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Substance abuse and addiction in HIV-infected patients

Authors
Andrew A Pieper, MD, PhD
Glenn J Treisman, MD, PhD
Section Editor
Jonathan M Silver, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Neuropsychiatric disorders are common in individuals infected with the human immunodeficiency virus (HIV), based upon a wide variety of factors including: direct effects of the virus, preexisting psychiatric conditions, personality vulnerabilities, affective disorders, addictions, or responses to the social isolation and disenfranchisement that can result from the diagnosis of HIV. Adding to the complexity, many HIV-infected persons have difficulty with treatment adherence due to their behavior patterns as well as specific neuropsychiatric disorders associated with HIV disease progression [1].

Substance abuse and addiction in HIV-infected patients will be reviewed here. An overview of the range of neuropsychiatric conditions associated with HIV infection and more detailed reviews of other specific conditions are discussed separately. (See "Overview of the neuropsychiatric aspects of HIV infection and AIDS" and "HIV-associated neurocognitive disorders: Epidemiology, clinical manifestations, and diagnosis" and "Depression, mania, and schizophrenia in HIV-infected patients".)

DEFINITIONS

Substance abuse is defined as a maladaptive pattern of substance use that has become socially, legally, or occupationally problematic for the individual. Substance dependence refers to tolerance or the physical need for a substance. Tolerance is the need to use increasing amounts of a substance in order to achieve the desired effect. While the term addiction has often been rejected due to the difficulty in developing a clear definition, it persists among clinicians because of its utility in describing patients. We define addiction as a pattern of increasing drug use in an increasingly stereotypical manner for intoxication despite increasing negative consequences of the behavior.  

Dependence is divided into two components: physiological and psychological. An example that illustrates the difference between abuse and dependence is to compare the college fraternity student who becomes intoxicated at a fraternity party and behaves badly (alcohol abuse) with the retired businessman who drinks martinis on a daily basis and suffers tremors and anxiety when he stops drinking (alcohol dependence). Physiological dependence occurs when an individual has physically adapted to a substance to the point that he or she must continue using the substance in order to feel normal. If the physically dependent individual stops using the substance abruptly, he or she will experience uncomfortable physical withdrawal symptoms that could be relieved by using the substance. Psychological dependence occurs when the individual believes that he or she needs to continue using the substance to feel emotionally stable.

Primary substance abuse disorders include both substance abuse and dependence. Secondary substance-induced disorders include substance intoxication, substance withdrawal, substance-induced psychotic disorder, substance-induced mood disorder, substance-induced anxiety disorder, substance-induced sleep disorder, substance-induced persisting dementia disorder, substance-induced amnestic disorder, and substance-induced sexual dysfunction. These secondary disorders typically resolve with elimination of the underlying substance abuse.

            

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Literature review current through: Nov 2016. | This topic last updated: Tue Dec 08 00:00:00 GMT+00:00 2015.
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References
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  1. Cofrancesco J Jr, Scherzer R, Tien PC, et al. Illicit drug use and HIV treatment outcomes in a US cohort. AIDS 2008; 22:357.
  2. Muga R, Sanvisens A, Egea JM, et al. Trends in human immunodeficiency virus infection among drug users in a detoxification unit. Clin Infect Dis 2003; 37 Suppl 5:S404.
  3. Wiebel WW, Jimenez A, Johnson W, et al. Risk behavior and HIV seroincidence among out-of-treatment injection drug users: a four-year prospective study. J Acquir Immune Defic Syndr Hum Retrovirol 1996; 12:282.
  4. Maslow CB, Friedman SR, Perlis TE, et al. Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990-1999. Am J Public Health 2002; 92:382.
  5. Murrill CS, Weeks H, Castrucci BC, et al. Age-specific seroprevalence of HIV, hepatitis B virus, and hepatitis C virus infection among injection drug users admitted to drug treatment in 6 US cities. Am J Public Health 2002; 92:385.
  6. Tun W, Gange SJ, Vlahov D, et al. Increase in sexual risk behavior associated with immunologic response to highly active antiretroviral therapy among HIV-infected injection drug users. Clin Infect Dis 2004; 38:1167.
  7. Edlin BR, Irwin KL, Faruque S, et al. Intersecting epidemics--crack cocaine use and HIV infection among inner-city young adults. Multicenter Crack Cocaine and HIV Infection Study Team. N Engl J Med 1994; 331:1422.
  8. Astemborski J, Vlahov D, Warren D, et al. The trading of sex for drugs or money and HIV seropositivity among female intravenous drug users. Am J Public Health 1994; 84:382.
  9. de Souza CT, Diaz T, Sutmoller F, Bastos FI. The association of socioeconomic status and use of crack/cocaine with unprotected anal sex in a cohort of men who have sex with men in Rio de Janeiro, Brazil. J Acquir Immune Defic Syndr 2002; 29:95.
  10. Stein MD, Hanna L, Natarajan R, et al. Alcohol use patterns predict high-risk HIV behaviors among active injection drug users. J Subst Abuse Treat 2000; 18:359.
  11. Rees V, Saitz R, Horton NJ, Samet J. Association of alcohol consumption with HIV sex- and drug-risk behaviors among drug users. J Subst Abuse Treat 2001; 21:129.
  12. Ahmad B, Mufti KA, Farooq S. Psychiatric comorbidity in substance abuse (opioids). J Pak Med Assoc 2001; 51:183.
  13. Kokkevi A, Stefanis N, Anastasopoulou E, Kostogianni C. Personality disorders in drug abusers: prevalence and their association with AXIS I disorders as predictors of treatment retention. Addict Behav 1998; 23:841.
  14. Lyketsos CG, Hanson A, Fishman M, et al. Screening for psychiatric morbidity in a medical outpatient clinic for HIV infection: the need for a psychiatric presence. Int J Psychiatry Med 1994; 24:103.
  15. Muga R, Langohr K, Tor J, et al. Survival of HIV-infected injection drug users (IDUs) in the highly active antiretroviral therapy era, relative to sex- and age-specific survival of HIV-uninfected IDUs. Clin Infect Dis 2007; 45:370.
  16. Gourevitch MN, Friedland GH. Interactions between methadone and medications used to treat HIV infection: a review. Mt Sinai J Med 2000; 67:429.
  17. Pariante CM, Orrù MG, Baita A, et al. Treatment with interferon-alpha in patients with chronic hepatitis and mood or anxiety disorders. Lancet 1999; 354:131.
  18. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol 1992; 47:1102.