Improving health outcomes among individuals with HIV, mental illness, and substance use disorders in the Southeast

Abstract

Providing behavioral treatment for mental health and substance use disorders among HIV-infected individuals is critical because these disorders have been associated with negative outcomes such as poorer medication adherence. This study examines the effectiveness of an integrated treatment model for HIV-infected individuals who have both substance use and mental disorders. Study participants (n = 141) were recruited through routine mental health and substance abuse screening at tertiary Infectious Disease clinics in North Carolina. The study participants received integrated mental health and substance abuse treatment for one year and were interviewed at three-month intervals. Using linear regression analyses, we detected statistically significant decreases in participants’ psychiatric symptomatology, illicit substance use, alcohol use, and inpatient hospital days. Participants also reported fewer emergency room visits and were more likely to be receiving antiretroviral medications and adequate psychotropic medication regimens at follow-up. No changes in sexual risk, physical health, or medical adherence were detected after treatment participation. This integrated treatment model offers an option for treating HIV-infected individuals with mental health and substance use disorders that can be adapted for use in a variety of psychiatric and medical treatment settings.

Acknowledgments

This manuscript is a product of research conducted with support from the Substance Abuse and Mental Health Services Administration's (SAMHSA) Center for Mental Health Services (CMHS), Grant #93–230, and its Center for Substance Abuse Treatment (CSAT); the HIV/AIDS Bureau (HAB), Health Resources and Services Administration; and the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The content of this publication does not necessarily reflect the views or policies of SAMHSA, HRSA, NIH or the U.S. Department of Health and Human Services.

In addition, we would like to thank Rodney Thompson and Leslie King for their excellent work with the screener. We thank Melissa Moore for her editorial and administrative support and Curtis Coomes and Chandra Ford for their editorial support. We would also like to thank the clinics involved for their assistance in providing space for this study and all study participants for their contribution to this research.

Notes

1. Includes Barbiturates, Cocaine, Crack, Hallucinogens, Heroin, Inhalants, Methadone, Amphetamines, Other opiates, Other sedatives.

2. Each composite score is the sum of answers to several questions within the respective ASI problem area, weighing all questions equally (McGahan et al., 1986).