This document discusses the relationship between substance use and HIV/AIDS. It notes that between 55,000-60,000 people in the US become infected with HIV each year, totaling over 1.1 million currently infected. Scientists have found that alcohol use can contribute to the spread of HIV/AIDS and impact treatment for infected patients in several ways: by impairing judgment and leading to risky sexual behaviors, causing delays in getting tested for HIV or seeking treatment if positive, and making it difficult for infected patients to adhere to complex medication regimens.

2.  Examples (affects) of addiction---smoker
dying of emphysema, crack addict arrested,
pregnant mother drinking heavily, girl
hooked on meth she started using to lose
weight
 Economic (impact) cost—health/care, war on
drugs, over 1 million in prison for drug
involvement. Big business—gambling, Philip
Morris, beer

3.  (Latin) addictus---attached to something,
positive.Today alcoholism called a “brain
disease "or bad habit or sin. Leading
assumption of the text:Addiction is the key,
not the substance or behavior
 Addiction defined by researchers as “a bad
habit,” “a brain disease,” “helplessness,” “a
problem of motivation”

4.  Addiction
 pattern of compulsive use.
 Has physical, psychological, social aspects.
 Emphasis on process rather than outcome.
 Pattern of preoccupation, lack of control, form of
escape, chasing one’s losses, serious
consequences.
 Gambling now considered an addiction in
DSM-5

5.  What is the ethical dilemma here?
 How do the managers ensure that the
gamblers keep spending their money?
 How are the employees controlled by the
establishment?

6.  Changes to DSM in new edition:
 no longer dichotomy between abuse and dependence
 Addiction now the preferred term instead of dependence.
 Addiction now seen as a continuum.
 Substance use disorder requires 2 of following:
 Tolerance
 inability to stop
 withdrawal problems
 excessive spending or effort
 use more than intended to obtain
 reduced involvement
 continued use

7. Is alcoholism a disease (or is it “like a disease)?
 Arguments pro:
 The AMA “endorses the proportion that drug
dependencies (including alcoholism) are disease
and that their treatment is a legitimate part of
medical practice.
 Arguments con:
 If the term “disease” is used, then one will expect a
“cure.”
 Alcoholism should only be referred to as an
addiction, except when discussing the
consequences of alcoholism such as pancreatitis.

8.  Random House Dictionary defines alcoholism as disease is a
condition of the body in which this is incorrect function.
 OxfordUniversity Dictionary – disease is absence of ease (in
treatment – disease as: primary, progressive, chronic, and
possibly fatal).
 Disease - as metaphor by Dr. Elfrim Jellinek: “alcoholism is
like a disease”
 Illness – term preferred here, less controversial, less medical.
 Best arguments pro disease: alcoholism is a brain disease
because the addicted brain has changed.
 Best arguments against: just a habit, a behavior, need to
take responsibility, people mature out of it.

9.  Why (bio), what (psycho), where (social)
 Need for spiritual healing, connection with
Higher Power
 Interactionism and cycle of pain: pain and
suffering  loss  pain, stress and
drinking more pain
 Family as a system in interaction, roles

10.  80% of people behind bars have problems,
pervasive in child welfare system, alcoholism in the
workplace.
 71% of social workers worked with clients with
substance use disorders in the past year.
 Headlines:
-“WhenTanningTurns into an Addiction”
-“Help! I’m Addicted to Facebook”
 Relevant movies: 28 days, Traffic,Walk the Line

11.  Traditional approach dichotomizes alcoholic
and non-alcoholic
Use of labels—I am an alcoholic, addict,
dysfunctional family
Focus on losses, client in denial, resistant
Strengths approach—avoids labels, focus on
strengths, family as resource

12. Traditional
Bio
Dichotomy
Psycho
Problems mandate—one
size fits all
Social
Identify family dysfunction
Strengths-based
Bio
Continuum
Psycho
Strengths-motivation
Social
Holistic family as resource

13. o Strengths-based treatment approach endorsed
by UN Office on Drugs and Crime: Drug
DependenceTreatment (2008).
o Case management
o Community resources for long-term care
o Interventions relate to personal needs in
society—mental health care, housing
o Success measured in drinking, using less, not
total abstinence

14. Rapp and Goscha:
Six critical elements: person is not the illness, choice, hope, purpose,
achievement, presence of one key person to help.
 Finding the strengths in divergent models—harm reduction and 12
Step approach
 Different models for different folks.
 Very negative view of disease model: Stanton Peele: Resisting 12
Step Coercion
 Harm reduction and the strengths perspective— “meet the client
where the client is.”
 Policy issues of reducing harm.

