Alcohol Dependence and HIV Part 1

Size: px

Start display at page:

Download "Alcohol Dependence and HIV Part 1"

Ann Snow
8 years ago
Views:

1 HIV Case Conference: Management of Psychiatric Conditions Patrick Marsh, MD Faculty, Florida/Caribbean AIDS Education and Training Center Assistant Professor, College Of Medicine, Psychiatry And Behavioral Neurosciences, USF Health Morsani College of Medicine (Up to 1.0 hour of CE/CME) Alcohol Dependence and HIV Part 1 1

2 Taking drugs if you have HIV is BAD Poor adherence Never on ART Stopping ART to drink HIV and Alcohol Reduced CD4 counts (independent of ART) Poor viral suppression (independent of ART) Increased rates of Hep C co-infection Baum

3 Substance Treatment in the USA Forty million Americans ages 12 and older (16 percent) 40-74% HIV/AIDS Only about 1 in 10 people receive treatment Addiction treatment programs are not adequately regulated The CASA Columbia National Advisory Commission on Addiction Treatment Gonzalez 2011 Substance Treatment in the USA In 2010 $28 billion was spent to treat the 40 million people with addiction cents of every dollar spent by federal, state and local governments on risky substance use and addiction go to pay for the consequences; only 1.9 cents go to prevention and treatment The CASA Columbia National Advisory Commission on Addiction Treatment 3

4 Medicine and Substance Abuse Substance abuse is a moral problem and therefore I have no business addressing it in a medical visit. A. True B. False Medicine and Substance Use 1956 AMA declared alcoholism an illness that can and should be treated within the medical profession 1989 AMA adopted a policy declaring addiction involving other drugs, including nicotine, to be a disease 47% of Americans would turn to a health professional if someone close to them needed help for addiction < 6% of referrals to publically funded addiction treatment come from a health care provider The CASA Columbia National Advisory Commission on Addiction Treatment 4

5 No medical training required 14 states do not require all addiction counselors to be licensed or certified 6 states no minimum degree requirements 14 states minimum requirement of high school degree or GED 10 states minimum requirement of associate s degree 6 states minimum requirement of bachelor s degree 1 state minimum requirement of master s degree The CASA Columbia National Advisory Commission on Addiction Treatment Florida Certified Addiction Specialist No degree, 150 hours of training and 100 hours of supervision Certified Addiction Counselor High School degree, 250 hours of training and 300 hours of supervision Certified Addiction Professional Bachelor degree, 350 hours of training and 300 hours of supervision 5

6 Substance Abuse Treatments Psychological Pharmacological Combination Public Health 6

7 Psychosocial Motivational Cognitive behavioral Community reinforcement Contingency management Behavioral/couples/family Substance Abuse Outcomes Abstinence Harm reduction Reduced use Fewer days of drinking/using Reduced consequences Reduced mortality Reduced crime Reduced transmission 7

8 Psychology of Substance User Impulsive Fearless Incapable of delayed gratification Opposite of people who go into health care!!! Traditional Counseling Immediate and Total Abstinence Provider set goals Confrontational Dichotomies Good (What I say) Bad (What you do) Nearly Completely Ineffective!! 8

9 Harm Reduction Transtheoretical Model of Behavioral Change Prochaska & DiClemente, 1982 Motivational Interviewing Miller & Rollnick, 2002 Transtheoretical Model Gradual Behavioral Change Conceptualized stages Identify patient s current stage Strategies to advance the stage Understanding of backward and forward progress of change Reduced provider frustration Increased patient acceptance 9

Motivational Interviewing Miller & Rollnick, 2002 Patient s are ambivalent Immediate positive reward for current behavior Delayed ambiguous reward for change Recognize the patient s desire to

10 Motivational Interviewing Miller & Rollnick, 2002 Patient s are ambivalent Immediate positive reward for current behavior Delayed ambiguous reward for change Recognize the patient s desire to continue current behavior Support and encourage recognition of helpfulness of behavioral change Strategy to move patient along stages of change Motivational Interviewing

11 References Centers for Disease Control and Prevention. Vital signs: current cigarette smoking among adults aged 18 years United States, Morbid Mortal Wkly Rep. 2010;59: Fuster M, Estrada V, Fernandez-Pinilla MC, et al. Smoking cessation in HIV patients: rate of success and associated factors HIV Med. 2009;10: Webb MS, Vanable PA, Carey MP, Blair DC. Cigarette smoking among HIV+ men and women: examining health, substance use,and psychosocial correlates across the smoking spectrum. J Behav Med. 2007;30: Lifson AR, Neuhaus J, Arribas JR, et al. Smoking-related health risks among persons with HIV in the strategies for management Feldman DN, Feldman JG, Greenblatt R, et al. CYP1A1 genotype modifies the impact of smoking on effectiveness of HAART among women. AIDS Educ Prev. 2009;21: Baum MK, Rafie C, Lai S, et al. Alcohol use accelerates HIV disease progression. AIDS Res Hum Retroviruses. 2010;26: Iralu J, Duran B, Pearson CR, et al. Risk factors for HIV disease progression in a rural southwest American Indian population. Public Health Rep. 2010;125: Shuper PA, Neuman M, Kanteres F, et al. Causal considerations on alcohol and HIV/AIDS a systematic review. Alcohol. 2010;45: de Jong BC, Prentiss D, McFarland W, et al. Marijuana use and its association with adherence to antiretroviral therapy among HIV-infected persons with moderate to severe nausea. J Acquir Immune Defic Syndr. 2005;38:43 6. Baum M, Rafie C, Lai S, et al. Crack-cocaine use accelerates IV disease progression in a cohort of HIVpositive drug users. J Acquir Immune Defic Syndr. 2009;50:93 9. Mehta SH, Lucas G, Astemborski J, et al. Early immunologic and virologic responses to highly active antiretroviral therapy and subsequent disease progression among HIV-infected injection drug users. AIDS Care. 2007;19: References Anton, Raymond F et al, Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence, JAMA, May 3, 2006 Vol 295, No. 17 Adam Gonzalez & Jennifer Barinas & Conall O Cleirigh, Substance Use: Impact on Adherence and HIV Medical Treatment, Curr HIV/AIDS Rep (2011) 8: The CASA Columbia National Advisory Commission on Addiction Treatment, Addiction Medicine: Closing the Gap between Science and Practice, June 2012 Rajasingham R, Mimiaga MJ, White JM, Pinkston MM, Baden RP, Mitty JA., AIDS Patient Care STDS Jan;26(1): Epub 2011 Nov 9. A systematic review of behavioral and treatment outcome studies among HIV-infected men who have sex with men who abuse crystal methamphetamine Grassi MP, Perin C, Clerici F, Zocchetti C, Cargnel A, Mangoni A. Acta Neurol Scand Aug;88(2): Neuropsychological performance in HIV-1-infected drug abusers. 11

12 Question & Answer Session 12

1. To create a comprehensive Benchmark plan that will assure maximum tobacco cessation coverage to all populations in Rhode Island:

1. To create a comprehensive Benchmark plan that will assure maximum tobacco cessation coverage to all populations in Rhode Island: POSTION STATEMENT Submitted to the Rhode Island Health Benefits Exchange Submitted By the Public Policy Workgroup of the Statewide Tobacco Cessation Committee on Tobacco Cessation Treatment Benchmarks