One-Year Outcomes among Members of a Dual-Recovery Self-Help Program.

Research Objective: Self-help is gaining increased acceptance among treatment professionals as empirical support for of its effectiveness is growing and the advent of managed care warrants the use of cost-effective modalities. Traditional “one disease-one recovery” self-help programs cannot serve adequately the needs of the dually-diagnosed.

This paper presents one-year outcome data from a longitudinal study of the effectiveness of self-help for the dually-diagnosed.

Subjects are members of Double Trouble in Recovery (DTR), a 12-step self-help program designed to meet the special needs of those diagnosed with both a mental health disorder and a chemical addiction.Study.

Design: The study uses a 12-month prospective longitudinal design with follow-ups at 12 and 24 months after baseline. Subjects (N = 310) were recruited at 25 DTR meeting sites throughout New York City. Semi-structured instruments assess history and current status of mental health and substance abuse, treatment in both areas, and self help participation (DTR as well as traditional 12-step groups such as AA and NA).

Population Studied: Community-based individuals dually-diagnosed with a mental health disorder and substance abuse.

Principal Findings: S’s are mostly members of underserved minority groups with long histories of substance abuse and mental health disorders.

Most S’s attend outpatient treatment (for drug use, mental health or dual-diagnosis – 77%) and take psychotropic medications (87%).

At the 12 months follow-up,

• 76% were still attending DTR;
• 68% were also attending AA or NA.

Mean number of symptoms S’s. experienced in the past year decreased significantly;

• two-thirds (69%) of S’s reported that their mental health was “better” in the past month than it was at baseline.
• One-third (29%) reported substance use in the past year, compared to 42% at baseline (p = .002).

Substance use (less) was significantly associated with DTR attendance:

• Total time abstinent was related to lifetime length of DTR attendance (r = .25, p = .002) and
• past year substance use was related to number of months of DTR attendance in the past year (r = -.17, p = .02).

Conclusions: For dually-diagnosed individuals, continued participation in dual recovery self-help groups plays a significant role in the recovery process, particularly in the area of substance use.

Implications for Policy, Delivery or Practice: Participation in dual-recovery self-help groups, both during and after formal treatment, should be encouraged as part of an integrated lifelong recovery plan for dually-diagnosed individuals.

Research; One-Year Outcomes among Members of a Dual-Recovery Self-Help Program. Laudet A, Magura S, Vogel H, Knight E, Staines G; Abstr Acad Health Serv Res Health Policy Meet. 2000; 17.

More at; Double Trouble in Recovery

See also;

• 12-Step Treatment More Effective than Alternative
• AA and Treatment Work Better Together
• Subscribe to Twelve Step Facilitation by e-Mail

Dual Diagnosis; Counseling the Mentally Ill Substance Abuser by Katie Evans, J. Michael Sullivan Read more about this title…

On any given day in the United States, one million people are in treatment for alcoholism or drug addiction. It is not getting into treatment, however, that makes the difference. Instead, it is what a person gets out of treatment. The fact that many people do not find success in treatment on their first attempt is due in part to a lack of understanding about what makes effective treatment.

The ten effective elements of treatment are;

1. There is no treatment formula that will work for everyone.

2. Medically supervised withdrawal is only one step in addiction treatment; alone it will do little.

3. Length of treatment counts

4. Drug addiction is a multidimensional problem, and treatment needs to address all of an individual’s needs

5. Counseling (individual and/or group) is a critical part of effective addiction treatment.

6. Medications are an important part of treatment for many people.

7. Drug testing during treatment is important.

8. Alcoholics and addicts with mental health disorders should be treated for both at the same time.

9.Addiction Treatment works even for people who don’t choose it of their own free will.

10. Don’t give up.

As with other chronic illnesses, relapses can occur during or after successful treatment episodes. Addicted individuals may need lengthy treatment and more than one time in treatment before they can enjoy long-term abstinence and full restoration to a drug free life. The period after treatment is just as important as being in treatment. Finding support and continuous work to stay drug free will be necessary. A slip or relapse is just an indicator that more work, and possibly more treatment, is necessary. Don’t give up.

