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. Author manuscript; available in PMC: 2011 Jan 1.
Published in final edited form as: Subst Use Misuse. 2010;45(1-2):116–133. doi: 10.3109/10826080902869620

Binge Use and Sex and Drug Use Behaviors among HIV(−), Heterosexual Methamphetamine Users in San Diego

W Susan Cheng 1, Richard S Garfein 1, Shirley J Semple 1, Steffanie A Strathdee 1, James K Zians 1, Thomas L Patterson 2,3
PMCID: PMC2861916  NIHMSID: NIHMS192069  PMID: 20025442

Abstract

This study identified sociodemographic factors, drug using practices, sexual behaviors, and motivational factors associated with binge (a period of uninterrupted) methamphetamine (MA) use among heterosexual MA users.

Sample and Method

The FASTLANE study provided cross-sectional data collected by audio-CASI between June 2001 and August 2004 from 451 HIV-negative MA users in San Diego, CA USA who had engaged in unprotected sex and used MA in the previous two months.

Results

The study sample was 67.8% male, 49.4% Caucasian, 26.8% African-American, and 12.8% Hispanic with a mean age of 36.6 years; 183 (40.5%) reported binge use in the past 2 months. Compared with non-binge users, binge users of MA were more likely to report risky drug use and sex behaviors and differed in motivations to initiate and currently use MA. The final logistic regression model for binge use included more days of MA use in the last month, ever treated for MA use, injection drug use, higher Beck Depression Inventory score, “experimentation” as a motivation for initiating MA use, and engaging in sex marathons while high on MA. HIV prevention efforts should differentiate and address these differences in motivations for MA use and the associated HIV-risk sex and drug use behaviors as key targets for effective intervention.

Keywords: methamphetamine, binge, drug use, motivations, intensity

Introduction

Despite prevention efforts of the last few decades, methamphetamine (MA) use remains a major public health concern (Boddiger, 2005; Colfax & Shoptaw, 2005; Meredith et al., 2005; Mansergh et al., 2006; Bucardo et al., 2005; Brouwer et al., 2006). Long-term use of MA, which acts on the dopamine centers of the brain, depletes the normal, physiological supply of dopamine leading to a “crash” from a MA-induced high and subsequent increased use of MA. A subgroup of MA users may binge on the drug in order to prolong euphoria and delay the inevitable crash (Sulzer et al., 2005; Cadet et al., 2003; McCann & Ricaurte, 2004; Semple et al., 2003; Cho & Melega, 2002). Although studies have shown a link between increasing years of MA use, increased tolerance to the drug’s effects, and greater amounts or frequency of MA use (Cho & Melega, 2002; Urbina & Jones, 2004), it is unclear whether binge use is also associated with length of the history of use. Binge use is often either self-classified or dichotomized as heavy versus light (Halkitis & Shrem, 2006), and an established definition of “binge use” of MA is currently lacking in the existing literature.

Chronic use of MA leads to commonly reported social, physical, and psychological consequences (Sommers et al., 2006; Domier et al., 2000; Havens et al., 2006; Brecht et al., 2004; Cho & Melega, 2002; Gibson et al., 2002; Kurtz, 2005; Matsumoto et al., 2002; Semple et al., 2004b; Semple et al., 2003; Semple et al., 2005). MA use has also been associated with HIV-risk behaviors such as unprotected sex, greater numbers of sex partners, casual or anonymous sex partners, engaging in marathon sex while high, and injection drug use (Bogart et al., 2005; Centers of Disease Control., 2006; Boddiger, 2005; Farabee et al., 2002a; Molitor et al., 1998; Molitor et al., 1999; Yen, 2004; Hacker et al., 2005; Somlai et al., 2003; Patterson et al., 2005; Semple et al., 2004b; Semple et al., 2003; Semple et al., 2005; Semple et al., 2004a). Studies have also shown a link between MA use and increased libido, as well as associations to a desire to enhance sexual pleasure or to lower inhibitions in order to seek sex partners, thus potentially leading to greater numbers of partners and engaging in marathon sex (Brecht et al., 2004; Diaz et al., 2005; Semple et al., 2002; Urbina & Jones, 2004) with concomitant increases in STIs and HIV infection (Urbina & Jones, 2004; Hirshfield et al., 2004; Halkitis et al., 2001; Shoptaw & Reback, 2006).

