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Heroin use in Bulgaria

Bulgarian-born Dr. Jasmin Vassileva lived in Sofia for 25 years under communism before leaving for the West. But her native country posed challenges irresistible to a neuropsychologist: researching a link between the spread of HIV/AIDS and impulsivity triggered by heroin use - in a country where research is scarce and her own field is barely recognized.

“We’re hoping to identify the people who are most at risk for getting infected with HIV in particular, which will be very useful for Bulgaria given their very limited resources for funding,” said Vassileva, who teaches at the University of Illinois at Chicago. “Research is almost nonexistent in Bulgaria.”

Young Bulgarian man looks into camera, village buildings and other people in background
Photo by Scott Wallace/World Bank

Heroin is relatively cheap in Bulgaria, where the
unemployment rate is high among young male
adults, especially the Roma.

Vassileva began studying the effects of antisocial and psychopathic tendencies on decision-making and other cognitive functions in heroin addicts. After communism, heroin became a significant public health problem in Bulgaria due to its location on the Balkan drug route between the poppy fields of Afghanistan and western Europe. Studying heroin users in Bulgaria was also ideal in that they are typically not polysubstance users. In Chicago, between 70 and 80 percent of heroin addicts are also addicted to crack cocaine.

“This allows us to investigate the unique effects of a drug on neurocognitive functioning without having the issue of additional drugs,” said Vassileva.

Vassileva said two of her studies in Bulgaria were funded by Fogarty and the National Institute on Drug Abuse as part of the Brain Disorders in the Developing World: Research Across the Lifespan program, which develops collaborative research and capacity building projects on brain disorders throughout life in low- and middle-income countries.

Muddy path full of puddles between shantys in a ghetto in Sophia, Bulgaria, rain falls, two people run away from camera
Photo by Scott Wallace/World Bank

Heroin use in Bulgaria may be linked to risky
sexual behavior and the spread of HIV/AIDS.

The research in Bulgaria promises to add important findings to the research of addiction. Results from the current study, Vassileva explained, can be used to determine whether and how heroin and amphetamines contribute to impairment of neurocognitive functions and thus increase the likelihood of getting HIV. “By identifying the people who are most impaired we can identify the ones who should be targeted first by drug prevention programs before they become infected or before they infect others with HIV and other hard to treat diseases,” she said.

In the current study, comparing heroin users to amphetamine users, researchers are looking at neurocognitive impairments associated with the long term pharmacological effects of the two different types of drugs. Would stimulant users be more impulsive than heroin users? The study goal is to test 300 subjects and they are about halfway there after three years, with two years remaining. Preliminary data reveal that amphetamine users have a more impulsive personality style and show greater risk-taking on neurocognitive tests, whereas heroin users tend to engage in more risky drug and sexual behaviors that increase their risk for HIV and other diseases such as hepatitis C.

Interestingly, the greater engagement of heroin addicts in risky behaviors appears to be driven not so much by impulsivity, but rather by diminished self-efficacy in implementing safer sex and drug use behaviors, Vassileva noted. A goal is to develop biological and psychological interventions for substance-dependent individuals.

Last year, Vassileva’s researchers began extracting DNA from participants. They don’t have funding for genotyping, but colleagues at the Medical University at Sofia are storing the DNA. This will allow time to apply for an additional grant to look for a genetic link between impulsive behavior and addiction to particular drugs.

Another goal for Vassileva is to help young people learn about neuropsychology and diseases of the brain, so during her two or three yearly visits to Bulgaria she organizes small workshops for researchers. She’s hoping that some of these budding scientists will choose to stay, rather than seeking opportunities in countries where research is better established.

Vassileva has been invited to give the keynote address at the November meeting of the Bulgarian Psychological Association. “Even psychologists don’t think of addiction as a brain disease,” she said, “so that’s one of the main goals of my speech.”