Estimated lifetime rates of partner violence among women in methadone maintenance treatment programs (MMTPs) range between 60% and 75% and rates of current crack/cocaine use among this population vary between 50% and 66%. Despite the high prevalence of both crack/cocaine and partner abuse among women in MMTP's and mounting evidence suggesting that they are interrelated phenomena, studies have yet to disentangle the temporal and multidimensional relationships between partner abuse and crack/cocaine dependence. A few studies have implicated partner abuse as a factor for sexual risk behaviors, further research is needed to explore the bidirectional relationships between partner abuse and sexual risk behaviors among women in MMTPs. Social support factors have been found to moderate drug use and HIV risk behaviors, and a few studies have suggested the importance of social support in helping women to avoid abusive situations and to mitigate the more deleterious effects of abuse such as post-traumatic stress disorder (PTSD). However, the influence of social support factors in mitigating the effects of partner abuse among women drug users remains unclear. Addressing these critical knowledge gaps, the proposed study will: 1) use in-depth qualitative methods to explore the relationship dynamics, drug and alcohol use situations and event sequences that culminate in actual episodes of partner violence among women in MMTP's; and 2) determine the prevalence and incidence of partner abuse and longitudinally examine the interrelationships among partner abuse, crack/cocaine use, sexual risk behavior, PTSD and social networks and support over time. The qualitative study, conducted early in the first year, will include 150 women on methadone who have recently experienced partner abuse, and who will participate in focus groups. An additional 50 abused women will participate in gender script interviews. For the longitudinal study beginning late in the first year, 750 women will be recruited and then pretested with a six and twelve month follow-up. All study participants will be recruited from Beth Israel Medical Center MMTP's in Harlem. Data from the proposed study may inform the assessment, treatment and referral protocols used by MMTP's staff to meet the diverse needs of their patients. The research will be led by investigators from the Social Intervention Group at Columbia University School of Social Work and conducted collaboratively with Beth Israel Medical Center and the HIV Center for Clinical and Behavioral Studies of the New York State Psychiatric Institute at Columbia University.
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