15. Project MATCH (1997)
 Directed byThe National Institute for AlcoholAbuse and Alcoholism (NIAAA) –
2,000 clients over 8 yrs.
 What works? 12 step facilitation, cognitive, motivational enhancement therapy
(MET)

 MET most effective for those with low motivation, 12 Step with religious persons.
 Criticism: lack of a control group. MET, a shorter intervention. Models only tested
on alcoholic clients.
 Project MATCH confirms the effectiveness of diverse treatments. New measure
for recovery is improvement, not total abstinence.
Vaillant’s Research (2005)
40 year longitudinal study—those who recovered had crisis with alcohol or joined AA
or entered a stable relationship or had a religious conversion.

16.  Research from California: $1.00 spent saves 7
across states.
 Hester and Miller found that these treatment
modalities were proven to be most effective: brief
intervention, motivational interviewing (MI), use of
the medication naltrexone, social skills training,
aversion therapy, cognitive therapy, acupuncture.
(See chapter 8)

17.  Prescription drug misuse as increasing problem;
 Harm reduction recognized as important to save lives; public
health approach;
 Belief that punitive laws cause harm;
 Majority of Americans favor treatment over jail;
 De-emphasis on incarceration, reentry programming;
 Drug courts, mental health courts;
 Attention to co-occurring disorders and extensive use of
prescribed medications to reduce craving;
 Restorative Justice: victim-offender programming to
promote healing. PEASE Academy.

18.  The “Amphetamines” are a group of drugs that are central nervous system
stimulants.This group includes „amphetamine‟ and „methamphetamine‟, and
related designer drugs like „3,4 Methylenedioxymethamphetamine‟, (better
known as Ecstasy or MDMA, a psychoactive drug with hallucinogenic effects).
 The drug „Amphetamine‟ (d-amphetamine) is detected on the device only at the (AM)
position. Both the designer drug Ecstasy (mA)
 „Methylenedioxymethamphetamine‟ and methamphetamine (d-
methamphetamine) are detected on the device at the (mA) position.The (mA)
antibody does not differentiate between methamphetamine and ecstasy.
 Barbiturates (BA) are a group of structurally related prescription drugs that are
used to reduce restlessness and emotional tension, induce sleep and to treat
certain convulsive disorders.
 Benzodiazepines (BZ), a group of structurally related central nervous system
depressants, are primarily used to reduce anxiety and induce sleep.

19.  Cocaine (CO) is a central nervous system stimulant. Its primary metabolite is benzoylecgonine.
 Methadone (MT) is a synthetic opioid used clinically as a maintenance drug for opiate abusers
and for pain management.
 Opiates (OP) are a class of natural and semi-synthetic sedative narcotic drugs that include
morphine, codeine and heroin.
 Oxycodone (OX) (Oxycontin®, Percodan, Percocet)) is a semi synthetic narcotic analgesic that is
prescribed for moderately severe pain. It is available in both standard and sustained release oral
formulations. Oxycodone is metabolized to Oxymorphone and Noroxycodone.
 Phencyclidine (PC) is a hallucinogenic drug.
 Propoxyphene (PP) is a narcotic analgesic. Its primary metabolite is norpropoxyphene.
 Marijuana (TH) is a hallucinogenic drug derived from the hemp plant. Marijuana contains a
number of active ingredients collectively known as Cannabinoids.