Full story at Recovery Today

See also;

• AA and Treatment Work Better Together
• AA Offers Recovery Not Religion
• If you have healthcare training this manual may help.

Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings.

The past decade has seen an expansion of research and knowledge on pharmacotherapy for the treatment of alcohol dependence.

The US Food and Drug Administration (FDA)-approved medications naltrexone and acamprosate have shown mixed results in clinical trials.

Oral naltrexone and naltrexone depot formulations have generally demonstrated efficacy at treating alcohol dependence, but their treatment effect size is small, and more research is needed to compare the effects of different doses on drinking outcome.

Acamprosate has demonstrated efficacy for treating alcohol dependence in European trials, but with a small effect size. In U.S. trials, acamprosate has not proved to be efficacious.

Research continues to explore which types of alcohol-dependent individual would benefit the most from treatment with naltrexone or acamprosate.

The combination of the two medications demonstrated efficacy for treating alcohol dependence in one European study but not in a multi-site U.S. study.

Another US FDA-approved medication, disulfiram, is an aversive agent that does not diminish craving for alcohol. Disulfiram is most effective when given to those who are highly compliant or who are receiving their medication under supervision.

Of the non-approved medications, topiramate is among the most promising, with a medium effect size in clinical trials.

Another promising medication, baclofen, has shown efficacy in small trials.

Serotonergic agents such as selective serotonin reuptake inhibitors and the serotonin-3 receptor antagonist, ondansetron, appear to be efficacious only among certain genetic subtypes of alcoholic.

As neuroscientific research progresses, other promising medications, as well as medication combinations, for treating alcohol dependence continue to be explored.

Research; Johnson BA. Update on neuropharmacological treatments for alcoholism: Scientific basis and clinical findings. Biochem Pharmacol. 2007 Aug 9;

Brief-TSF is an excellent psychosocial adjunctive therapy with anticraving medications.

In a new target population researchers have found that alcoholics who have a particular variant of an opioid-receptor gene appear to respond better to naltrexone, an opioid antagonist that is used to reduce alcohol craving and relapse.

National Institute on Alcohol Abuse and Alcoholism (NIAAA) researchers who reviewed data from the 2001-2004 COMBINE (Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence) study found that 87 percent of patients with the OPRM1 gene variant reported good outcomes with naltrexone treatment, compared to 49 percent of those receiving placebos and 55 percent of individuals lacking the gene variant who received either a placebo or naltrexone.

The study defined good outcomes as abstinence or moderate alcohol consumption without attendant problems.

“Analysis of the large COMBINE patient population increases confidence that the OPRM1 variant is in part responsible for positive responses to naltrexone,” said Ting-Kai Li, director of NIAAA. “This study points to the promise of research on gene-medication interactions to refine treatment selection, improve clinical results, and inform ongoing medications development.”

The research was published in the Feb. 4, 2008 issue of the Archives of General Psychiatry.

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Anti-craving Naltrexone Injection Reduces Drinking

Persistent pain is prevalent among people with substance use disorders.

It is not known, however, whether such pain increases the risk of relapse following periods of abstinence.

Researchers assessed data on pain and substance use in 397 adults who, as part of a larger randomized trial, had been interviewed periodically in the 24 months after their discharge from an urban, residential alcohol and drug detoxification unit.

Pain was measured with the pain item on the SF-36 Health Survey. Analyses were adjusted for potential confounders (e.g., demographics, addiction severity, depressive symptoms).

• Sixteen percent of subjects reported persistent pain (moderate-to-higher levels of pain at all available interviews) in the 24 months after detoxification.
• Subjects reporting persistent pain were significantly more likely than those with mild or no pain to have used the following in the past 30 days at the 24-month follow-up:
• heroin/opioids not prescribed for pain (odds ratio, 5.4);
• heavy amounts of alcohol* (odds ratio, 2.2).

Comments: Persistent pain is common among alcohol and drug users who have undergone residential detoxification and increases the likelihood of relapse. This study suggests that clinicians must be careful to screen for pain symptoms in patients with substance dependence. When persistent pain is present, thoughtful management is required to minimize risks associated with undertreatment while not fostering opioid analgesic abuse.