In a study of HIV-positive men who have sex with men (MSM) in San Diego, California, USA, binge use of MA was associated with higher levels of unprotected anal intercourse with HIV negative or unknown-status sex partners as well as with more MA-related consequences (Semple et al., 2003). Binge users were also more likely to cite injection drug use as the possible transmission mode of their HIV infection. In a different study of 98 female MA users in the same city, Semple et al. (Semple et al., 2004a) noted an association between intensity of MA use and behavioral consequences, although “binge use” was not specifically examined. In a prospective study of 1013 HIV-negative injection drug users (IDU) in Vancouver, British Columbia, Canada, although MA was not specifically examined, Miller et al. (Miller et al., 2006a) noted an association between binge use and HIV seroconversion, where binging was also associated with sharing of injection equipment, polydrug use, and trading sex for money or drugs. In addition, studies have also shown MA use to interfere with antiretroviral therapies and other HIV treatments (Urbina & Jones, 2004).

To date, there have been no studies of drug use patterns among heterosexual MA users. To address this gap in the literature, this study aims to: 1) describe the background characteristics, drug use and sex behaviors, and motivations for and consequences of MA use among binge users; and 2) to identify correlates of binge use in a sample of HIV-negative, heterosexual MA users. Results from this study will add to the growing body of literature regarding MA use among heterosexual populations and may help guide the development of future interventions.

Methods

The sample consisted of 451 HIV-negative, heterosexual, male and female MA users who were enrolled in the FASTLANE sexual risk reduction intervention study at the University of California, San Diego. Data were collected between June 2001 and August 2004 using a 90-minute Audio Computer-Assisted Self-Interview (ACASI) that queried socio-demographic characteristics, alcohol and drug use, MA use patterns, sexual risk behaviors, social cognitive factors, social network factors, and physical and psychiatric health variables. Participants were compensated $30 for their baseline assessment and first intervention counseling session.

Setting and Sample

Recruitment and Screening of Participants

Subjects were recruited predominantly from target areas with known high concentrations of MA users at specific peak times of day (e.g., Saturday night after 11 p.m.) (Semple et al., 2005). Participants were approached and recruited in person by community outreach workers. Recruitment efforts also utilized a social marketing approach through posters in public areas and ads in newspapers and magazines, and through referrals by family, friends, and previously-enrolled participants (Semple et al., 2005).

Study Population

The study population consisted of heterosexual, HIV(−) adults (≥ 18 years old) who had used MA at least twice in the 2 months prior to screening. Participants were also required to have engaged in unprotected anal, vaginal, or oral sex in the previous 2 months with a partner of the opposite sex. HIV-negative status was tested and confirmed prior to entry into the study and verified with the OraSure HIV-1 Oral Collection Specimen Device (reliability=99.9%) (Gallo et al., 1997).

Measures

Of the data collected by the FASTLANE baseline assessment, this study examined variables that had been found in previous studies to be correlated to either binge use or increased HIV risk.

Binge Use

Self-reported binge use was assessed as “yes” or “no” depending on participant response to the question, “Are you a binge user? By binge user, I mean you keep using large quantities of meth for a period of time, until you run out or just can’t physically do it anymore.” The definition for binge use was derived through in-depth qualitative interviews, and key components of binge use were identified through thematic analyses (Semple et all, 2002). Participants were also asked to describe a “typical binge,” including number of days of a “typical binge” and reason(s) for terminating the binge.

Demographic Characteristics

The following demographic characteristics were examined: gender (male or female); age at baseline interview (years); ethnicity (Caucasian or non-Caucasian); and educational attainment (no college or some college and beyond).

Drug Use

Drug-use characteristics included: polydrug use in last 30 days (yes or no); number of years of drug use (years); age at MA initiation (years); injection drug use (ever or never); ever been in treatment for MA (yes or no), and, consequently, completion of treatment program (completed or never completed). The amount (in grams) and frequency (number of days used) of MA use in the last 30 days were also examined.

