultiple substance use at circuit parties has recently become a great concern inthe gay community, in the context of the crystal methamphetamine epidemicand the rising incidence of HIV transmission among young gay men in largeurban environments. A study of 428 young gay and bisexual men under the SanFrancisco Young Men’s Health Study (Greenwood et al., 2001) found polydrugusers to be more likely to be HIV seropositive (OR = 2.05) or of unknown HIVstatus (OR = 2.78). The common link between HIV seropositivity and multiplesubstance use has not been demonstrated, but given the preceding discussion, itis reasonable to suspect that an important personality factor may be involved,such as behavioral dyscontrol in the form of impulsivity or sensation seeking.When disinhibiting drugs such as alcohol and GHB are taken concert, a personwho has high trait impulsivity is even more likely to engage in risky behavior.For example, Cook and colleagues (2001) identified gay men recently infectedwith syphilis in Liverpool, United Kingdom, and found that 61% had usedGHB as an aphrodisiac in the context of unprotected sex.The association of multiple substance use and HIV raises medical concernsboth in terms of HIV transmission and HIV treatment. Sexual disinhibitionand increased risk of HIV transmission have been correlated to substance use,and particularly to stimulants, not only in the gay community but also in a varietyof other settings (Levounis, Galanter, Dermatis, Hamowy, & De Leon,2002). These findings support the hypothesis that multiple substance use maydirectly result in increased rates of unsafe sex and HIV seroconversion. In termsof HIV treatment, club drugs such as MDMA and GHB interact with proteaseinhibitors, resulting in dangerously high levels of the club drugs (Harrington,Woodward, Hoofon, & Horn, 1999). Furthermore, patients often fail to adhereto complicated HIV pharmacological regimens during intoxication with orwithdrawal from a variety of different drugs of abuse (Lee et al., 2003).