Academic journal article Health and Social Work

An Integrated, Multidimensional Treatment Model for Individuals Living with HIV, Mental Illness, and Substance Abuse

Academic journal article Health and Social Work

An Integrated, Multidimensional Treatment Model for Individuals Living with HIV, Mental Illness, and Substance Abuse

Article excerpt

Mental illness and substance use disorders are common among people living with HIV (Galvan, Burnam, & Bing, 2003) and have been linked with negative outcomes, including HIV-related morbidity and mortality, poor medication adherence, inadequate medical treatment, lower quality of life, and risky sexual behaviors (Avants, Warburton, Hawkins, & Margolin, 2000; Bartlett, 2002; Fairfield, Libman, Davis, Eisenberg, & Phillips, 1999; Kelly et al., 1993; Sherbourne et al., 2000; Turner et al., 2001). HIV-infected individuals who have both mental and substance use disorders are particularly vulnerable to poor outcomes because of the level of disease burden they experience (Batki, 1990; Douaihy, Jou, Gorske, & Salloum, 2003). Previous studies have identified 13 percent to 23 percent of HIV-infected individuals as having symptoms of both mental and substance use disorders (Galvan et al.; Whetten et al., 2005).

Although there is increasing recognition of the negative implications of co-occurring mental and substance use disorders among HIV-infected individuals and the need to address them (Batki, 1990; Douaihy et al., 2003), we identified no outcomes-evaluated comprehensive mental health and substance use treatment models for HIV-infected individuals in the literature. We developed a treatment intervention to address the behavioral health care needs of HIV-infected individuals with both mental health and substance use problems, hereinafter referred to as "triply diagnosed individuals." This treatment model used evidence-based strategies for treating individuals dually diagnosed with mental health and substance use and added an HIV-specific component to address the unique needs of triply diagnosed individuals. Addressing HIV-related concerns and issues was essential because an HIV diagnosis often precipitates myriad physical, social, emotional, and financial concerns that may influence mental health and substance use treatment outcomes (Angelino & Treisman, 2001; Douaihy et al., 2003; Griffin, Rabkin, Remien, & Williams, 1998). Furthermore, because treatment for triply diagnosed individuals involves two distinct systems of care (behavioral and medical), the treatment model included an integrated approach that bridged these systems.


The treatment model described herein was used in a multisite study of integrated treatment options for triply diagnosed individuals (HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study Group, 2004). Study participants were recruited from four academic medical center infectious diseases clinics in North Carolina from 2000 to 2003. Greater detail regarding recruitment is presented in Whetten and colleagues (2006).

The treatment participants (N = 141) entered the year-long treatment program at one of two participating mental health treatment sites. One treatment center was affiliated with an academic medical center and the other was part of a county mental health center. The behavioral health clinicians involved in the treatment program, hereinafter referred to as clinical social workers, were predominantly licensed clinical social workers with dual-diagnosis experience and cross-training in HIV care.

More than two-thirds of the treatment participants (79 percent) were African American, and the majority (56 percent) were male. The most prevalent mental disorders were major depressive episode (58 percent), borderline personality disorder (38 percent), antisocial personality disorder (35 percent), and posttraumatic stress disorder (30 percent). More than half of the participants (64 percent) were diagnosed with alcohol dependence, and 79 percent were diagnosed with other substance use dependencies.

The treatment model, which included individual counseling, group treatment, and psychiatric medication management, was developed using the transtheoretical model of behavior change (DiClemente & Prochaska, 1988), which postulates that there are varying stages of readiness for behavior change and that interventions to facilitate change need to be tailored to the client's stage of readiness. …

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