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U.S. Department of Health and Human Services

Archival Content: 1999-2005

A Comprehensive Approach:
Preventing Blood-Borne Infections Among Injection Drug Users

Chapter 3, Section 2: Key Strategies


Drug addiction is a chronic illness characterized by compulsive, uncontrollable drug craving, seeking, and use, even in the face of enormous negative consequences. Though nearly all addicts believe initially that they can stop on their own, most of their attempts fail to achieve long-term abstinence (NIDA, 1999). Substance abuse treatment provides the medical, psychological, and behavioral support necessary for individuals to stop using drugs and to allow their brain processes to return to pre-addiction functioning (see Negative Attitudes and Stigma Toward IDUs Persist Despite a New Understanding of Addiction for more detail on the changes in brain function that occur during addiction). Often, because of the complexity of the disease and the frequency of relapse to drug use, treatment requires multiple episodes over a long period of time.

Key Strategies For injection drug users, substance abuse treatment is a powerful disease prevention strategy. Drug injectors who do not enter treatment are up to six times more likely to become infected with HIV than are injectors who enter and remain in treatment (NIDA, 1999). Because substance abuse treatment helps users reduce or eliminate the number of drug injections, it lowers the risk of infection with HIV or hepatitis that might occur through unsafe injection practices, such as multi-person use of syringes or sharing of drug injection equipment (Thiede et al., 2000). It also prevents or reduces other harmful consequences of drug use, such as abscesses and endocarditis (inflammation of the lining of the heart). Further, because drug use impairs rational decision making, which can lead to high-risk behavior, substance abuse treatment can reduce the risk of HIV and hepatitis infection that can occur through high-risk, unprotected sex.

In the last decade, the effectiveness of substance abuse treatment and its broader social benefits have been emphatically demonstrated (Gerstein and Harwood, 1990; Hubbard et al., 1989; Metzger et al., 1998; NIDA, 1999; NIH, 1997a; Pickens et al., 1991). Successful treatment can have a major positive impact on many areas of a person's life, helping him or her improve family life, employment and health, and decrease involvement with crime. Overall, treatment for addiction is as successful as treatment of other chronic conditions, such as asthma, diabetes, and hypertension (NIDA, 1999; O'Brien and McLellan, 1996).

Key Strategies Substance abuse treatment makes financial sense as well. Every $1 invested in substance abuse treatment reduces the costs of drug-related crime, criminal justice costs, and theft by $4 to $7. The average cost of 1 year of methadone maintenance treatment is $4,700 per person. The cost of 1 year of imprisonment per person is about $18,400. When health care savings are added in, total savings can exceed costs by a ratio of 12 to 1 (NIDA, 1999).

Substance abuse treatment programs also reach drug users and their partners with other HIV prevention messages and interventions. Participation in these intervention offered in the treatment setting is associated with reduced drug- and sex-related risk behaviors (Calsyn et al., 1992; El-Bassel and Schilling, 1992; Malow et al., 1994; McCusker et al., 1993).


In Substance Abuse Treatment, Be Persistent and Accept Small Victories

River Region Human Services AIDS Outreach Program, located in Jacksonville, Florida, focuses on providing substance abuse treatment services to high-risk IDUs. Additional services include HIV, STD, and TB testing; group support meetings; referrals to mental health and substance abuse treatment services; sexual risk reduction education and condom distribution; and counseling and education. Over time, it has developed links and collaborative relationships with a variety of other agencies that provide substance abuse treatment, case management, and medical services. River Region recently assumed management of a 40-bed supportive housing facility.

River Region is unusual in that outreach is an integral component of its services. River Region goes out into the community to find IDUs and offer them substance abuse treatment, HIV testing, and other services. By working in the neighborhoods with IDUs, they've been able to develop trust and credibility. "We've been doing it so long, we are recognized and have a good rep," says director Marc Gross. "Once you get one good one with all the connections, they will work with you and get their buddies into treatment."

Persistence and patience are key elements. "You have to address the substance abuse problems first," says Gross. "The other issues can come later. If the person isn't interested in treatment, don't give up. Keep after them, eventually they will come. It's not a fast process."

In addition to working in the community, River Region is the substance abuse treatment provider for the Jacksonville jail, and has recently added an HIV testing and education component to these services. Its numerous links with community-based agencies and service providers ensure continuity and consistency for inmates once they return to the community.

For more information: River Region Human Services AIDS Outreach Program,Link to a Non-CDC Link Jacksonville FL, 904/359-6088.

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