Sex History and Behavior

Participants were asked the following questions regarding their sex behaviors in the previous two months: if they had a spouse or steady sex partner (yes or no); casual or anonymous sex partner (yes or no); total number sex partners (continuous); any STI in the last 60 days (yes or no); unprotected vaginal sex with (spouse or steady, and/or casual or anonymous) partners (always or sometimes); and engaged in sex marathons (prolonged sexual activity with genital contact for hours and hours, yes or no).

Psychosocial Measures

The following psychosocial variables were examined. number of consequences (physical, psychological, and social or legal) associated with MA use; level of depressive symptoms as measured by the Beck Depression Inventory (BDI) Score (Beck, 1967; Beck, 1976); and the following motivations to initiate and to currently use MA: to lose weight or feel more attractive, stay awake or get more energy, enhance sex or meet sex partners, experiment, and to escape or cope with mood.

Analysis

We compared correlates of binge use of MA. Descriptive statistics were calculated for the entire sample. Univariate logistic regression analyses were performed for all variables; subsequently, multivariate analyses for each grouping of variables (demographic, drug use, sex behavior, consequences of MA use, and motivations) were performed. A full multivariate regression model included significant variables (p<0.05) from the multivariate analysis by group, and manual backwards elimination was conducted to produce a final multivariate model that identified factors independently associated with binge use (p<0.05). Variables were checked for normal distribution, and variables which deviated were log-transformed. Covariates were also checked for collinearity. Potential effect modification by gender or by injection drug use status with drug use and sex behaviors was identified from the literature and examined.

Results

Among the 451 participants were 306 men and 145 women (Table 1). Although minorities were over-sampled to increase representation, most participants were Caucasian (49%), followed by African-Americans (27%) and Hispanics (13%). The average age at baseline was 36.6 years, and most participants had never attended college (58%). Demographic characteristics did not differ significantly between binge and non-binge users.

Table 1.

Univariate associations between sociodemographic, drug use, and sexual behavior characteristics and binge use (yes or no) among 268 non-binge and 183 binge methamphetamine (MA) users in San Diego, CA, 2001–2004.
All Non Binge Use Binge Use
Characteristic % (n) % (n) % (n) OR 95%CI
Gender: female (vs. male) 32.2 (145) 33.6 (90) 30.1 (55) 0.85 n.s.
Mean age (years) at interview (SD)* 36.6 (9.9) 37.2 (10.1) 35.6 (9.5) 0.98 n.s.
Ethnicity: Caucasian (vs. other minority) 49.4 (223) 48.5 (130) 50.8 (93) 1.1 n.s.
Education: ≤ high school (vs. ≥ college) 57.9 (259) 57.5 (153) 58.6 (106) 0.96 n.s.
Mean amount MA used in last 30 days in
 grams (SD)* 		9.4 (17.4) 7.5 (16.2) 12.3 (18.7) 1.02 (1.00, 1.03)
Mean number of days on which MA was
 used in last 30 days (SD)* 		14.6 (9.1) 13.4 (9.3) 16.3 (8.5) 1.04 (1.01, 1.06)
Injection drug use: ever (vs. never) 29.5 (133) 23.9 (64) 37.7 (69) 1.93 (1.28, 2.91)
Polydrug use: yes (vs. no) 47.5 (213) 45.5 (122) 50.6 (91) 1.09 n.s.
Mean years of MA use (SD)* 13.6 (8.9) 13.2 (8.9) 14.2 (8.9) 1.01 n.s.
Mean age of MA initiation (SD)* 22.9 (9.2) 24.0 (9.3) 21.4 (8.9) 0.97 (0.95, 0.99)
Ever treated for MA: yes (vs. no) 34.7 (156) 27.0 (72) 46.1 (84) 2.32 (1.56, 3.45)
Completed treatment: yes (vs. no) 52.3 (68) 51.7 (30) 52.8 (38) 1.04 n.s.
Types of sex partners in last 60 days:
 Spouse or steady: yes (vs. no) 93.1 (420) 92.9 (249) 93.4 (171) 1.09 n.s.
 Casual or anonymous: yes (vs. no) 88.9 (401) 86.9 (233) 91.8 (168) 1.68 n.s.
Mean # of sex partners in last 60 days
 (SD)* 		4.7 (6.1) 4.9 (6.8) 4.3 (5.0) 0.99 n.s.
Any STIs in last 60 days: yes (vs. no) 20.0 (89) 17.8 (47) 23.2 (42) 1.39 n.s.
Unprotected vaginal sex (last 60 days):
 With spouse or steady: always (vs.
  sometimes)		 85.4 (385) 82.8 (222) 89.1 (163) 1.69 n.s.
 With casual or anonymous partner:
  always (vs. sometimes)		 69.0 (311) 64.6 (173) 75.4 (138) 1.68 (1.11, 2.56)
Unprotected anal sex (last 60 days):
 Spouse or steady: always (vs.
  sometimes)		 32.8 (148) 28.4 (76) 39.3 (72) 1.64 (1.10, 2.44)
 Casual or anonymous: always (vs.
  sometimes)		 26.2 (118) 23.1 (62) 30.6 (56) 1.47 n.s.
Marathon sex while high on MA: yes (vs.
  no)		 64.7 (292) 59.7 (160) 72.1 (132) 1.75 (1.16, 2.62)
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*

