Substance Abuse Treatment among Patients with HIV and Mental Illness

Untreated substance use and mental health conditions are associated with increased HIV transmission risk, decreased adherence to highly active antiretroviral therapy (HAART), and poor response to HAART. Researchers sought to determine the receipt of substance abuse and mental health treatment over a 3-month period in a cohort of 803 HIV infected individuals who met diagnostic criteria for substance use and mental health disorders. Primary findings were as follows:

• Forty-seven percent of subjects had drug and alcohol dependence, 33% had drug dependence, 15% had alcohol dependence, and 5% had drug and/or alcohol abuse but not dependence.

• Only 33 percent had received concurrent treatment for substance abuse and mental illness in the past 3 months; 26 percent had received only mental health services, 15 percent had received only substance abuse services, and 26 percent had received no services.

• Use of concurrent substance abuse and mental health services was lower among nonwhites and Hispanics (p<0.05) but was positively associated with Veterans Affairs Civilian Health and Medical Program of the Uniformed Services (VA CHAMPUS) insurance coverage (p<0.05).

• African American, Hispanic, and nonwhite subjects were more likely to use self-help groups than white non-Hispanic subjects (p<0.001).

Comments:

The low use and racial disparities seen in the receipt of substance-abuse treatment services among patients diagnosed with HIV infection, substance abuse, and mental health disorders is concerning. These findings have implications for the individual and the public. Strategies to make substance-abuse treatment services more attractive, more available, and more effective are needed to address the issues highlighted in this study.

David A. Fiellin, MD

Reference:

Weaver MR, Conover CJ, Proescholdbell RJ, et al. Cost Subcommittee of the HIV/AIDS Treatment Adherence, Health Outcomes, and Cost Study Group. Utilization of mental health and substance abuse care for people living with HIV/AIDS, chronic mental illness, and substance abuse disorders. J Acquir Immune Defic Syndr. 2008;47(4):449–458.