Concurrent disorders among HIV+ clients

CrossCurrents

Clinicians at St. Michael’s Hospital in Toronto are examining the potential benefits of integrated mental health and substance abuse care with HIV+ individuals. Substance-related disorders are common among people with HIV. And while injection drug use has long been recognized as a transmission risk factor for HIV, it is increasingly apparent that non-injection drug use increases risk behaviour that can lead to HIV. Most recently, crystal methamphetamine has been shown to be associated with increased HIV risk and significant neuropsychiatric effects. Treating substance-related disorders is particularly important in HIV+ clients with concurrent psychiatric issues because the two are connected. Many clients referred to St. Michael’s with substance disorders have significant psychiatric comorbidity, including depression, suicidality and psychosis, which are exacerbated by drug use.

Frustrated by the hospital’s inability to more successfully address this growing problem, a team from the HIV Psychiatry Program and the Substance Abuse / Mental Illness Program developed a novel approach to enhance its ability to help facilitate entry into substance abuse treatment. This was done by partnering with a substance abuse nurse from the hospital who has traditionally worked in the substance abuse field, primarily with clients with concurrent substance abuse disorders and severe and persistent mental illness. The study results, which have been submitted for publication, are encouraging: “They suggest that the intervention did better than care as usual in terms of getting clients to follow through with substance abuse treatment,” says Dr. Mark Halman, co-lead on the project and director of the HIV Psychiatry Program. The team plans to use the findings from this preliminary work to inform the design of future interventions aimed at concurrent substance use and psychiatric disorders among HIV+ clients.

For more information about the study, contact Dr. Mark Halman at halmanm@smh.toronto.on.ca, or Adrianne Sequeira at sequeiraa@smh.toronto.on.ca.