Research References:Larson MJ, Paasche-Orlow M, Cheng DM, et al. Persistent pain is associated with substance use after detoxification: a prospective cohort analysis. Addiction. 2007.

The Mindbody Prescription: Healing the Body, Healing the Pain by John E. Sarno Read more about this title…

Al-Anon offers new life

AA’s 12-Step Recovery Program

Alcohol and Anxiety

Alcohol Problems Database

Alcoholic Defence Mechanisms

Alcoholics Anonymous and Nursing

An Introduction to Medication for Alcohol Dependence

Anti-craving Drugs

Binge Drinking & Brain Damage

Brain Damage & Cirrhosis

Brief-TSF Description

Brief-TSF Learning Objectives

Characteristics of Children of Alcoholic

Controlled drinking?

Counselling and the 12 Steps of AA

Counsellor Characteristics

Craving Reduction

Depression & 12-Step Programs

Effects of Gambling Addiction

Elderly Substance Abuse

Families, Mental Health & Alcohol abuse

Female Victims of Child Abuse

Five Alcoholism Subtypes

Free Training Alcoholism Anti-craving Medications

Gender Matching Hypothesis in Alcohol Treatment

Healing through Social and Spiritual Affiliation

How Alcoholics Anonymous is changing

How do alcoholics get to AA?

Humility and Surrender

Nutritional Therapy in Alcoholic Liver Disease

Painkiller abuse

Phases of Recovery from Alcoholism

Readiness to Change Profiles

Recovery through the Twelve Steps

Research Evidence for TSF

Risky Partners and Domestic Violence

Slogans for everyday life in AA

Spiritual Assessment

Spirituality in Alcoholism Recovery

Stages of an Eating Disorder

Strategies for Dealing With Denial

Symptoms of alcoholism

The 12-Steps Promote Acceptance of Addiction

The Personality Traits of Alcoholics

Treating Alcoholism as a Chronic Disease

TSF Description

Twelve step programs

What about partners of alcoholics?

Women and the Twelve Steps of AA

World view change in Adult Children of Alcoholics

• Subscribe to Twelve Step Facilitation by e-Mail

Prevalence of alcohol and drug use in a highly educated workforce.

This study examined alcohol and licit and illicit drug use in a highly educated medical related workforce.

A comprehensive health survey of a 10% random sample of a workforce (n = 8,567) yielded a 60% response rate (n = 504) after accounting for 15 undeliverable surveys.

• Many respondents reported past-year use of alcohol (87%).
• Thirteen percent of respondents consumed three or more drinks daily; 15% were binge drinkers.
• Twelve percent of the workforce was assessed as having a high likelihood of lifetime alcohol dependence;
• 5% of respondents met criteria for current problem drinking.
• Overall, 42% reported using mood-altering prescription drugs (analgesics, antidepressants, sedatives, or tranquilizers).
• Eleven percent reported using illicit drugs (cocaine, hallucinogens, heroin, or marijuana) in the past year.

Significant relationships were found between gender, age, ethnicity, and occupation with some measures of alcohol consumption and use of mood-altering drugs.

These results indicate prevention and early intervention programs need to address use of mood-altering substances (including alcohol) in highly educated workforces.

Research; J Behav Health Serv Res. ;29(1):30-44. Prevalence of alcohol and drug use in a highly educated workforce. Matano RA, Wanat SF, Westrup D, Koopman C, Whitsell SD.

See also;

• Brief-TSF is designed to address these issues.

Staying Sober: A Guide for Relapse Prevention by Terence T. Gorski, Merlene Miller Read more about this title…

Those under age 25 are particularly vulnerable to dual abuse.

Men and women with alcohol use disorders (AUD’s) are 18 times more likely to report nonmedical use of prescription drugs than people who don’t drink at all, according to researchers at the University of Michigan. Dr. Sean Esteban McCabe and colleagues documented this link in two NIDA-funded studies; they also discovered that young adults were most at risk for concurrent or simultaneous abuse of both alcohol and prescription drugs.

“The message of these studies is that clinicians should conduct thorough drug use histories, particularly when working with young adults,” says Dr. McCabe. “Clinicians should ask patients with alcohol use disorders about nonmedical use of prescription drugs [NMUPD] and in turn ask nonmedical users of prescription medications about their drinking behaviors.” The authors also recommend that college staff educate students about the adverse health outcomes associated with using alcohol and prescription medications at the same time.

