Substance Abuse and Infectious Disease in Women

Glenda Clare, M.A.

Workshop Objectives

Increase their knowledge of the connection between substance abuse and infectious disease in women;

Gain an understanding and an appreciation for the issues facing substance abuse treatment and prevention specialists, public health specialists and child welfare workers working with addicted women and their children;

Identify the effects of substances on the body and brain of the female user and how they relate to their roles as public health practitioners;

Increase their knowledge of specific sexually transmitted and other infectious diseases and how they relate to their roles as substance abuse treatment and prevention counselors;

Workshop Objectives

Improve their skills in the areas of behavioral change and risk screening and assessment for women;

Increase their knowledge and skills in the areas of collaboration, cultural awareness and appropriateness, capacity building, and communications;

Develop strategies and mechanisms that will enable them to apply the knowledge, information, and skills gained in the training with their clients and colleagues; and

Expand their capacity for new and improved linkages and referral systems with other individuals and programs.

Philosophical Frameworks

In addition to cross-training, the workshop is based on several philosophical frameworks:

Collaboration Networking Diversity awareness Cultural appropriateness Capacity building Effective Communication

Collaboration

Working together on mutually agreed-upon goals and objectives

Networking

Interacting with others for mutual assistance and support

Diversity Awareness

Gaining information and understanding about the dimensions that make individuals and groups similar to and different from one another

Cultural Appropriateness

Developing and implementing products and services that meet the specific needs of diverse background in a manner that recognizes, affirms, and values the worth of individuals, families and communities

Cultural groups are more than ethnic and racial, and may include gender, sexual orientation, age/generation, socioeconomic status, educational status, employment, spirituality, religious belief, regional views, physical capacity and immigration status

Capacity Building

Developing and implementing strategies that provide for the sharing of information and knowledge with clients, colleagues, and the community

Effective Communication

Expressing ideas, information, and decisions in a manner appropriate to and understandable by different individuals and groups

Language and Labels

Substance abuse Substance abusers Substance use disorder Dependence Use Abuse Alcoholics Addicts People with addiction disease Chemical dependency Transgender at sexual risk (TSR) Women at sexual risk (WSR)

Language and Labels

Sexually transmitted disease (STD) Sexually transmitted infection (STI) AIDS victim People living with AIDS (PLWA) Men who have sex with men (MSM) Female to male transgender (FTM TG) Intravenous drug user (IDU) Male to female transgender (MTF TG) Men who have sex with men and women (MSM/W) On the Down Low Person/People with AIDS (PWA)

Possible Effects of Substance Abuse

History of infectious disease Poor nutrition High stress – psychiatric disorders Compromised socioeconomic and housing

status Liver disease Criminal justice issues High-risk sexual practices

State and National Data on Infectious Disease

State NationalHIVAIDSSTDs

SyphilisGonorrheaChlamydia

Hepatitis CTuberculosis

Contexts Influencing High-Risk Behavior

Substance use settings Social networks Geographic region Income and social factors

Population Groups with Especially High Risks

Certain racial and ethnic groups Men who have sex with men (MSM) Homeless individuals Incarcerated individuals Injection drug users (IDUs) Female sex workers and IDUs Adolescents Immigrant Population

Population Groups with Especially High Risks

Men and women involved in international slave trafficking (i.e. “indentured servants,” “mail-order brides,” “garment workers”)

Transgendered male to female on injection hormone therapy

Transgendered male to female sex workers

Guiding Principles

1. Ensure coordination and collaboration

2. Ensure coverage, access and quality

3. Recognize and overcome stigma

4. Tailor services and programs

Women, Sexually Transmitted & Other Infectious Diseases

Women & Substance Abuse

Definition of Addiction

“Addiction is a complex interaction of physical, emotional, psychological, socio-cultural, and economic variables, characterized by compulsion, loss of control and continuation of use despite adverse consequences.”

(American Society for Addiction Medicine)

Definition of Addiction

“Addiction is a chronic relapsing disorder of the brain expressed in behavioral ways and in a social context (characterized by the repeated, compulsive seeking or use of a substance despite adverse social, psychological, and/or physical consequences). A wide range of substances, both legal and illegal, can be abused addictively. The addiction process is activated by the interaction of alcohol and drugs with the reward system in the brain, and has an impact on the concentration of neurotransmitters in the central nervous system.”

