Deficits in executive function as a predictor of lifetime drug use among African American women

Background: African American female drug users are more likely than African American male drug users to exhibit frontal-executive deficits. The present study sought to test whether African American female drug users who have impairments in executive functioning have a higher risk of lifetime drug use.

Methods: A series of secondary data analyses were conducted on data from African American female drug users (N= 240) enrolled in the NEURO Epidemiologic Study of HIV in Baltimore, MD. Participants were recruited through street outreach and administered a standardized HIV Risk Behavior Interview and a neuropsychological battery, including the Wisconsin Card Sorting Test (WCST).

Results: African American female drug users who were impaired on WCST total errors (Adjusted Odds Ratio [AOR]=2.49, 95% Confidence Interval [CI]: 1.45-4.27, p=.001) and WCST preservative errors (AOR=2.26, 95% CI: 1.33-3.84, p=.003) were more likely to have a history of lifetime injection heroin use. In addition, women with impairments on WCST total errors (AOR=2.53, 95% CI: 1.37-4.63, p=.003) and WCST preservative errors (AOR=.55, 95% CI: .31-.95, p=.034) were more likely to have a lifetime prevalence of injection cocaine use. Conversely, impairment on WCST did not predict increased non-injection heroin or cocaine use.

Conclusion: Our findings suggest that impairments in complex problem solving ability may be associated with increased likelihood of injecting heroin and cocaine. Injection drug use is notably related to the spread of HIV as well as increased engagement in other risk behaviors. Thus, HIV prevention efforts should consider interventions that focus on cognitive executive skill training.