Values for these characteristics are in the form of Mean (SD) instead of % (n).

Abbreviations: SD = standard deviation; n.s. = not significant (95%CI includes 1.0); OR = odds ratio; CI = confidence interval

Drug Use Behavior

Of the 451 participants, 183 self-reported binge use of MA in the past 2 months. The average MA binge lasted 6.6 days (Table 2). The most commonly reported reasons for stopping a binge were to “get some sleep” (35%), having “crashed, burned out” (21%), depletion of drug supply (18%), onset of paranoia (15%), and hallucinations (6%).

Table 2.

Characteristics of binge use among 183 binge methamphetamine (MA) users in San Diego, CA, 2001–2004.

Characteristic % (n) or Mean (SD)
Mean days of typical binge 6.6 (5.8)
Most common method of MA use:
  Smoke 54.6 (100)
  Snort 20.8 (38)
  Inject 24.6 (45)
Reported reasons for stopping a binge:
  To get some sleep 35.0 (64)
  Crashed, burned out 20.8 (38)
  Depletion of drug supply 17.5 (32)
  Onset of paranoia 14.8 (27)
  Hallucinations 6.0 (11)
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In the previous month, participants consumed on average 9.4g (SD=17.4) and used MA on 14.6 days (SD=9.1). As shown in Table 1, binge users reported a higher mean frequency of MA use (OR=1.29, 95%CI=1.17, 1.42) and a higher mean amount of MA used (OR=1.02, 95%CI=1.00, 1.03) compared to non-binge users. Study participants reported an average of 13.6 years of MA use (SD=8.9; range 0–42 years), and almost half (47.5%) of participants reported polydrug use; neither mean years of MA use nor polydrug use differed by binge status. The average age for MA initiation was 22.9 years, and binge users were significantly younger than non-binge users (OR=0.97, 95%CI=0.95, 0.99). Injection drug use was reported by 29.5% of participants and was associated with binge use (OR=1.93, 95%CI=1.28, 2.91). Among the subsample of participants who had ever been treated for MA use (N=156), only 52.3% had completed the treatment program. Past treatment for MA use was significantly associated with binge use (OR=2.32, 95%CI=1.56, 3.45).

Sex Behavior

During the two-month period prior to the interview, participants reported having had the following: an average of 4.7 (SD=6.1) sex partners; a spouse or steady sex partner (93.1%); a casual or anonymous sex partner (88.9%); unprotected vaginal sex (an inclusion criterion) with a spousal or steady sex partner (85.4%) or casual or anonymous partner (69.0%); unprotected anal sex with a spousal or steady partner (32.8%) or a casual or anonymous partner (26.2%); and sex marathons while high on MA (64.7%). In addition, 20% of participants reported having had an STI in the 60 days prior to the interview (Table 1). Unprotected vaginal sex with a casual or anonymous sex partner (OR=1.68, 95%CI=1.11, 2.56), unprotected anal sex with a spousal or steady sex partner (OR=1.64, 95%CI=1.10, 2.44), and engaging in marathon sex while high (OR=1.75, 95%CI=1.16, 2.62) were the only sexual behaviors that were significantly correlated with binge use.