TWO STUDIES

The authors’ first study looked at the prevalence of AUD’s and NMUPD in 43,093 individuals 18 and older who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) between 2001 and 2005. Participants lived across the United States in a broad spectrum of household arrangements and represented White, African-American, Asian, Hispanic, and Native American populations. Although people with AUD’s constituted only 9 percent of NESARC’s total sample, they accounted for more than a third of those who reported NMUPD.

Since the largest group of alcohol/prescription drug abusers were between the ages of 18 and 24, the team’s second study focused entirely on this population and involved 4,580 young adults at a large, public, Midwestern university. The participants completed a self-administered Web survey, which revealed that 12 percent of them had used both alcohol and prescription drugs nonmedically within the last year but at different times (concurrent use), and 7 percent had taken them at the same time (simultaneous use).

When alcohol and prescription drugs are used simultaneously, severe medical problems can result, including alcohol poisoning, unconsciousness, respiratory depression, and sometimes death. In addition, college students who drank and took prescription drugs simultaneously were more likely than those who did not to blackout, vomit, and engage in other risky behaviors such as drunk driving and unplanned sex.

Prescription drug misuse rises with drinking severity. Increases are most pronounced in adults aged 18-24.

WHO, WHAT, AND WHEN

The prescription drugs that were combined with alcohol in order of prevalence included prescription opiates (e.g., Vicodin, OxyContin, Tylenol 3 with codeine, Percocet), stimulant medication (e.g., Ritalin, Adderall, Concerta), sedative/anxiety medication (e.g., Ativan, Xanax, Valium), and sleeping medication (e.g., Ambien, Halcion, Restoril). The college study asked about the respondent’s use of medications prescribed for other people while the NESARC explored both use of someone else’s prescription medications as well as the use of one’s own prescription medications in a manner not intended by the prescribing clinician (e.g., to get high).

The researchers found that the more alcohol a person drank and the younger he or she started drinking, the more likely he or she was to report NMUPD. Compared with people who did not drink at all, drinkers who did not binge were almost twice as likely to engage in NMUPD; binge drinkers with no AUD’s were three times as likely; people who abused alcohol but were not dependent on alcohol were nearly seven times as likely; and people who were dependent on alcohol were 18 times as likely to report NMUPD (see figure, page 8).

While the majority of the respondents in both studies were White (71 percent in NESARC and 65 percent in the college group), an even higher percentage of the simultaneous polydrug users in the college study were White males who had started drinking in their early teens. The NESARC study also found that Whites in general were two to five times more likely than African-Americans to report NMUPD during the past year. Native Americans were at increased risk for NMUPD, and the authors indicated that this subpopulation should receive greater research attention in the future.

Dr. McCabe emphasizes that many people who simultaneously drink alcohol and use prescription medications have no idea how dangerous the interactions between these substances can be. “Passing out is a protective mechanism that stops people from drinking when they are approaching potentially dangerous blood alcohol concentrations,” he explains. “But if you take stimulants when you drink, you can potentially override this mechanism and this could lead to life-threatening consequences.”

Dr. James Colliver, formerly of NIDA’s Division of Epidemiology, Services and Prevention Research, offers perspective on these studies. “Prescription sedatives, tranquilizers, painkillers, and stimulants are generally safe and effective medications for patients who take them as prescribed by a clinician,” Dr. Colliver states. “They are used to treat acute and chronic pain, attention deficit hyperactivity disorder, anxiety disorders, and sleep disorders.

“The problem is that many people think that, because prescription drugs have been tested and approved by the Food and Drug Administration, they are always safe to use; but they are safe only when used under the direction of a physician for the purpose for which they are prescribed.”

Nonmedical Use of Prescription Drugs

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), sponsored by the National Institutes of Health, defines nonmedical use as follows:

Using drugs that were not prescribed to you by a doctor, or using drugs in a manner not intended by the prescribing clinician (e.g., to get high). Nonmedical use does not include taking prescription medications as directed by a health practitioner or the use of over the- counter medications.