20.  Street Names: Speed, Snap, Uppers

21.  Commonly known as meth and crystal meth

22.  Street Names: Coke, Powder,White Girl

23.  Cheaper than powder cocaine
https://www.youtube.com/watch?v=4eHMgXlugIU

24. • Double whammy—substance dependence and mental
disorder. Bipolar—feeling high can imitate drug use.
• Mental Health Parity and Addiction Equity Act of 2008
ended discrimination against consumers of mental
health and substance abuse treatment services in
insurance coverage.
• The numbers of people with serious mental disorders
who misuse substances and who smoke is double the
rate of those without mental health disorders.
• Around half of people in treatment for substance use
disorder have a serious mental disorder.

25. • Integrated Approach—fits with harm
reduction
• About a third of addiction treatment
programs now include treatment for
psychiatric disorders.
• Only 8.5% offer integrated programming
(2006)
• Anxiety disorder diagnosed in 40% of persons
with drug dependency; may be effect of
stimulant drugs.

26. • Addiction counselors often explain psychosis
as drug induced.
• Mental health professionals tend to see
alcohol use as self medication.
• Truth is both/and, not either/or.
• Coexisting disorders: anxiety, compulsive
gambling, eating and mood disorders.

27. • Anxiety
• Compulsive gambling
• Mood disorders
• Eating disorders
• Personality disorders
• Psychosis

28. • Borderline personality
• Anti-social personality
• These diagnoses often based on cultural
biases
• Integrated treatment needed
• Need to offer better housing, can rely on
funding by Supplemental Security
Insurance (SSI)

29. • Diagnosis came in 1980 in response toVietnam
war veterans and feminist movement on behalf
of rape victims
• About 25% exposed to severe trauma will develop
substance related problems
• High rate of relapse among women in substance
abuse treatment with PTSD upon release
• High anxiety a problem
• Trauma from natural disasters such as Hurricane
Katrina

30. • At least 1 in 6 veterans of war in Iraq has
PTSD
• Flashbacks common
• Immediate intervention with SSRIs
recommended to offset formation of locked
memories
• Women seeking help for rape trauma,
someimes from attacks by fellow soldiers

31. • Most commonly diagnosed of the mental
disorders for those with co-occurring
disorders.
• From mania to depression
• 90% with this disorder have substance-
related problems in a prison sample

32. • About 1% develop schizophrenia
• Delusions, hallucinations, apathy and loss
of pleasure, problems concentrating
• John Nash, A Beautiful Mind
• 48% have substance-related problems, a
variety of substances used
• “No wrong door” to treatment
• Prone to homelessness; Housing First
programs

33. • Integrated treatment specialists are trained to treat both
substance use disorders and serious mental illnesses.
• Co-occurring disorders are treated in a stage-wise fashion
with different services provided at different stages.
• Motivational interventions are used to treat consumers in all
stages, but especially in the “persuasion” stage.

34. • Substance abuse counseling, using a
cognitive-behavioral approach for the active
treatment and relapse prevention stages.
• Multiple formats for services are available,
including individual, group, self-help, and
family.
• Medication services are integrated and
coordinated with psychosocial services.

35. • Unlike integrated treatment, here the counselors go to
the client and are available around the clock. Only
for the most severe mental illness. Principles:
• Team approach: ACT team members interdisciplinary
and act as a whole to ensure basic needs are met.
• Small caseload: Teams of 10–12 serve 100
consumers.
• Time unlimited services. No individual caseloads.

36. • Supportive model for chronically mentally ill
with substance use problems. In contrast to
housing programs requiring total abstinence.
• Intensive case management provided. Client
choices are respected.
• “Wet” houses.
• Cost effective for communities—NewYork
City, Seattle, San Francisco, Portland, OR.

37. 1990 Americans with Disabilities Act for full
participation in services
Persons with head injuries at high risk for
substance misuse; many were intoxicated
when injured
High among wounded war veterans—
Traumatic brain injury from war in Iraq
Barriers to treatment—few programs with
expertise to meet the need.