Consequences of MA Use

The most commonly reported consequences of MA use were sleeplessness (95.4%), weight loss (87.4%), financial problems (87.4%), family problems (86.2%), and dehydration (81.6%) (data not shown). The majority reported physical problems such as lesions, dehydration, or diarrhea (85.3%), social consequences such as financial, legal, family, or relationship problems (76.9%), and psychological effects such as paranoia or hallucinations (53.4%) due to MA use (Table 3). Compared to non-binge users, binge users reported significantly higher rates of physical (OR=1.90, 95%CI=1.06, 3.40), social (OR=2.39, 95%CI=1.46, 3.91), and psychological problems (OR=1.95, 95%CI=1.33, 2.87). Study participants reported 6.2 (SD = 4.2) consequences on average (range = 0–13 consequences). The mean BDI score was 15.3 (SD = 10.2; range = 0–51); assuming commonly used cut-off scores (Beck et al., 1996), participants could be classified with BDI scores of 0–13 “minimal” (50.4%), 14–19 “mild” (17.3%), 20–28 “moderate” (19.9%), or 29–63 “severe” (12.4%) depression. Binge use was also associated with each unit increase of both greater number of consequences due to MA use (OR=1.12, 95%CI=1.05, 1.19) and a higher mean BDI score (OR=1.03, 95%CI=1.01, 1.05).

Table 3.

Univariate associations between consequences of current methamphetamine (MA) use and motivations for initiating MA use and binge use (yes or no) among 451 MA users in San Diego, CA, 2001–2004.
All Non Binge Use Binge Use
Characteristic % (n) % (n) % (n) OR 95%CI
Consequences of MA use:
 Social problems (e.g. relationship loss) 76.9 (350) 71.6 (192) 85.8 (157) 2.39 (1.46, 3.91)
 Psychological problems (e.g. paranoia) 53.4 (243) 47.0 (126) 63.3 (116) 1.95 (1.33, 2.87)
 Physical problems (e.g. lesions, diarrhea) 85.3 (388) 82.8 (222) 90.2 (183) 1.90 (1.06, 3.40)
Mean # of consequences of MA use (SD)* 6.2 (4.2) 6.6 (4.1) 7.3 (4.2) 1.11 (1.06, 1.16)
Mean Beck Depression Inventory Score (SD)* 15.3 (10.2) 14.0 (10.1) 17.2 (10.1) 1.03 (1.01, 1.05)
Motivations for starting MA use:
 To lose weight 20.4 (92) 18.7 (50) 22.9 (42) 1.30 n.s.
 To stay awake / get more energy 41.0 (185) 40.7 (109) 41.5 (76) 1.04 n.s.
 To enhance sex / meet sex partners 30.8 (139) 29.1 (78) 33.3 (61) 1.22 n.s.
 To experiment 42.1 (190) 35.4 (95) 51.9 (95) 1.95 (1.33, 2.87)
 To escape / avoidant coping 25.5 (115) 22.0 (59) 30.6 (56) 1.56 (1.02, 2.39)
Motivations for continuing MA use:
 To lose weight / feel more attractive 12.7 (57) 12.0 (32) 13.8 (25) 1.18 n.s.
 To stay awake / get more energy 33.9 (153) 35.4 (95) 31.7 (58) 0.84 n.s.
 To enhance sex / meet sex partners 30.6 (138) 26.5 (71) 36.6 (67) 1.60 (1.07, 2.40)
 To experiment 4.0 (18) 4.5 (12) 3.3 (6) 0.73 n.s.
 To escape / avoidant coping 24.4 (110) 20.2 (54) 30.6 (56) 1.75 (1.13, 2.70)
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*

Values for these characteristics are in the form of Mean (SD) instead of % (n).

Abbreviations: SD = standard deviation; n.s. = not significant (95%CI includes 1.0); OR = odds ratio; CI = confidence interval

Motivations for Initiating and Currently Using MA

Participants most often reported the following motivations to initiate MA use: “to lose weight” (20.4%), “to stay awake or get more energy” (41.0%), “to enhance sex or meet sex partners” (30.8%), “to experiment” (42.1%), and “to escape or avoidant coping” (25.5%) (Table 3). Using MA “to experiment” and “to escape or avoidant coping” were associated with binge use.

