Assessment and Treatment of Alcohol- and Substance-Use Disorders in Patients with HIV Infection



Throughout the world, alcohol and substance use can be described as vectors of HIV infection. Transmission of HIV related to alcohol and substance use may be direct or indirect. Direct transmission of HIV comes through the sharing of needles or other “works” among injection drug users (IDUs), or through exposure to blood by other means, such as sharing a contaminated straw used for intranasal inhalation of cocaine. Indirect transmission occurs when substance users, often while under the influence of the substance, become vulnerable to unsafe practices, such as trading sex for drugs or money to get drugs, failure to use condoms or safer sex practices, or failure to maintain stable relationships, thus increasing the number of sexual partners, about whom they may know very little.


Opioid Receptor Substance Dependence Methadone Maintenance Treatment Addiction Severity Index Narcotic Anonymous 
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  1. 1.
    Singh N, Squier C, Sivek C, Wagener M, Nguyen MH, Yu VL. Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. AIDS Care. 1996;8:261–9.PubMedCrossRefGoogle Scholar
  2. 2.
    Bouhnik A-D, Chesney M, Carrieri P, Gallais H, Moreau J, Moatti JP, Obadia Y, Spire B; the MANIF 2000 Study Group. Nonadherence among HIV-infected injecting drug users: the impact of social instability. J Acquir Immune Defic Syndr. 2002;31 Suppl 3:S149–53.Google Scholar
  3. 3.
    Rotheram-Borus MJ, Desmond K, Comulada WS, Arnold EM, Johnson M, the Healthy Living Group. Reducing risky sexual behavior and substance us among currently and formerly homeless adults living with HIV. Research and Practice. 2009;99(6):1100–7.Google Scholar
  4. 4.
    Lyketsos CG, Hanson A, Fishman M, McHugh PR, Treisman GJ. Screening for psychiatric morbidity in a medical outpatient clinic for HIV infection: the need for a psychiatric presence. Int J Psychiatry Med. 1994;24:103–13.PubMedCrossRefGoogle Scholar
  5. 5.
    Atkinson JH, Higgins JA, Vigil O, Dubrow R, Remien RH, Steward WT, et al. Psychiatric context of acute/early HIV infection. The NIMH multisite acute HIV infection study: IV. AIDS Behav. 2009;13:1061–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Mayfield D, McLeod G, Hall P. The CAGE questionnaire: a validation of a new alcoholism screening instrument. Am J Psychiatry. 1974;131:1121–3.PubMedGoogle Scholar
  7. 7.
    Skinner HA. The drug abuse screening test. Addict Behav. 1982;7:363–71.PubMedCrossRefGoogle Scholar
  8. 8.
    McLellan AT, Luborsky L, Woody GE, Obrien CP. An improved diagnostic evaluation instrument for substance abuse patients, the Addiction Severity Index. J Nerv Ment Dis. 1980;168:26–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992;47:1102–14.PubMedCrossRefGoogle Scholar
  10. 10.
    Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York: Guilford; 1991.Google Scholar
  11. 11.
    Miller WR, Benefield G, Tonigan JS. Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles. J Consult Clin Psychol. 1993;61:455–61.PubMedCrossRefGoogle Scholar
  12. 12.
    Regier DA, Farmer ME, Rae DS, Locke BZ, Keith SJ, Judd LL, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study. JAMA. 1990;264:2511–8.PubMedCrossRefGoogle Scholar
  13. 13.
    McHugh PR, Slavney PR. The Perspectives of Psychiatry. 2nd ed. Baltimore: Johns Hopkins University Press; 1998.Google Scholar
  14. 14.
    Thorndike E. Educational psychology: the psychology of learning. New York: Teacher’s College Press; 1921. p. 172.Google Scholar
  15. 15.
    Ferster CB, Skinner BF. Schedules of reinforcement. Acton, MA: Copley; 1957.CrossRefGoogle Scholar
  16. 16.
    Levy MS. Take control of your drinking…and you may not need to quit. Baltimore: Johns Hopkins; 2007.Google Scholar
  17. 17.
    Batkis MF, Treisman GJ, Angelino AF. Integrated opioid use disorder and HIV treatment: rationale, clinical guidelines for addiction treatment, and review of interactions of antiretroviral agents and opioid agonist therapies. AIDS Patient Care STDS. 2010;24:15–22.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreUSA

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