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  Booth, R.E., Watters, J., & Chittwood, D.D. (1993). HIV risk-related sex behaviors among injection drug- users, crack smokers, and injection drug users who smoke crack. American Journal of Public Health, 83, 1144-48. 

Centers for Disease Control. (1991). September HIV/AIDS Surveillance. Atlanta: Author. 

Edlin, B.R., Irwin, K.L., Farugue, S., McCoy, C.B., Word, C., Serrano, Y., Inciardi, J.A., Bowser, B.P., Schilling, R.F., Holmbert, S.D., & the Multicenter K. Crack Cocaine and HIV Infection Study Team. (1994). Intersection epidemics - crack cocaine use and HIV infection among inner-city young adults. The New England Journal of Medicine, 331 (21), 1422-7. 

Goehl, L., Nunes, E., Quitkin, F., & Hilton, I. (1993). Social networks and methadone treatment outcome: The costs and benefits of social ties. American Journal of Drug and Alcohol Abuse, 19 (3), 251-62. 

National Commission on AIDS. (1991). Report on the twin epidemics of substance use and HIV. Washington, D.C.: U.S. Government Printing Office. 

Rossi, J.S., Rosenbloom, D., Monti, P.M., Rohsenow, D.J., Prochaska, J.O., & Martin, R.A. (August, 1993). Transtheoretical model of behavior change for cocaine use. Paper presented at the 101st annual meeting of the American Psychological Association in Toronto, Ontario, Canada. 

Schafer, J., and Fals-Stewart, W., (1996). Measuring cocaine effect expectancies among therapeutic community in- patients. Addictive Behavior, 21, 205-10. 

Schilling, R.F., El-Bassel, N., & Gilbert, L. (1992). Drug use and AIDS risks in a soup kitchen population. Social Work, 37 (4). 

Schilling, R.F., El-Bassel, N., & Gilbert, L. (1993). Predicators of changes in sexual behavior among women on methadone. American Journal of Drug and Alcohol Abuse, 19(4), 409-422. 

Velicer, W.F., DiClemente, C.C., Rossi, J.S., & Prochaska, J.O. (1990). Relapse situations and self-efficacy. Addictive Behavior, 15, 271-283.