Motivations for current use of MA differed from motivations for initiating MA use. Fewer participants attributed current MA use to their desire “to lose weight or feel more attractive” (12.7%), or “to experiment” (4.0%); however, the motivation “to enhance sex or meet sex partners” (30.6%) and “to escape or avoidant coping” (24.4%) remained similar. Binge use itself was correlated with the motivation “to escape or avoidant coping” and the desire “to enhance sex or meet sex partners.”

Factors Independently Associated with Binge Use

Multivariate logistic regression modeling was performed for variables in each of the following groups: demographics, drug use behavior, sex history and behavior, and motivations or consequences. The following variables that were significantly associated with binge use (p<0.05) in univariate analyses also emerged as significant in the multivariate analyses within one of the four groups of variables and were thus entered into the full multivariate model: number of days of MA use in last 30 days, injection drug use, ever enrolled in a MA treatment program, and age at MA initiation (drug use variables); unprotected vaginal intercourse with a casual or anonymous partner, involvement in sex marathons while high on MA (sex behavior variables); number of consequences of MA use and BDI score (consequences); initiating MA use in order “to experiment” or “to escape or avoidant coping” (motivations to initiate use); and a desire to “enhance sex experiences or get sex partners” or “to escape or avoidant coping” (motivations for current use). The final multivariate model identifying factors independently associated with binge use (p<0.05) included number of days of MA use in last 30 days, ever treated for MA use, injection drug use, higher BDI score, engaging in sex marathons while high on MA, and initiating MA use due to a desire “to experiment,” and the full model explained 10% of the total variance (pseudo R2=0.10) (Table 4). No significant effect modification by gender or by injection drug use status was detected.

Table 4.

Multivariate analysis of sociodemographic, drug use, and sexual behavior characteristics by binge use (yes or no) among 451 methamphetamine (MA) users in San Diego, CA, 2001–2004.
Binge Use (yes/no)
Characteristic Odds
Ratio		 95% Confidence
Interval		 P-value
Number of days in last 30 used MA (in days) 1.02 (1.00, 1.05) 0.042
Ever treated for MA use: Yes (vs. No) 2.36 (1.55, 3.61) <0.001
Injection drug use: Yes (vs. No) 1.81 (1.17, 2.82) 0.008
BDI score (1 unit increase) 1.02 (1.00, 1.04) 0.023
Marathon sex while high on MA: Yes (vs. No) 1.86 (1.21, 2.87) 0.005
Starting MA use motivations: To experiment 2.01 (1.33, 3.03) 0.001
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Discussion

In this study of HIV-negative MA users, binge users did not differ significantly from non-binge users on any of the demographic characteristics that were assessed. Several drug use and sex behaviors differed by binge use including higher amounts and number of days of MA use, injection drug use, unprotected vaginal sex with a casual or anonymous partner, and engaging in marathon sex while high on MA. Binge use was also associated with a higher number of consequences, higher BDI score, and differences in motivations for MA use. The final multivariate model included more days of MA use in the last 30 days, prior treatment for MA use, injection drug use, engaging in marathon sex, higher BDI score, and the desire “to experiment” in initiating MA use.

Binge users reported significantly higher quantity and frequency of MA use compared to non-binge users. However, unlike intensity of drug use, which has been reported in the literature to increase with duration of use, binge use was not associated with average years of MA use. Therefore, binge use should be examined in both chronic, long-term MA users and in relatively new MA users. Binge use was also associated with a younger age at MA initiation; taken together, these findings suggest that incorporating awareness of the increased dangers associated with binge use into prevention programs adapted for younger adults is warranted. In a study of 90 HIV(+) MSM, Semple et al. (2003) also reported an association between binge use and younger age at MA initiation; injection drug use was reported by 40% of the study population, but it was not associated with binge use, unlike in the present study. The association of binge use with IDU in this study highlights a potential difference in drug use behavior between MSM and heterosexual binge use populations and reflects the importance of subgroup behaviors in HIV and STI prevention programs.

