The anatomy of risk: a quantitative investigation into injection drug users' taxonomy of risk attitudes and perceptions.

The authors report on the first study to use the systematic quantitative methods of the psychometric paradigm of risk analysis to examine risk perceptions among substance abusers. Fifty opioid-dependent injection drug users (IDUs) and 50 matched, control individuals completed a series of measures to provide quantitative representations of risk perceptions about 53 risk-laden items (including activities, substances, technologies, and diseases). Results indicated that risk perceptions of IDUs and controls were highly correlated on many items; however, IDUs perceived several items, such as hepatitis, HIV, handguns, and unprotected sex, as markedly more risky. IDUs also perceived both themselves and others as having greater risk of contracting hepatitis and HIV. IDUs wanted significantly reduced regulation of drugs, including prescription drugs, heroin, valium, and barbiturates. Factor analyses conducted to understand how risk ratings related to various characteristics that have been shown to influence risk perception revealed 3 factors that account for approximately 80% of the variability in risk perception across groups: Factor 1, related to the severity of the risk; Factor 2, related to the certainty of the risk; and Factor 3, related to the immediacy of the risk. However, IDUs more strongly associated the extent to which they were personally affected by a risk item and the extent to which the risk affected fewer or more people to Factor 1, whereas control participants more strongly associated these characteristics with Factor 2. Identifying improved methodologies for evaluating the risk perceptions of IDUs may be of considerable utility in understanding their high-risk behavior.