Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

19. HIV/AIDS and Substance Use Disorders 423Reactions run the gamut and many immediately react as if they had animminently terminal condition. Delayed emotional reactions are common aswell. There are reports of knowledge of positive HIV status having severeadverse psychological effects, including suicidal behavior (Glass, 1988). Hospitalizedpatients may be especially vulnerable to suicidal ideation and intent(Alfonso et al., 1994).Posttest Counseling: Negative Result• Emphasize test limitations.• Emphasize the need for continued HIV precautions.• Emphasize the need for retesting.• Preemptively address erroneous conclusions about negative tests inhigh-risk individuals.• Have a low threshold for specialized referral to mental health services,especially for individuals from groups that have endured multiple andongoing losses to the AIDS epidemic or from particularly marginalizedgroups.Residential treatment programs should make information about HIV availableand provide a variety of support mechanisms for those affected, includingaccess to medical and mental health services. Ethical issues raised by HIV testingare not readily resolved. For example, if an individual is found to be HIVantibody positive, is there a duty to warn the sexual partner(s)? How will thesesorts of issues affect the therapeutic relationship? Because public health regulationsregarding these matters vary from state to state, practitioners must consultlocal public health requirements and guidelines.Clinical Assessment and ManagementThe many physical and emotional effects of AIDS complicate the contemporaneoustreatment of chemical dependence. The presence of those with AIDS indrug treatment units elicits complex feelings in staff and others if their status isknown. Issues of death and dying may dominate, and patients may express feelingsof hopelessness and question the value or practicality of abstinence fromdrug and alcohol use. Issues of medical regimen compliance and drug adherenceversus control become critical features in treatment. Arrangements for aftercareand placement of patients with AIDS following inpatient detoxification or residentialdrug treatment may be difficult.Combined diagnoses complicate treatment. Retention may be a problem:In one study, those with HIV who were receiving ambulatory psychiatric treatmentwere more likely to drop out of treatment if they drank or used drugs(Kennedy, Skurnick, & Lintott, 1994). The patient’s family and significant