The Development of Substance Abuse Treatment for Persons with AIDS

Andrew Hamid, Ph.D.

The combined impact of substance abuse and AIDS has created a formidable challenge for service providers. Currently, more than 30% of all reported cases of AIDS are directly linked to injection drug use (IDU) (Centers for Disease Control, 1994). It is the second risk factor for HIV infection nationwide and the first risk factor in some urban areas of the country. In the New York metropolitan area, for example, HIV seroprevalence among injection drug users is approximately 60% (National Commission on AIDS, 1994). Furthermore, IDU is the fastest growing risk factor for heterosexuals, persons of color, women, and children.

While much has been written about AIDS prevention among substance abusers, and studies have examined high-risk drug-related behavior among HIV+ persons (Booth, et al., 1993; Schilling, et al., 1992), few outcome studies have been designed to examine ways of enhancing service delivery and effective treatment to substance abusers with AIDS. This particular study focuses on developing specific interventions aimed at effectively addressing on-going substance use among persons with AIDS.

Substance abusers with AIDS comprise a challenging population to work with. The possible terminal nature of their AIDS condition removes much of the hope which often motivates a drug user to make lifestyle changes. This perceived hopelessness may be used as a justification for on-going drug-use among persons with AIDS, while some may even increase their involvement in drug use to cope with the despair of being afflicted with AIDS. On-going substance abuse among persons with AIDS often leads to consequences such as high attrition or inconsistent participation in treatment, a sequelae of high-risk behaviors, neglect of personal health, and a further compromised immune system.

At this project site, the JBFCS AIDS Day Program (ADP), approximately 80% of the clients have reported some history of drug use upon admission to the program, with approximately 70% reporting on-going drug use. As an initial survey of this client population, this study will examine history of substance use, recent patterns of substance abuse, participation in the ADP's recovery groups, antecedent conditions to drug use, reasons for abstinence, means of achieving and maintaining abstinence, difficulties in achieving abstinence, and involvement in high-risk behaviors related to drug- use.

Recent studies examining factors related to substance abuse treatment outcome have focused on such factors as client self-efficacy (Velicier et al., 1990), readiness to change (Rossi et al., 1993), locus of control (Schilling et al., 1993),outcome expectancies (Schafer, 1996), perceived risk (Schilling et al., 1992), and social support and social networks (Goehl et al., 1993). For the present study, a questionnaire will be developed and administered to investigate the above factors as they relate to substance abusers with AIDS. As relationships emerge between these factors and change in drug use, it is the aim of this study to use these factors in designing and empirically testing their effectiveness in effecting a change in the drug use patterns of persons with AIDS.

The study Principal Investigator is Andrew Hamid, Ph.D., Assistant Professor, CUSSW. The program Director is Susan Bear, M.S.W., JBFCS, AIDS Day Program.


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