(National Institute on Drug Abuse)

Addendum to the NIDA Definition of Addiction

On January 25, 2001, Dr. Alan T. Leshner, NIDA Director amended the definition of addiction as…”uncontrollable, compulsive drug seeking and use, even in the face of negative health and social consequences…It is really only this expression of addiction – uncontrollable, compulsive, craving, seeking and use of drugs- that matters to the addict and to his/her family, and that should matter to society as a whole. These are the elements responsible for the massive health and social problems caused by drug addiction”

Biological Aspects of Addiction

Complexity of biochemical system Role of neurotransmitters Examples of neurotransmitter imbalances Examples of biological factors in substance

abuse

Psychological Aspects of Addiction

Developmental experiences Substance abuse as adaptive response Risk factors for substance abuse: comorbidity

of psychiatric disorders and psychological adjustment

Examples of psychological factors in substance abuse

Social Aspects of Addiction

Societal attitudes Socioeconomic conditions Work pressures Family relationships Examples of substance abuse as a result of

social factors

Women, HIV/AIDS Prevention, Treatment &

Care

HIV/AIDS Prevention

Primarily transmission occurs via two routes Sharing contaminated syringes, needles, and

other drug injecting equipment Unprotected sex with infected individuals

Key Issues

Substance abuse increases the risk of contracting HIV.

Substance abusers are at risk for HIV infection through sexual behaviors.

Despite the fact that primary spread is associated with same sex activities amongst men and male injection drug use, HIV is rapidly spreading among women and adolescents

Key Issues

Substance abuse treatment serves as HIV prevention.

HIV/AIDS, substance abuse disorders and mental disorders interact in a complex fashion

High-risk behaviors for HIV transmission – sex, drug use, sharing of injection materials and tattooing – occur in correctional facilities.

Strategies to Prevent Sexual Transmission of HIV

HIV Prevention, Counseling and Testing

Services (C&T)

Barriers to Testing & Treatment

Limited or no access to programs Cost of testing and treatment Fear/mistrust of testing and treatment Cultural differences

What are the Barriers to Care?

Promoting Risk Assessment & Behavior Change

Motivational Interviewing

Motivational interviewing is based on motivational psychology. The model was developed by Miller and Rollnick

Motivational interviewing can be used with anyone at any time

In motivational interviewing the job of the clinician is to find out what motivates an individual to change a behavior to a desired one

Components of a Motivational Interview

The following components are key to conducting an effective motivational interview:

Express empathy Develop discrepancy Avoid argumentation Roll with resistance Support self-efficacy

Motivational Interviewing ApproachThe following elements are part of a motivational approach in

interviewing

Giving advice Removing barriers Providing choices Decreasing desirability

Practicing empathy Providing feedback Clarifying goals Active helping

The Legal Implications of Collaboration

Reporting Requirements

Reporting Anonymously Using Qualified Service Organization

Agreements (QSOAs) Medical Emergency Exception Criminal Activity Court-Ordered Disclosure

Anonymous Disclosure

Under Anonymous or Non-Patient-Identifying Disclosures, a program is allowed, for example to disclose a patient’s name and state of health and even his or her whereabouts, as long as in doing so it does not also disclose that the client is in substance abuse treatment

Qualified Service Organization Agreement

The QSOA is a written document that authorizes ongoing communications between the program and an outside agency involved in treating or monitoring a patient’s care

Qualified Service Organization Agreement

The QSOA is an agreement between a program and a person providing services to a program, in which that person: Acknowledges that in receiving, storing, processing, or

otherwise dealing with any patient records from the program, he or she is fully bound by the Federal confidentiality regulations, and

Promises that, if necessary, he or she will resist in judicial proceedings any efforts to obtain access to patient records except as permitted by these regulations

Medical Emergency Exception

Under the Medical Emergency Exception, a program may disclose patient-identifying information to medical personnel in a medical emergency that requires immediate medical intervention

Medical Emergency Exception

A program can report a communicable disease to public health officials only if the following conditions are met The presence of an infected or allegedly infected

individual in the program could be said to constitute a medical emergency

Public health officials are medical personnel

Strategy Development & Action Planning

Reality Assessment

What are the current problems/issues related to your topic of choice in your area?

What programs, activities, stakeholders, and resources are currently at your disposal?

What are the strengths of your current system? Weaknesses? Opportunities? Threats?

Team Priorities/Goals

Which of the problems and issues that you identified previously can your learning application team address?

Define your long-term and short-term goals? What are the challenges to achieving your desired

results? What evidence or benchmarks will you need to

achieve to know you are making progress?

Strategies With Potential(Tactics)

What approaches, tactics, or methods should states, programs and communities pursue in order to address each of the specific goals that you outlined above?

Who has influence over specific policies and programs that can influence or advance your overall strategies?

Who will be responsible for coordinating the actions (and actors) needed to implement each strategy?

Action Steps

What specific actions must be taken to overcome identified barriers to implement your strategies?

Who will be responsible for taking each action?

What resources will be needed to support each action?

What is your timeline for completing each action?