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 terminal nature of their AIDS condition removes much of the hope which
often motivates a drug user to make lifestyle changes. This perceived hopelessness
justifies on-going drug-use among persons with AIDS, while some 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 reported some history of drug use upon admission to the
program, with approximately 70% reporting on-going drug use. In initially
surveying the client population, this study will examine their 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, this study intends to include these factors in designing and empirically
testing their effectiveness in effecting a change in the drug use patterns
of persons with AIDS.
The Principal Investigator of the study is Andrew Hamid, Ph.D., Assistant
Professor, CUSSW. The Program Director is Susan Bear, M.S.W., JBFCS, Director
AIDS Day Program and Brooklyn Scattered Site Program.
References
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Centers for Disease Control. (1991). September HIV/AIDS Surveillance.
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the Multicenter K. Crack Cocaine and HIV Infection Study Team. (1994).
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