NIDA Research Findings; Vol. 21, No. 5 (March 2008)

See also;

• Brief-TSF can assist patients cease alcohol consumption.
• Alcohol & Medication Interactions

Painkiller abuse continues to grow; new treatments offer hope

Increasingly, drug abusers are getting their next fix from their medicine cabinets, instead of from drug dealers.

More than 6 million Americans abuse prescription drugs, according to the U.S. Drug Enforcement Administration. One in 10 teenagers admits to abusing painkillers, such as Vicodin and Oxycontin. Painkillers cause more overdoses than cocaine and heroin combined.

"Access to prescription painkillers has never been easier," says addictions psychiatrist Donna Yi, MD, associate chief of staff and clinical director for The Menninger Clinic and assistant professor in the Menninger Department of Psychiatry & Behavioral Sciences at Baylor College of Medicine. "Many people start taking prescription painkillers for a legitimate reason, for pain after surgery or childbirth, or to deal with chronic pain. As the sense of euphoria and relaxation provided by the drugs gets reinforced, they become increasingly reliant on the drugs even when they no longer need them for pain."

Once hooked, patients may doctor shop to get multiple prescriptions to painkillers, forge prescriptions, order painkillers from web sites that don’t require prescriptions or take a road trip to Mexico to supply their habits. Teenagers can get prescription painkillers from their parents’ medicine cabinets and their friends-even dealers. Because prescription painkillers are so readily available, they don’t have the stigma of illegal drugs, like heroin.

Yi adds that it may seem much easier and acceptable to swallow a pill than to find a vein, inject yourself with a drug and risk getting AIDS or overdosing. The word "heroin" instantly evokes a negative image-usually that of someone homeless and on the street.

However, like heroin, prescription painkillers such as Oxycontin and Vicodin stimulate opiate receptors in the brain, relieving pain and providing a sense of euphoria, and are highly addictive and difficult to quit without medical intervention.

Because opiates are so rewarding and reinforcing, once a person stops using them, the body goes into shock and withdrawal. Symptoms of withdrawal are similar to a severe case of the flu and may include fever, vomiting, diarrhea, muscle and bone pain, insomnia, cold flashes with goose bumps and involuntary leg movements. To avoid pain, many people abusing painkillers keep using.

New medications help painkiller abusers avoid the painful symptoms of withdrawal and cut the time of withdrawal. The drug buprenorphine was approved by the FDA in 2002 to help ease the symptoms of detoxification and radically decreases the time of detox from an average of two weeks to one or two days. Buprenorphine is a safer alternative to methadone and is available in a convenient pill form. The medication speeds a patient’s entry into treatment, cutting down the time he or she is in bed and feeling uncomfortable withdrawal symptoms and drug cravings.

Patients may have accompanying mental illness and issues driving their addiction, such as anxiety, depression, life stresses, relationship problems, personality disorders or poor coping skills. A successful treatment program for addiction includes a thorough patient assessment and offers group and individual therapy, psychoeducation and access to self-help groups. Patients’ families are also involved in the treatment process.

Relapse rates for patients who abuse painkillers are high, so creating a relapse prevention plan is crucial. Patients at Menninger leave with a wellness plan that might include appointments with therapists, support group meetings and exercise to improve their mood and health. Patients also learn the signs and symptoms that constitute a lapse, so they can stop a full-blown relapse.

Some patients may also need medications on a continual basis, such as prenorphine or naltrexone, to help them avoid relapse. Both buprenorphine and naltrexone block the effects of opiates on the body. Patients who take buprenorphine, however, will feel mild withdrawal symptoms if they stop taking the drug-reminding them to consistently take their medicine. Doctors often prescribe a version of buprenorphine, combined with another opiate-blocker, naloxone, to guard against the intravenous use of buprenorphine. If the drug combination is injected, the naloxone can cause that person to quickly go into withdrawal.

"As the supply and variety of painkillers increase, more people will try them for non-medical reasons, and some will become addicted," Yi says. "Increased awareness, new medications used to treat painkiller abuse and novel therapies offer hope for people struggling with painkiller abuse."