38. • Addiction is a family disease…pain and stigma.
• Box 10.1 Des Moines Register “Children of Addicts”—meth
labs, family fights, and child neglect in Iowa
• Classic Family Structure:
• Addict as symptom of carrier.
• Faulty communication in family >anorexia
• Confusion of cause and effect
• Family therapy field, little attention to addiction
problems except as symptoms
• Little attention to cultural diversity as well. See
McGoldrick et al’s Ethnicity and FamilyTherapy (2005)

39. • Lack of insurance prevents emphasis on
family treatment
• Virginia Satir: studied family adaptation
to person’s illness.
• Claudia Black
• “It will never happen to me”
• Don’t talk, trust, feel—co-alcoholic,
codependent.
• Al-Anon—1950s

40. • Codependent person, chief enabler—terms took
on negative connotations later.
• This text uses the more positive term, family
manager instead of chief enabler.
• Wegscheider’s terms for family roles: hero,
scapegoat, lost child, mascot
• Melody Beattie: Codependency No More
popularized the term. We suggest survivor
instead of codependent, a term that has taken on
a life of its own.

41. Enmeshed family: Spouses are estranged:
one child here is enmeshed with father, one
with mother
F C M C

42. Lack of cohesion and social support. Each
member is protected by wall of defenses.
C
F
M
C

43. All are touching, but their boundaries are
not overlapping.
C
M
F
C

44. • 1. Precontemplation: Counselors describe
family communication patterns.
• 2. Contemplation: family concerns – look
for solutions. Male partners may be hard to
engage.
• 3. Preparation: Breaking point--formal
intervention (see boxed reading by Carroll
Schutey) Family members make a list of
feeling responses to addict’s actions.

45. • 4. Action:
• Rehearsal and treatment of family without
• addicted member.
• Therapist feedback—Example of therapist response to family
argument: “I note that as you, Steve said that just then, you
(kid) fell out of chair.” Purpose to reveal how the family roles
operate in a system.
• 5. Maintenance:
• Focus on process not content “what to do
if….”Transition with sobriety.

46. McGoldrick et al’s book on different ethnicities.
Describes work with:
• African American families—reciprocity a strength
here
• Latino families—avoid a businesslike approach
• Asian and Asian American families—engage most
powerful person in the family
• Appalachian families—engage the women who
will teach health care practices

47. Connection of substance use and violence.
Battering intervention programs.
Motivational interviewing as bridge between
women’s domestic violence services and
substance abuse treatment.
Teaching women safety plans for harm
reduction.
Risk of serious violence and death.

48. • Attack behavior, not person
• Keep issues of manageable size, don’t
label,
• Don’t use negative labels.
• Don’t rehash the past.

49. • Rename: No labels, shopping addiction as
illness, not foolish spending.
• Reframe: help client see things happen for a
reason
• Reclaim: healing, we-ness, family circles to
make decisions (from Native Americans)
• Kathy and Ed: Case Study

51. Human immunodeficiency virus (HIV) targets the body’s immune system and often
leads to acquired immune deficiency syndrome (AIDS).
Each year in the United States, between 55,000 and 60,000 people become infected
with HIV, for a total of more than 1.1 million currently infected.
Scientists have learned that alcohol use and abuse can contribute to the spread of
HIV/AIDS and affect treatment for infected patients.
 Abusing alcohol or other drugs can impair judgment, leading a person to engage
in risky sexual behaviors.
 People who drink heavily may delay getting tested for HIV and, if they do test
positive, they may postpone seeking treatment.
 Alcohol use and abuse may make it difficult for infected patients to follow the
complex medications regimen that is often prescribed to treat HIV/AIDS.
 Alcohol abuse and dependence can contribute to conditions such as liver disease
and other disorders that have an impact on the progression of HIV infection.
 All of these factors increase the likelihood that an infected person will infect
others or will go on to develop AIDS.

52.  Alcohol and other drug use can play a significant role in the spread of HIV. For
example:
 Injection drug use is one of the causes of HIV in the United States and is
responsible for approximately 10% of HIV cases annually.
 If you inject drugs, you can get HIV from sharing drug preparation or injecting
equipment (“works”) with a person who has HIV.You can also then pass HIV to
your sex and drug-using partners.
 Drinking alcohol or taking other drugs can increase your risk for HIV and other
sexually transmitted diseases (STDs). Being drunk or high affects your ability to
make safe choices and lowers your inhibitions, leading you to take risks you are
less likely to take when sober, such as having sex without a condom or sex with
multiple partners.
 Transactional sex (trading sex for drugs or money) can also increase your risk for
getting HIV.
 If you use drugs, you at are a higher risk for HIV infection and therefore should
seek HIV testing. Use the HIV/AIDS Prevention and Services Locator to find a HIV
testing site near you.
 If you already have HIV, drinking alcohol or taking other drugs can affect your
immune system and may speed up the progression of the disease. Drinking or
taking drugs also can affect your HIV treatment adherence.