Consistent with the existing literature on MA-using populations (Bogart et al., 2005; Centers of Disease Control., 2006; Boddiger, 2005; Farabee et al., 2002b; Molitor et al., 1998; Molitor et al., 1999; Yen, 2004; Hacker et al., 2005; Somlai et al., 2003; Patterson et al., 2005; Semple et al., 2004b; Semple et al., 2003; Semple et al., 2005; Semple et al., 2004a), this study found that both binge and non-binge users of MA reported several STI-associated risk behaviors, including anonymous or casual sex partners, multiple sex partners, an STI in the last sixty days, unprotected vaginal sex, and engaging in sex marathons while high on MA. However, only engaging in sex marathons while high on MA, unprotected vaginal sex with a casual or anonymous partner, and unprotected anal sex with a spouse or steady sex partner were independently associated with binge status; no other sex behaviors differed by binge status. The participants in this study were recruited specifically for their higher HIV-risk behavior, and a majority reported engaging in unprotected vaginal intercourse with anonymous, casual, or steady partners. The combination of unprotected sex with the increased duration of (and the potentially greater number of partners during) sex marathons suggests that binge users may experience a higher risk of acquiring an STI or HIV. Therefore, binge MA use should be addressed in the design of STI prevention measures.

Previous studies have found an association between MA use and social, physical, and psychological consequences (Sommers et al., 2006; Domier et al., 2000; Havens et al., 2006; Brecht et al., 2004; Cho & Melega, 2002; Gibson et al., 2002; Kurtz, 2005; Matsumoto et al., 2002; Semple et al., 2004b; Semple et al., 2003; Semple et al., 2005). We found that binge users reported a greater number of consequences of MA use and higher Beck Depression Inventory scores, a finding that may help intervention programs address the overall well-being of treatment clients as well as reduce their HIV-risk in sex and drug use behaviors. In a study of MA binge use among HIV-positive men who have sex with men, Semple et al. (Semple et al., 2003) suggested that clinicians should discuss the consequences of MA with clients and encourage them to change or cease drug using behavior as a way to decrease the undesirable consequences.

Associated with binge use, the motivation “to escape” (avoidant coping) was cited as a motivation in initiating and currently using MA, and it may be that MA was used to mitigate the negative consequences surrounding the environments of MA users. Intervention programs that fail to address the consequences and lifestyle factors or environment of MA users may leave participants in a cycle of MA use, negative consequences, and further MA use to cope with the consequences. The motivations to escape that were cited by binge users may be addressed by incorporating counseling regarding negative self-perceptions or attitudes into current treatment modalities. Despite the significant number of participants who reported past enrollment in and even completion of a MA treatment program, all participants were still using MA at the time of their baseline interview (which was an inclusion criterion for the study). However, the cross-sectional nature of the data prohibits the causal examination of the consequences and the motivations “to escape” associated with binge use.

The differences in motivations for starting vs. continuing MA use on the part of binge users could be helpful in targeting vulnerable MA-using subpopulations. The association between binge use and the motivation “to experiment” in initiating MA use, and the prevalence of polydrug use in our study population, suggest that prevention and intervention programs targeting other drugs and alcohol may include discussion of the consequences and STI risks associated with MA use for a population potentially curious about and at risk for starting MA use. The desire “to experiment” may also suggest a propensity towards impulsivity or sensation seeking; in a previous study of this same FASTLANE population, impulsivity (including sensation seeking) was associated with binge use (Semple et al., 2005). Prevention strategies may wish to identify young individuals at risk for initiating MA use who report other impulsive or sensation seeking behaviors.

For current MA users, the increase in libido from MA (Volkow et al., 2007; Green & Halkitis, 2006; Gibson et al., 2002) may explain binge users’ increased desire to enhance sexual experiences or the desire to meet sex partners, which is particularly concerning when combined with the increased odds among binge users of engaging in sex marathons while high and the prevalence of unprotected sex in this study. A similar finding was reported by Semple et al. (2003) among their MSM population; total number of unprotected sex acts with HIV-negative or unknown status sex partners was also reported. The desire to use MA “to enhance sex” may provide extra challenges for prevention and intervention efforts; however, this observation also suggests that MA-using populations may serve as suitable targets for condom self-efficacy and negotiation interventions to encourage and improve safer sex behaviors. It is therefore important to note not only the differences in motivations to initiate (for prevention programs) and to currently use MA (for intervention efforts) but also the differences in motivations by binge use status.