From a press release of the Menninger Clinic

Principles of Effective Treatment

1. Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain’s structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.
2. No single treatment is appropriate for everyone. Matching treatment settings, interventions, and services to an individual’s particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.
3. Treatment needs to be readily available. Because drug-addicted individuals may be uncertain about entering treatment, taking advantage of available services the moment people are ready for treatment is critical. Potential patients can be lost if treatment is not immediately available or readily accessible. As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of positive outcomes.
4. Effective treatment attends to multiple needs of the individual, not just his or her drug abuse. To be effective, treatment must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual’s age, gender, ethnicity, and culture.
5. Remaining in treatment for an adequate period of time is critical. The appropriate duration for an individual depends on the type and degree of his or her problems and needs. Research indicates that most addicted individuals need at least 3 months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. Recovery from drug addiction is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapses to drug abuse can occur and should signal a need for treatment to be reinstated or adjusted. Because individuals often leave treatment prematurely, programs should include strategies to engage and keep patients in treatment.
6. Counseling—individual and/or group—and other behavioral therapies are the most commonly used forms of drug abuse treatment. Behavioral therapies vary in their focus and may involve addressing a patient’s motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem solving skills, and facilitating better interpersonal relationships.
7. Self-help encouragement and availability. Participation in group peer support programs during and following treatment can help maintain abstinence.
8. Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, methadone and buprenorphine are effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opioid-addicted individuals and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram, and topiramate. For persons addicted to nicotine, a nicotine replacement product (such as patches, gum, or lozenges) or an oral medication (such as bupropion or varenicline) can be an effective component of treatment when part of a comprehensive behavioral treatment program.
9. An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that it meets his or her changing needs. A patient may require varying combinations of services and treatment components during the course of treatment and recovery. In addition to counseling or psychotherapy, a patient may require medication, medical services, family therapy, parenting instruction, vocational rehabilitation, and/or social and legal services. For many patients, a continuing care approach provides the best results, with the treatment intensity varying according to a person’s changing needs.
10. Many drug-addicted individuals also have other mental disorders. Because drug abuse and addiction—both of which are mental disorders—often co-occur with other mental illnesses, patients presenting with one condition should be assessed for the other(s). And when these problems co-occur, treatment should address both (or all), including the use of medications as appropriate.
11. Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. Although medically assisted detoxification can safely manage the acute physical symptoms of withdrawal and, for some, can pave the way for effective long-term addiction treatment, detoxification alone is rarely sufficient to help addicted individuals achieve long-term abstinence. Thus, patients should be encouraged to continue drug treatment following detoxification. Motivational enhancement and incentive strategies, begun at initial patient intake, can improve treatment engagement.
12. Treatment does not need to be voluntary to be effective. Sanctions or enticements from family, employment settings, and/or the criminal justice system can significantly increase treatment entry, retention rates, and the ultimate success of drug treatment interventions.
13. Drug use during treatment must be monitored continuously, as lapses during treatment do occur. Knowing their drug use is being monitored can be a powerful incentive for patients and can help them withstand urges to use drugs. Monitoring also provides an early indication of a return to drug use, signaling a possible need to adjust an individual’s treatment plan to better meet his or her needs.
14. Treatment programs should assess patients for the presence of HIV/ AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as provide targeted risk-reduction counseling to help patients modify or change behaviors that place them at risk of contracting or spreading infectious diseases. Typically, drug abuse treatment addresses some of the drug-related behaviors that put people at risk of infectious diseases. Targeted counseling specifically focused on reducing infectious disease risk can help patients further reduce or avoid substance-related and other high-risk behaviors. Counseling can also help those who are already infected to manage their illness. Moreover, engaging in substance abuse treatment can facilitate adherence to other medical treatments. Patients may be reluctant to accept screening for HIV (and other infectious diseases); therefore, it is incumbent upon treatment providers to encourage and support HIV screening and inform patients that highly active antiretroviral therapy (HAART) has proven effective in combating HIV, including among drug abusing populations.

See also

• 5 Alcoholism Myths
• 5 Alcoholism Subtypes
• Brief-TSF can assist patients cease alcohol consumption.
• The Dual Disorders Recovery Book
• Improving Treatment Compliance