53. Injected drugs are drugs that are introduced into the bloodstream using a needle and syringe. Sharing
drug preparation or injecting equipment ("works") can expose you to HIV-infected blood. If you
share works with someone who is HIV-positive, that person’s blood can stay on needles or spread
to the drug solution. In that case, you can inject HIV directly into your body.
 HIV-infected blood can also get into drug solutions by:
 Using blood-contaminated syringes to prepare drugs
 Reusing water
 Reusing bottle caps, spoons, or other containers ("cookers") to dissolve drugs into water and to
heat drugs solutions
 Reusing small pieces of cotton or cigarette filters ("cottons") to filter out particles that could block
the needle
“Street sellers” of syringes may repackage used syringes and sell them as sterile syringes. For this
reason, people who inject drugs should get syringes from reliable sources of sterile syringes, such
as pharmacies or needle-exchange programs.
It is important to know that sharing a needle or syringe for any use, including skin popping and
injecting steroids, hormones, or silicone, can put you at risk for HIV and other blood-borne
infections.

54. Methamphetamine ("meth") is a very addictive stimulant that can be snorted, smoked, or injected. It
has many street names, including crystal, tina, black beauties, and more.
Meth can reduce your inhibitions and interfere with you sound judgment regarding your behavior,
which may make you less likely to protect yourself or others.This increases your risk of getting or
transmitting HIV infection, both through sex and injection drug use.
Even though using meth is an HIV risk factor for anyone who does it, there is a strong link between
meth use and HIV transmission for men who have sex with men (MSM). Studies show that
MSM who use meth may increase their sexual AND drug-use risk factors.They may:
 Use condoms less often
 Have more sex partners
 Engage in unprotected anal sex (especially as the receptive partner, which is the highest risk
behavior)
 Inject meth instead of smoking or snorting it
Meth use can also make the effects of HIV worse for people who already have HIV.

55.  Drinking alcohol, particularly binge drinking, can increase
your risk for HIV. Being drunk affects your ability to make
safe choices and lowers your inhibitions, which may lead
you to take risks you are less likely to take when sober,
such as having sex without a condom.
 Alcohol use and abuse can also make the effects of HIV
worse if you already have HIV. For example, alcohol use
and abuse may make it difficult for you to follow your HIV
treatment plan. In addition, alcohol abuse can contribute
to health conditions such as liver disease that have an
impact on the progression of HIV infection.

56. Cocaine is a powerfully addictive stimulant drug.The powdered form of
cocaine is either inhaled through the nose (snorted), or dissolved in water
and injected into the bloodstream. Crack is a form of cocaine that has
been processed to make a rock crystal that users smoke.
If you use crack cocaine, you put yourself at risk for contracting HIV because
crack impairs your judgment, which can lead to risky sexual behavior.
In addition, crack’s short-lived high and addictiveness can create a
compulsive cycle in which you quickly exhaust your resources and may
turn to other ways to get the drug, including trading sex for drugs or
money, which increases your HIV infection risk.
 Compared to nonusers, crack cocaine users report:
 A greater number of recent and lifetime sexual partners
 Infrequent condom use
 Using more than one substance
 Being less responsive to HIV prevention programs

57. Other drugs are also associated with increased risk for HIV infection.
For example:
 Using “club drugs” like Ecstasy, ketamine, GHB, and poppers can
alter your judgment and impair your decisions about sex or other
drug use.You may be more likely to have unplanned and
unprotected sex or use other drugs, including injection drugs or
meth.Those behaviors can increase your risk of exposure to HIV. If
you have HIV, this can also increase your risk of spreading HIV to
others.
 The use of amyl nitrite (an inhalant known as “poppers”) has also
been associated with HIV risk. Poppers, which are sometimes used
in anal sex because they relax the sphincter, have long been linked
to risky sexual behaviors, illegal drug use, and sexually transmitted
infections among gay and bisexual men.They also have recently
been linked to increased use among adolescents.

