Implementing an Updated “Break the Cycle” Intervention to Reduce Initiating Persons into Injecting Drug Use in an Eastern European and a US “opioid epidemic” Setting

  • Don Des JarlaisEmail author
  • Anneli Uuskula
  • Ave Talu
  • David M. Barnes
  • Mait Raag
  • Kamyar Arasteh
  • Greete Org
  • Donna Demarest
  • Jonathan Feelemyer
  • Hayley Berg
  • Susan Tross
Original Paper


We tested the hypothesis that an updated “Break the Cycle” (BtC) intervention, based in social cognitive theory and motivational interviewing, would reduce the likelihood that current persons who inject drugs (PWID) would assist persons who do not inject drugs (non-PWID) with first injections in Tallinn, Estonia and Staten Island, New York City. 402 PWID were recruited, a baseline interview covering demographics, drug use, and assisting non-PWID with first drug injections was administered, followed by BtC intervention. 296 follow-up interviews were conducted 6 months post-intervention. Percentages assisting with first injections declined from 4.7 to 1.3% (73% reduction) in Tallinn (p < 0.02), and from 15 to 6% (60% reduction) in Staten Island (p < 0.05). Persons assisted with first injections declined from 11 to 3 in Tallinn (p = 0.02) and from 32 to 13 in Staten Island. (p = 0.024). Further implementation research on BtC interventions is urgently needed where injecting drug use is driving HIV/HCV epidemics and areas experiencing opioid epidemics.


Injecting drug use Initiation First injection Break the cycle HIV Opioid epidemic 



This work was supported through Grant 5-DP1-DA039542 from the US National Institute on Drug Abuse and Grant # IUT34-17 from the Estonian Ministry of Education and Research. The funding agency had no role in the design, conduct, data analysis or report preparation for the study.

Compliance with Ethical Standards

Conflict of interest

All authors have declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10461_2019_2467_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Don Des Jarlais
    • 1
    Email author
  • Anneli Uuskula
    • 2
  • Ave Talu
    • 2
  • David M. Barnes
    • 1
  • Mait Raag
    • 2
  • Kamyar Arasteh
    • 1
  • Greete Org
    • 2
  • Donna Demarest
    • 3
  • Jonathan Feelemyer
    • 4
  • Hayley Berg
    • 1
  • Susan Tross
    • 5
  1. 1.Social and Behavioral Sciences, College of Global Public HealthNew York UniversityNew YorkUSA
  2. 2.Department of Family Medicine and Public HealthUniversity of TartuTartuEstonia
  3. 3.CHASI: Community Health Action of Staten IslandNew YorkUSA
  4. 4.Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkUSA
  5. 5.HIV Center for Clinical and Behavioral Studies at The New York State Psychiatric Institute and Columbia UniversityNew YorkUSA

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