Work with treatment centers to help injection drug users
Collaboration more important now than ever
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The HIV epidemic has changed greatly in the past decade, increasingly affecting injection drug users (IDUs), minorities, the disadvantaged, and people with multiple physical and mental health problems. As a result, the HIV/AIDS population often needs substance abuse treatment, mental health services, primary health care services, and hepatitis treatment, in addition to treatment for their HIV, according to the Centers for Disease Control and Prevention in Atlanta.
One of the keys to treating these patients is for HIV clinicians to collaborate with substance abuse clinicians and facilities. In a report titled "Substance Abuse Treatment and Public Health: Working Together to Benefit Injection Drug Users," the CDC offers these suggestions for how this collaboration might best work:
• Staff from public health or substance abuse treatment centers may not know what questions to ask a patient or how to assess the patient’s risk for HIV infection. HIV clinicians could help by providing them with HIV brochures and other information to hand out to their injection-drug-using clients.
• Federal confidentiality protections prohibit substance abuse treatment staff from revealing anything about patients, even to state and local public health staff. This is why it’s important that substance abuse treatment staff are given information about HIV testing that they can give to patients to encourage them to seek testing and counseling services. Another strategy is for collaborative agencies to develop Qualified Service Organization Agreements, which are interagency agreements that allow substance abuse treatment and public health provider agencies to share information about patients within the constraints of federal confidentiality protections.
• HIV staff should learn about the structure, funding, philosophy, and policies of substance abuse agencies and other organizations that work with injection drug users.
• HIV health care workers also should enhance their knowledge about substance abuse, as well as about tuberculosis, viral hepatitis, and other infections that affect HIV patients who inject drugs.
• Health care workers should be willing to make personal connections across agency disciplines, cultures, and bureaucracies. These connections may bridge the divisions by promoting mutual respect and a common vocabulary. They also foster willingness to hear other points of view and motivate staff to develop regular communications and collaborative working relationships with other agencies and organizations.
• HIV staff could be cross-trained to deal with the mental health and substance abuse issues confronting their patients. Successful cross-training initiatives will focus on these areas:
— Reflect the diversity of the epidemic: Training should cover prevention, treatment, and care issues for various substance abuse and infectious disease topics, and should include participants from a range of disciplines that work with affected individuals.
— Obtain high-level participation and endorsement: High-level administrators should be involved in the planning and execution of the workshops because their involvement can help break down the barriers between disciplines and reinforce the training.
— Tailor to the community: Cross-training planners should analyze the community to ensure that topics and skills-building exercises reflect the needs, cultures, and languages of the community, and this needs to be done before the workshops are developed. Likewise, participants and trainers should reflect the community’s cultures and languages.
— Recognize the value of the cultures and perspectives of each discipline involved in training: Participants need to be sensitive to other agencies and organizations involved and try to work through differences in priorities, missions, and perspectives that often pose the greatest challenge for collaboration.
— Work to develop QSOAs before beginning a cross-training program: Qualified Service Organization Agreements should be in place before cross-training occurs, because this will allow participants to immediately build on relations forged during the training.
— Follow-up and referrals: Someone should be in charge of following up on the training and QSOA to track changes and provide assistance to participants, nurturing the seeds of collaboration that may emerge during a cross-training session. Also, there will be a need for additional cross-training workshops to reinforce the training and to train new staff.
Health care workers dealing with HIV/AIDS patients also need to be aware of some of the strategies, outlined by the CDC, that are key to successful substance abuse treatment:
• Individuals need to be engaged in treatment for an adequate length of time. For example, participation in outpatient or residential programs for less than 90 days is of limited or no effectiveness. Patients should receive a minimum of 12 months of methadone maintenance treatment.
• Addiction often occurs simultaneously with other physical or mental health problems. The treatment plan must take those into consideration.
• All clinicians and health care staff working with patients who have substance abuse problems should learn some of the nuances of "recovery language." These include the following:
- It’s unrealistic to use the term "eliminate drug use" It’s realistic to say, "reduce or stop drug use."
- Avoid the word "recovered," and use the term "in recovery."
- Don’t say "cured" say "treated and controlled."
- It’s unrealistic to say "forever," but it’s more realistic to say, "one day at a time."
- Change patients’ views that what they’re doing is "on my own" to a view that they are doing it "with help."
- Don’t think of substance abuse treatment as a "one-shot treatment," but rather as an "ongoing process."
- And it’s unrealistic to expect that a "relapse is unacceptable," but it’s more realistic to think, "relapse happens."
For more information about substance abuse treatment and drug users, here are some resources:
• The CDC’s web site has information at the address: www.cdc.gov/idu. Or obtain IDU-related technical assistance, which is available to health departments funded by CDC to conduct HIV prevention and to HIV prevention community planning groups, by calling (404) 639-5230, or call the Academy for Educational Development at (202) 884-8952.
• The Academy for Educational Development has information on its web site at www.healthstrategies.org/pubs/publications.htm.
• To learn more about the topic of "Substance Abuse and Infectious Disease: Cross-Training for Collaborative Systems of Prevention, Treatment and Care Initiative," visit www.treatment.org/Topics/infectious.html, and the Cross-Training Connections web site at www.hsrnet.com/crosstraining.
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