The findings of this study are limited by the subjective data collection of behaviors and history of the participants. However, short recall periods and consistent reassurances of confidentiality were employed to limit potential recall and reporting bias. Another limitation is that “binge use” status was collected from self-classified and self-reported data; however, no established quantitative definitions are available for “binge use” in the literature, and corresponding studies of binge alcohol use and blood alcohol concentrations (BAC) highlight the difficulty in quantifying this concept. Several studies have shown the lack of correlation between “binge” drinking and blood alcohol concentration (BAC) levels, suggesting that those classified as “binge drinkers” are not necessarily the heaviest drinkers nor the ones most at risk of injury and health consequences from their alcohol use (Lange & Voas, 2001; Perkins et al., 2001; Wechsler & Kuo, 2000). The definition of “binge use” as the use of “large quantities of meth for a period of time–until you run out or just can’t physically do it anymore” prevents examination of the overlap between the reasons for ending a binge and binge criteria.

To further describe patterns of MA use, amount (in grams) and frequency (number of days) of MA use in the last 30 days were included in the multivariate model, which may produce an overly conservative estimate of binge use due to a potential overlap of amount and frequency of MA use with the definition of “binge use” in this study. Another potential limitation of the study may be in the generalizability of the data, since unprotected sex was an inclusion criterion. Finally the lack of a control group of non-users of MA prevents analysis of the binge use of other drugs (e.g., cocaine or heroin) as opposed to binge use of MA. It would be of interest to examine the drug use and sex behaviors of participants when they were high on MA versus when they consumed alcohol or other drugs. Also, it would be useful to examine if weekend or infrequent binge users differ from chronic or “weekday” binge users. Future studies may wish to examine whether motivations for MA use, including potential sensation-seeking behaviors, vary by binge use. Further “event-level” examination of drug use (amount and frequency of MA use, injection drug use) and sex behaviors during a binge may also be warranted. The increased HIV risk in drug-use behavior (injection drug use) and sex behavior (unprotected, multiple partners) may not be MA-specific. Further studies are required to differentiate the effects of MA versus other drugs on behaviors correlated with binge use.

In spite of these limitations, this study adds to the growing literature on MA use, especially among heterosexuals. Binging behavior may be an appropriate, distinct target of prevention and intervention strategies, especially given the associated risks of HIV and Hepatitis B or C infection and the potential for overdose with injection drug use (Domier et al., 2000; Razak et al., 2003; Vlahov et al., 1991; Miller et al., 2006a; Scheinmann et al., 2007; Miller et al., 2006b; Latkin et al., 2004; Kerr et al., 2006). The findings regarding increased HIV-risk behaviors associated with binge use will improve current knowledge of heterosexual populations and of the correlated behaviors and consequences of binge use, and it is to be hoped that they will also guide and improve current prevention and intervention programs tailored for MA users. In addition to increased HIV risk, binging on MA may be correlated with an increase in the number of physical, psychological, and social problems, while cessation or change in binge behavior may prove a reasonable goal of treatment. Future studies on the effects of binge use in other populations are warranted to complement these findings.

Acknowledgements

This study was funded in part by grants from the National Institute of Mental Health (R01 MH61146), the National Institute of Drug Abuse (R01 DA12116), by an NIMH Center Grant (P50 MH45294), by the Department of Veterans Affairs, and by the State of California’s Universitywide AIDS Research Program (IS02-SD-701). Special thanks to Brian Kelly for his editorial contribution and comments.

Glossary

Audio-CASI

Audio-enabled computer assisted self-interviewing provides increased privacy for participant interviews, especially with respect to sensitive topics regarding drug use and sex behaviors

Beck Depression Inventory Score

Based on 21 varied topics, the calculated BDI score allows for a measure of depression in the participant with a range from 0 to 63.

Binge use

A period of uninterrupted drug use.

Pseudo R2

The percentage of the total variance that was explained by the final multivariate logistic regression model

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