Integrating Medical and Substance Abuse Treatment for Addicts Living with HIV AIDS: Evidence-Based Nursing Practice Model

• Published in: The American journal of drug and alcohol abuse 2003-01, Vol.29 (4), p.847-859
• Main Authors: Andersen, Marcia, Paliwoda, Joseph, Kaczynski, Richard, Schoener, Eugene, Harris, Carlton, Madeja, Cheryl, Reid, Herbert, Weber, Christine, Trent, Calvin
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Addictive behaviors; Adult; Adult and adolescent clinical studies; AIDS; Biological and medical sciences; Continuity of Patient Care; Delivery of Health Care, Integrated; Drug abuse; Drug addiction; Evidence-Based Medicine; Evidenced-based practice; Female; Follow-Up Studies; HIV; HIV Infections - complications; HIV Infections - nursing; HIV/AIDS; Holistic Health; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Integrated care; Interviews as Topic; Male; Martha Rogers; Medical sciences; Michigan - epidemiology; Middle Aged; Models, Nursing; Nursing; Nursing Research; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; Substance abuse; Substance abuse treatment; Substance-Related Disorders - complications; Substance-Related Disorders - epidemiology; Substance-Related Disorders - nursing; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0095-2990; 1097-9891
• DOI: 10.1081/ADA-120026264

Forty-five active substance abusers with HIV AIDS voluntarily participated in a substance abuse treatment research study with interviews at intake, 6 months and 12 months. These participants were engaged in treatment for a minimum of 45 days and a maximum of 90 days. The study used a nursing model of care, The Personalized Nursing LIGHT model, to integrate treatment for HIV AIDS with substance abuse treatment. The LIGHT model seeks to enhance patient well being directly and thereby to support interventions that decrease substance use and improve management of chronic disease. The substance abuse treatment team included a nurse who used the LIGHT model and coordinated an integrated care protocol. The nurse accompanied clients on visits to their physicians for HIV treatment and facilitated the integration of medical recommendations with the substance abuse treatment. Six-month posttest data were gathered on all 45 participants and 12-month posttest interviews were accomplished with 29 of them. At 6 months, 78% of the respondents (35 45) reported no drug use in the past 30 days, and, at 12 months, 79% (23 29) were drug free for the past month. Significant decreases from intake to 6 months were detected on Addiction Severity Index (ASI) composite scores for drug use (p < 0.01), alcohol use (p < 0.04), medical severity (p < 0.02), psychiatric severity (p < 0.01), legal problems (p < 0.04), and employment difficulty (p < 0.01). Improvement of 6-month drug use composite scores was related significantly to treatment duration (R = 0.42; p < 0.01). Significant decreases in ASI measures of drug use (p < 0.01), alcohol use (p < 0.01), employment difficulty (p < 0.01), and family social problems (p < 0.01) also occurred at 12 months. Well being, as measured by a Global Well Being Index, was found to improve significantly at 6 months (p < 0.02) and 12 months (p < 0.07). Concurrently, significant improvement was observed on Medical Outcomes Study-36-Item Short-Form Health Survey (SF-36) measures of general health and health functioning. These changes were noted at 6 months in the general health (p < 0.02), mental health (p < 0.01), social functioning (p < 0.01), role emotional status (p < 0.04), and vitality (p < 0.01) subscales. At 12 months, the social functioning (p < 0.01) subscale responses were further decreased.