58. Hepatitis is broad term referring to inflammation of the liver.This condition is most
often caused by a virus. In the United States, the most common causes of viral
hepatitis are hepatitisA virus (HAV), hepatitis B virus (HBV), and hepatitis C virus
(HCV). HBV and HCV are common among people who are at risk for, or living
with, HIV.
You can get some forms of viral hepatitis the same way you get HIV—through
unprotected sexual contact and injection drug use. In fact, about 80% of HIV-
infected injection drug users in the U.S. are also infected with HCV.
HCV infection sometimes results in an acute illness, but most often becomes a
chronic condition that can lead to cirrhosis of the liver and liver cancer. HCV
infection is more serious in people living with HIV because it leads to liver
damage more quickly.
Co-infection with HCV may also affect the treatment of HIV infection.Therefore, it’s
important for people who inject drugs to know whether they are also infected
with HCV and, if they aren’t, to take steps to prevent infection.To find out if you
are infected with HCV, ask your doctor or other healthcare provider to test your
blood. HCV can be treated successfully, even in people who have HIV.

59.  Hepatitis means inflammation of the liver.This condition is most
often caused by a virus. In the United States, the most common
causes of viral hepatitis are hepatitis A virus (HAV), hepatitis B virus
(HBV), and hepatitis C virus (HCV). HBV and HCV are common
among people who are at risk for, or living with, HIV.
 You can get some forms of viral hepatitis the same way you get
HIV—through unprotected sexual contact and injection drug use.
HAV, which causes a short-term but occasionally severe illness, is
usually spread when the virus is ingested from contact with food,
drinks, or objects (including injection drug equipment),
contaminated by feces (or stool) of an infected person.

61.  People with HIV infection are often affected by viral hepatitis; about one-third
are coinfected with either HBV or HCV, which can cause long-term illness and
death. More people living with HIV have HCV than HBV.Viral hepatitis progresses
faster and causes more liver-related health problems among people with HIV
than among those who do not have HIV.Although drug therapy has extended the
life expectancy of people with HIV, liver disease—much of which is related to HCV
and HBV—has become the leading cause of non-AIDS-related deaths in this
population.
 People with HIV who are coinfected with either HBV or HCV are at increased risk
for serious, life-threatening complications.As a result, anyone living with HIV
should be tested for HBV and HCV. Coinfection with hepatitis may also
complicate the management of HIV infection.To prevent coinfection for those
who are not already infected with HBV, the Advisory Committee on
Immunization Practices recommends HAV and/or HBV vaccination of high-risk
patients (including those who are gay, bisexual, and other men who have sex
with men [MSM]a; injection drug users;) with HIV infection or AIDS.

62.  Of people with HIV in the United States, about 25%
are coinfected with HCV, and about 10% are
coinfected with HBV.
 About 80% of people with HIV who inject drugs
also have HCV.
 HIV coinfection more than triples the risk for liver
disease, liver failure, and liver-related death from
HCV.
 About 20% of all new HBV infections and 10% of all
new HAV infections in the United States are among
MSM. In the United States, HCV is twice as
prevalent among blacks as among whites.

63. People can be infected with the three most common types of hepatitis in these ways:
 HAV: Ingestion of contaminated fecal matter, even in tiny amounts, from close person-to-person contact
with an infected person, sexual contact with an infected person, or contaminated food, drink, or objects,
including injection equipment.
 HBV: Contact with infectious blood, semen, or other body fluids; sexual contact with an infected person;
sharing of contaminated needles, syringes, or other injection drug equipment; and needlesticks or other
sharp-instrument injuries. In addition, an infected woman can pass the virus to her newborn.
 HCV: Contact with blood of an infected person, primarily through sharing contaminated needles, syringes,
or other injection drug equipment, and, less commonly, sexual contact with an infected person, birth to an
infected mother, and needlesticks or other sharp-instrument injuries from an infected person.
 Chronic HCV is often “silent,” and many people can have the infection for decades without having symptoms or feeling sick.
Compared with other age groups, people aged 46 to 64 are 4 to 5 times as likely to be infected with HCV.
 Any sexual activity with an infected person increases the risk of contracting hepatitis. In particular, unprotected anal sex
increases the risk for both HBV and HIV among MSM, and direct anal-oral contact increases the risk for HAV.
 New data suggest that sexual transmission of HCV among MSM with HIV occurs more commonly than previously believed.

