Video by Dr. Dawn Elise Snipes on integrative behavioral health approaches to improving mental health and reducing mental illness.

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TIP 37: Substance Abuse Treatment for Persons with HIV/AIDS
Dr. Dawn-Elise Snipes, PhD, LMHC

Objectives
• Review current information about the prevention, transmission and treatment of HIV, Hepatitis and Blood Borne Pathogens
• Review current information about hepatitis transmission, symptoms and treatment.
Overview
 650,000 to 900,000 in the U.S. with HIV
 Approximately 3.2 million people in the US are living with Hepatitis B or C
 Hepatitis A is spread by close personal contact with people or things contaminated with feces
 HIV & Hepatitis B & C are most easily transmitted by contaminated blood and body fluids
 The incidence of hepatitis C among people who are heavy consumers of alcohol (e.g. men that consume 4-5 alcoholic drinks a day) is 7x higher than in the general population.
 Vaccines exist for Hepatitis A & B
Overview
 Alcoholic hepatitis is caused by drinking too much alcohol and occurs in 20% of alcoholics or approximately 3 million people
 Severe alcoholic hepatitis can develop suddenly and quickly lead to liver failure and death.
Viral Hepatitis Symptoms
 Viral hepatitis symptoms are similar no matter which type of hepatitis you have. Symptoms include:
◦ Jaundice
◦ Fever
◦ Loss of appetite
◦ Fatigue
◦ Dark urine
◦ Joint and abdominal pain
◦ Diarrhea, nausea, and vomiting.
 Incubation period 15-180 days
Risk-Reduction Counseling
 Clinician’s goals
◦ Help and support understanding need for behavior change
◦ Assist addressing cultural practices, beliefs contributing to resisting change
◦ Assist skills development to sustain behavior change
Counseling and Testing
 Pre- and posttest counseling by a trained HIV and Blood borne pathogens clinician
 Counseling should:
◦ Explain limitations of tests (i.e. incubation period and false +/-)
◦ Help clients assess risks
◦ Encourage, reinforce behavior change
◦ Refer infected clients for medical care
Factors for Noncompliance
 Addiction or mental health relapse
 Living in an institution
 Side effects
 Affordability
Increasing Compliance
 Write instructions
 Use timer, ensuring proper dosing
 Use check-sheet, notating dosage
 Provide positive feedback
 Empathize / Advocate regarding medication side effects
 Visual cues for persons with impaired language/cognitive abilities
Avoiding Drug Resistance
Take all medications as prescribed
Drug Interactions
◦ General drug interaction checker
LEARN Sensitivity
 Listen with empathy and understanding
 Elicit cultural information
 Acknowledge and discuss cultural differences and similarities
 Recommend action, treatment, intervention incorporating cultural knowledge
 Negotiate agreements and differences with client
Relapse Prevention
 Events which may initiate client relapse:
◦ Taking an HIV/Hepatitis test
◦ Receiving test results
◦ Experiencing first symptoms of the disease
◦ Experiencing first disease-related hospitalization
◦ Being diagnosed with AIDS or liver cancer / liver failure
◦ Friend or significant other dying from AIDS or hepatitis
◦ Beginning medication regimen for the disease
◦ Experiencing little or no response to various medications
◦ Decreasing CD4+ T cell count or increasing viral load
Relapse Prevention Interventions
 Nutrition (H)
 Relaxation and stress management (A)
 Grief management (A)
 Recreation (A/L)
 Peer support (L)
 Family Counseling (L)
 Sleep (T)
 Medical intervention for pain
Group Therapy

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