An Integrated, Multidimensional Treatment Model for Individuals Living with HIV, Mental Illness, And Substance Abuse‪.‬

Mental illness and substance use disorders are common among people living with HIV (Galvan, Burnam, & Bing, 2003) and have been linked with negative outcomes, including HIV-related morbidity and mortality, poor medication adherence, inadequate medical treatment, lower quality of life, and risky sexual behaviors (Avants, Warburton, Hawkins, & Margolin, 2000; Bartlett, 2002; Fairfield, Libman, Davis, Eisenberg, & Phillips, 1999; Kelly et al., 1993; Sherbourne et al., 2000; Turner et al., 2001). HIV-infected individuals who have both mental and substance use disorders are particularly vulnerable to poor outcomes because of the level of disease burden they experience (Batki, 1990; Douaihy, Jou, Gorske, & Salloum, 2003). Previous studies have identified 13 percent to 23 percent of HIV-infected individuals as having symptoms of both mental and substance use disorders (Galvan et al.; Whetten et al., 2005). Although there is increasing recognition of the negative implications of co-occurring mental and substance use disorders among HIV-infected individuals and the need to address them (Batki, 1990; Douaihy et al., 2003), we identified no outcomes-evaluated comprehensive mental health and substance use treatment models for HIV-infected individuals in the literature. We developed a treatment intervention to address the behavioral health care needs of HIV-infected individuals with both mental health and substance use problems, hereinafter referred to as "triply diagnosed individuals." This treatment model used evidence-based strategies for treating individuals dually diagnosed with mental health and substance use and added an HIV-specific component to address the unique needs of triply diagnosed individuals. Addressing HIV-related concerns and issues was essential because an HIV diagnosis often precipitates myriad physical, social, emotional, and financial concerns that may influence mental health and substance use treatment outcomes (Angelino & Treisman, 2001; Douaihy et al., 2003; Griffin, Rabkin, Remien, & Williams, 1998). Furthermore, because treatment for triply diagnosed individuals involves two distinct systems of care (behavioral and medical), the treatment model included an integrated approach that bridged these systems.