REMISSION OF SUBSTANCE USE DISORDERS - GAY MEN IN THE 1ST DECADE OF AIDS

Objective: Participants in a 5-year prospective study of HIV-seroposit ive and seronegative gay men demonstrated a significant decline in the rate (from lifetime to current) of alcohol and other DSM-III-R psycho active substance use disorders. The goal of the current study was to i dentify factors associated with the cessation of problematic substance use, to observe rates of relapse over 4 years, and to describe factor s associated with relapse and no relapse. Method: A volunteer communit y sample of self-identified gay men (N = 56) were administered a semi- structured interview and several self-report measures by trained menta l health clinicians, twice annually over a 5-year period. Results: Ret rospective and prospective data revealed a significant decline in subs tance use and problems associated with use in the decade of the 1980s. This change occurred, for the most part, without formal treatment. Nu merous motivating factors were associated with this change, which incl uded a fear of AIDS, a change in attitudes in the gay community, chang es in other risk-taking behaviors and concerns about self-image. A var iety of informal methods were employed. Most notable was ''avoiding si tuations associated with substance use.'' Conclusions: Changes in subs tance abuse/dependence occurred in the context of health concerns, car ing for oneself and ''cleaning up one's act.'' Having a concern about ''self-image,'' avoiding situations associated with drug use and not u sing ''drug substitution'' as a method of quitting were important fact ors for maintaining successful change.