Untreated substance use and mental health conditions are associated with increased HIV transmission risk, decreased adherence to highly active antiretroviral therapy (HAART), and poor response to HAART. Researchers sought to determine the receipt of substance abuse and mental health treatment over a 3-month period in a cohort of 803 HIV-infected individuals who met diagnostic criteria for substance use and mental health disorders. Primary findings were as follows:

• Forty-seven percent of subjects had drug and alcohol dependence, 33% had drug dependence, 15% had alcohol dependence, and 5% had drug and/or alcohol abuse but not dependence.
• Only 33 percent had received concurrent treatment for substance abuse and mental illness in the past 3 months; 26 percent had received only mental health services, 15 percent had received only substance abuse services, and 26 percent had received no services.
• Use of concurrent substance abuse and mental health services was lower among nonwhites and Hispanics (p<0.05) but was positively associated with Veterans Affairs Civilian Health and Medical Program of the Uniformed Services (VA CHAMPUS) insurance coverage (p<0.05).
• African American, Hispanic, and nonwhite subjects were more likely to use self-help groups than white non-Hispanic subjects (p<0.001).

Comments by James Harrison, MHS, CADC
Historically, persons with co-occurring substance use disorders and mental health diagnoses have been treated for either one disorder or the other. This approach fails to meet the unique needs of such patients. In the substance abuse field, clients with co-occurring mental illness are often seen as noncompliant, and negative staff attitudes and beliefs create a barrier to effectively serving this population. In addition, lack of adequate training and lack of interaction across treatment tracks creates a gap in treatment coordination. These findings show that changes in direct services, as well as system changes, must occur to treat patients with co-occurring substance use disorders and mental illness effectively.