A pilot survey of aberrant drug-taking attitudes and behaviors in samples of cancer and AIDS patients

The clinical assessment of drug-taking behaviors in medically ill patients with pain is complex and may be hindered by the lack of empirically derived information about such behaviors in particularly medically ill populations . To investigate issues surrounding the assessment of these behaviors, we p iloted a questionnaire based on the observations of specialists in pain man agement and substance abuse. This preliminary questionnaire evaluated medic ation use, present and past drug abuse, patients' beliefs about the risk of addiction in the context of pain treatment, and aberrant drug-taking attit udes and behaviors. This instrument was piloted in a mixed group of cancer patients (N = 52) and a group of women with HIV/AIDS (N = 111). Reports of past drug use and abuse were more frequent than present reports in both gro ups. Current aberrant drug-related behaviors were seldom reported, but atti tude items revealed that patients would consider engaging in aberrant behav iors, or would possibly excuse them in others, if pain or symptom managemen t were inadequate. Aberrant behaviors and atttitudes were endorsed more fre quently by the women with HIV/AIDS than by the cancer patients. Patients gr eatly overestimated the risk of addiction in pain treatment. We discuss the significance of these findings and the need for cautious interpretation gi ven the limitations of the methodology. This early experience suggests that both cancer and HIV/AIDS patients appear to respond in a forthcoming fashi on to drug-taking behavior questions and describe attitudes and behaviors t hat may be highly relevant to the diagnosis and understanding management of substance use among patients with medical illness. J Pain Symptom Manage 2 000;19:274-286. (C) U.S. Cancer Pain Relief Committee, 2000.