Substance abuse and addiction in HIV-infected patients
- Andrew A Pieper, MD, PhD
Andrew A Pieper, MD, PhD
- Professor of Psychiatry
- Director of Division of Translational Neuroscience
- University of Iowa Carver College of Medicine
- Glenn J Treisman, MD, PhD
Glenn J Treisman, MD, PhD
- Professor of Psychiatry and Behavioral Sciences, Professor of Medicine
- Johns Hopkins University School of Medicine
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 .
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".)
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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- SUBSTANCE ABUSE AND HIV TRANSMISSION
- Psychiatric comorbidity
- Personality comorbidity
- Medical comorbidity
- TREATMENT OF SUBSTANCE USE DISORDERS IN HIV
- Acceptance of patient role
- Treatment of comorbid psychiatric conditions
- Maintenance treatment and relapse prevention
- Adjunctive pharmacotherapy
- SUMMARY AND RECOMMENDATIONS