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Substance Abuse Treatment Modalities: Literature Review

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HIV Prevention/Support

Concerted efforts have been directed towards addressing the problems associated with the transmission of HIV/AIDS among federal offenders in Canada (Report of the Expert Committee on AIDS and Prisons, CSC, 1994)). In terms of substance abuse, attention has been directed towards examining the relationship between reducing risks associated with intravenous drug use and the transmission of the HIV antibody.

Historically, little attention has been directed towards examining infectious diseases in relation to treatment practices (Des Jarlais, 1990). The impetus to deal with the problems associated with intravenous drug use is strong, given the devastating effects of the transmission of an infectious disease that is fatal, incurable, may develop long after a person has stopped using drugs, and may be transmitted from drug users to non-users. Increasingly, substance abuse programs are finding themselves challenged by the need to provide substance abuse treatment to persons who are at high risk in relation to HIV/AIDS. Particular emphasis is placed on reducing the risks associated with unsafe practices involving drug injection equipment.

The most common way of treating AIDS patients in substance abuse programs is to make use of educational methods to enhance participants' awareness about AIDS, thereby reducing the risk of transmitting the disease (Galea, 1988; Pagliaro, 1994; Setzer, 1991). The goal of any educational program is to alter cognitions about behaviours that place a person at risk for HIV infection. It is important to note that changing the level of awareness of people does not mean that their behaviours will be effected (Bauman & Siegal, 1987). Even when research supports high levels of knowledge, it cannot be correlated to behaviour change (Calsyn et al., 1992).

The initial focus of HIV/AIDS education in corrections was to prevent transmission within the prison as well as to alleviate fear among both the staff and inmates about accidental infection. The basic educational model used in substance abuse programming is that of a structured intervention. This involves informing participants about the risks involved with AIDS and HIV transmission. For example, CSC's national educational program, “Alcohol, Drugs, and Personal Choice” includes an HIV/AIDS prevention component. The primary target of these types of programs is attitude and knowledge change as opposed to direct behaviour change.

The reasoning behind employing an educational model is a combination of the prevalence of AIDS in prisons coupled with the alarming misconceptions found among prisoners concerning the transmission and contraction of AIDS. A study done on the prevalence of AIDS in prisons indicated a substantial increase of AIDS among the offender population from January 1992 to December 1993 (CSC, 1994). In terms of misconceptions, one study found that offenders knowledge on the causes for transmitting HIV/AIDS ranged from sneezing or coughing to having mosquito bites (Toepell, 1993). Overall, men and women incarcerated in correctional facilities make up one of the highest risk population groups for HIV infection and AIDS (Pagliaro and Pagliaro, 1994).

There is very little research that comments on the effectiveness of using HIV prevention in substance abuse programs. There are preliminary findings, however, that suggest that well managed programs in this area can contribute to reductions in substance abuse and recidivism (Weisbuch, 1991). Overall, the high risk nature of drug use among federal offenders demands an ongoing strategy that targets HIV/AIDS prevention within CSC's substance abuse programs.

References for HIV Prevention/Support:

Bauman, L.J., & Siegal, K. (1987), “Misperception among gay men of the risk for AIDS associated with their sexual behaviour”, Journal of Applied Social Psychology, 17, 329-350.

Baxter, S. (1991), “AIDS education in the jail setting”, Crime and Delinquency, 37(4), 48-63.

Calsyn, D et al. (1992), “Ineffectiveness of AIDS education and HIV antibody testing in reducing high-risk behaviors among drug users” American Journal of Public Health 82(4), 573-575.

Correctional Service of Canada. (1994), Report of the Expert Committee on AIDS and Prisons, Ottawa.

Des Jarlais, Don C. (1990), “Stages in the Response of the Drug Abuse Treatment System to the AIDS epidemic in New York City”, The Journal of Drug Issues 20(2), 335,347.

MacNair. R, et al. (1991), “AIDS Prevention Groups as Persuasive Appeals Effects on Attitudes About Precautionary Behaviors Among Persons in Substance Abuse Treatment” Small Group Research, Vol. 22 No.3, 301-319.

Pagliaro, Ann Marie, & Pagliaro, Louis A. (1994), “Just Punishment? HIV Infection and AIDS in Correctional Facilities”, Forum on Corrections Research, Vol. 6, No.3, 40-43.

Setzer, J et al. (1991), “An integrated model for medical care, substance abuse treatment and AIDS prevention services to minority youth in a short-term detention facility”, Journal of Prison & Jail Health, Vol. 10, No.2.

Toepell, Andrea R. (1993), “AIDS Knowledge Among Prisoners”, Forum on Corrections Research, Vol. 5, No. 1, 31-33.

Weisbuch, Jonathan B. (1991), “The New Responsibility for Prison Health: Working with the Public Health Community”, Journal of Prison & Jail Health, Vol. 10, No.1. 3-15.