64. If you have HIV infection, you can lower your risk of contracting hepatitis and other bloodborne
viruses by not sharing toothbrushes, razors, or other personal items that may come into contact
with an infected person’s blood. Do not get tattoos or body piercings from an unlicensed facility
or in an informal setting, which may use dirty needles or other instruments. Just as HIV-positive
individuals would not want to engage in behaviors that would put them at risk for hepatitis, these
same behaviors would also put others at risk for HIV.
 HAV:The best way to prevent HAV infection is to get vaccinated.The Centers for Disease Control and
Prevention (CDC) recommends vaccination for HAV for people who are at risk for HIV infection,
including MSM; users of recreational drugs, whether injected or not; and sex partners of infected
people.
 HBV:The best way to prevent HBV infection is to get vaccinated. CDC recommends vaccination against
HBV for people who have or are at risk for HIV infection, including MSM; people who inject drugs; sex
partners of infected people; people with multiple sex partners; anyone with a sexually transmitted
infection; and health care and public safety workers exposed to blood on the job.
 HCV:There is no vaccine for HCV. CDC estimates that people born during 1945 through 1965 account for
nearly 75% of all HCV infections in the United States.The best way to prevent HCV infection is to never
inject drugs or to stop injecting drugs if you currently do so by getting into and staying in a drug
treatment program. If you continue injecting drugs, always use new, sterile syringes and never reuse or
share syringes, needles, water, or other drug preparation equipment.

65.  Substance abuse is often a cause of homelessness.
 Addictive disorders disrupt relationships with family
and friends and often cause people to lose their jobs.
 For people who are already struggling to pay their
bills, the onset or exacerbation of an addiction may
cause them to lose their housing.
 Breaking an addiction is difficult for anyone,
especially for substance abusers who are homeless.

66.  In many situations, however, substance abuse is a result of homelessness rather
than a cause.
 People who are homeless often turn to drugs and alcohol to cope with their
situations.They use substances in an attempt to attain temporary relief from
their problems.
 In reality, however, substance dependence only exacerbates their problems and
decreases their ability to achieve employment stability and get off the streets.
 Additionally, some people may view drug and alcohol use as necessary to be
accepted among the homeless community
 For many homeless people, survival is more important than personal growth and
development, and finding food and shelter take a higher priority than drug
counseling.

67.  According to the United States Conference of Mayors (2008), additional
substance abuse services were reported by 28% of cities surveyed as one of the
top three items needed to combat homelessness.
 Many Americans with substance abuse dependencies, both housed and
homeless, do not receive the treatment they need. In fact, the National
Association of State Alcohol and Drug Abuse Directors (NASADAD) estimated
that in 2005, over 19.3 million people needed, but did not receive, addiction
treatment services.
 The largest factors that prevented people from being treated were the high costs
and lack of insurance (NASADAD). Since many homeless people do not have
health insurance, substance abuse treatment may be unattainable.
 Other barriers to services include long waiting lists, lack of transportation, and
lack of documentation.
 Few federal substance abuse treatment and prevention programs target funds
specifically to the homeless population.

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 Edwards, J.T. (1990). Treating chemically dependent families: A practical systems approach for professionals.
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 Fisher, G. L. & Harrison,T. C. (2013). Substance abuse information for school counselors, social workers, therapists,
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 Miller,W. R & Rollnick. (2002). Motivational interviewing: Preparing people for change. (3rd ed.). NewYork:
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 U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration
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No. 39. Rockville, MD: Substance Abuse and Mental Health. Retrieved from
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 VanWormer, K, David, D. (2013). AddictionTreatment, 3rd Ed. Belmont, CA. Brooks/Cole.