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Because of the debilitating effects on the body and mind of drug and alcohol abuse, those patients with already compromised health must be encouraged as much as possible to minimize or eliminate their substance use and abuse. Additionally, because substance abuse can lead to a decrease in other medications compliance, drug abuse can exacerbate the symptoms and progression of an otherwise very treatable disease. Substance abuse also increases the prevalence of risky sexual and transmission behaviors, and as such achieving sobriety within this subset is also of public health importance.

The treatment needs of HIV and AIDS patients are both similar and as well more complicated than the treatment required for a single diagnosis of substance abuse. An HIV or AIDS patient may be suffering from additional health complications that require frequent medical interventions during a period of rehab, and they may also require life saving medications that may complicate the recovery process. Mentally, the prevalence of co occurring psychiatric disorders is significantly higher, and since any dual diagnosis complicates treatment, the existence of HIV or AIDS, substance abuse and a corresponding mental illness makes the effective rehabilitation of this group problematic.

AIDS, can cause cognitive declines, and patients struggling with these cognitive challenges, and the anxiety accompanying these declines, have more difficulty internalizing the lessons of drug and alcohol rehab and using the strategies and therapies of rehab to good effect in drug and alcohol avoidance.

In short, the treatment of HIV or AIDS affected substance abusers is very complex, but because drug or alcohol abuse can greatly damage an already weakened body, can reduce HIV medications compliance and cause an exacerbation of psychiatric conditions, HIV and AIDS patients with substance abuse issues desperately need intervention and intensive and appropriate drug residential rehab.

Individual Therapy

Private sessions with a psychologist or addictions therapist can help the recovering HIV positive addict to develop a sensible relapse prevention strategy, as well as to deal with many of the issues surrounding abuse and disease progression, and to continue to work through the psychological issues associated with both abuse and declining health.

The therapist or councilor working with the HIV or AIDS patient must be fully informed and educated about the mental health issues facing this sub group of addicts and must be aware of the interaction between mental health and AIDS HIV, the exacerbation of mental health issues through abuse, and the possible interactions of HIV AIDS medications and mental health and substance abuse.

Because disease progression can induce changing psychological issues, the therapist or psychologist must be prepared to continually re diagnosis and respond to emerging issues throughout the course of treatment.

Complete abstinence is not considered to be a reasonable goal when faced with the marked cognitive declines of the later stages of AIDS, and the therapist or psychologist must determine whether a harm reduction or abstinence model is preferable for the individual patient.

Essentially, the therapeutic goals are similar, but the underlying complexity of the treatment is increased, and therapists not educated to the challenges and complexities of HIV and AIDS, may not accurately diagnose or recognize certain pertinent issues.

Aftercare and Case Management

Long term sobriety and harm reduction best occurs when recovering HIV and AIDS patients continue with comprehensive aftercare under the supervision of a case management worker.

Through disease progression, there may be certain incidents (the first emergence of symptoms or the development of AIDS) that increase the likelihood of relapse and further abuse, and case management workers should be present to intervene when necessary.

The best aftercare regimen continues peer group and individual therapy with case management that may include social assistance (housing and employment) when appropriate.

HIV and AIDS patients suffering concurrent substance abuse issues need immediate intervention and treatment. Substance abuse exacerbates the health declines of the disease and lowers treatment compliance. Continuing abuse increases the transmission of HIV AIDS through risky sexual and drug taking behaviors, and continuing substance abuse exacerbates the commonly experienced psychological challenges facing these patients.

HIV and AIDS patients recovery from substance abuse presents complex challenges to addictions professionals, but because the harm of substance abuse is magnified within this group of addicts, intervention needs to occur, and treatment needs to take place with an understanding of the unique issues and challenges of HIV and AIDS substance abusers.

How Does It Differ From Conventional Rehab?

HIV and AIDS patients do not necessarily require a specific facility for their treatment, but any facility attempting to treat substance abuse for HIV or AIDS patients must provide additional programming and medical access.

The involvement of outside case workers and doctors will need to be incorporated into the treatment plan, and there needs to an awareness of the pharmaceutical requirements of these patients, as well as any pharmaceutical side effects issues.

Medical team involvement throughout the rehab stay ensures optimal health promotion and adequate pharmaceutical therapies. Community care workers, existing doctors and addictions professionals will need to work together to develop a medical care plan cognizant of the special challenges facing this community of drug abusers. Medical monitoring needs to continue throughout the rehab, and there needs to be an understanding of the possible HIV and AIDS complications, and how they may interact with detox and continuing recovery.

Mental health professionals also need to be very involved in the regular monitoring of these individuals.

Because HIV and AIDS can induce significant mental health strains in the non abusing HIV positive community, these mental health issues are exacerbated when accompanied by substance abuse. Mental health professionals need to be a part of ongoing care, and appropriate medications and therapies offered with the unique requirements of this population in mind.

Assessment and Pre-Intake

Due to the increased complexity of care, the pre-intake assessment should be more rigorous than normal, and should include consultation with all current medical personal and case management workers within the patient's network of support. An accurate picture of currently prescribed medications, therapies and health issues needs to be incorporated into the treatment plan. Because very low T cell counts indicate an increased probability of cognitive declines and mental health challenges, an examination of recent medical testing, or the performance of testing at intake needs to occur.

Family Involvement

When present, family offers the strongest long term and aftercare support network to the recovering HIV or AIDS addicts, and the family benefits from inclusion into the rehabilitation process.

Because the community of HIV and AIDS patients may define family in a less traditional way, the inclusion of any people the addict considers to be family is appropriate.

Family education and therapy helps supporting family better understand the disease progression, the interaction of disease and substance abuse, and helps family to best support the addict in their goal of abstinence or harm reduction.

HIV-Specific Peer Therapies

Because of the unique challenges facing this population in recovery, peer therapy works best when peers are in fact other HIV positive addicts in recovery.

This population may be both hetero and homosexual as long as there is respect and comfort with issues of sexual orientation. Traditionally segregating HIV positive substance abusers by sexual orientation has been less effective than by segregating this group between early and late onset stages of disease.

The life challenges faced by substance abusing HIV and AIDS patients are more similar when groups are segregated by a disease progression model than any other model, including gender or sexual orientation. Patients dealing with the initial diagnosis and asymptomatic phases may not do well in a group of substance abusers with late stage AIDS, and may be uncomfortable dealing with the obvious health and mortality issues within such a group.

If at all possible, the most effective peer group counseling separates people by disease progression, and them by type of drug abused, and lastly by other issues such as gender, sexual orientation and age. This type of extreme segregation of groups is not usually possible.

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