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Section 6
Substance Use in HIV

Question 6 | Test | Table of Contents | HIV/AIDS CEU Courses
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

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In the last section, we discussed suicidal tendencies.  We discussed the two types of suicide and steps caregivers can take to prevent suicide.

Clearly, as with other personal problems involving psychological difficulties, most of the work necessary to overcome a specific problem must be done by the HIV positive client.  However, caregivers of HIV positive friends or relatives can take an active role in helping the client to overcome substance abuse. 

Therefore, in this section... we will discuss ways caregivers can help an HIV positive client in overcoming substance abuse.  Four steps you might encourage your client to take if their HIV positive friend or family member has a substance abuse problem are avoiding nagging and preaching, encouraging honesty and positive thinking, promoting self affirmation, and supporting the process of change.  As you listen to this section, consider your HIV positive client.  Could the techniques in this section encourage your client to overcome substance abuse?

Josh, age 27, had contracted HIV from either unsafe sex or intravenous drug use, he wasn’t sure.  After his diagnosis, Josh discontinued having unsafe sex and he also stopped using heroin.  However, Josh continued drinking heavily.  He also took various prescription medication illegally and smoked marijuana.  As the virus progressively destroyed Josh’s immune system, doctors told him that discontinuing his substance abuse would greatly improve the effects of his treatment.  After several severe infections, Josh began to believe that he should stop using.  Josh’s mother, Evelyn, spoke with me regarding her role in helping Josh overcome substance abuse. 

4 Steps for Caregivers of Relatives or Friends who Abuse Substances

♦ Step #1 - Avoiding Nagging and Preaching
a. First, I discussed the importance of avoiding nagging and preaching.  Evelyn, perhaps like the caregiver of your HIV positive client, often felt tempted to nag and preach to Josh when she felt that her advice or suggestions were being ignored.  Evelyn asked, "Well, then how do I get my point across?"  How would you have responded to Evelyn?  I stated, "First, let Josh know that you are aware of his problem.  Avoid accusations or judgment and try to bring Josh’s substance abuse problem out into the open. 

b. Second, encourage Josh, in a straightforward and honest way, to seek help from a support group."  Evelyn asked how she could suggest Josh attend a support group without nagging.  I stated, "Avoid a forceful or nagging approach.  Don’t make threats to take certain actions unless you fully intend to carry them out."  Would you agree that substance abusers quickly learn to ignore advice unless there are actual consequences?  I stated to Evelyn, "Expect setbacks and maybe even a few broken promises.  You’ll have to stay persistent in your concern and caring, however.  Josh may only be half-hearted in some of his attempts to change.  Shaming him about failure may only stop him from trying to succeed."  Think of your Evelyn.  Could she benefit from having some alternatives to nagging?  Would you client benefit from listening to this section?

♦ Step #2 - Encouraging Honesty And Positive Thinking
Second, let’s examine encouraging honesty and positive thinking.  Have you found, like I have, that lies, deceit, denial, and avoidance are common tactics of a person with substance abuse problems?  I explained to Evelyn that because Josh, like other substance abusers, may be used to failure, positive thinking may be necessary in overcoming substance abuse.  I stated to Evelyn, "Encourage honest efforts and discourage excuses." 

Is your HIV positive client abusing drugs or alcohol?  Does he or she perceive the cause of the problem to be outside of him or herself?  Evelyn summarized when she stated, "So I should praise him if he tries to deal with his addiction, and not accept any blaming or excuses.  But Josh is always so negative about everything."  How would you have responded to Evelyn?  I stated, "That’s where positive thinking comes in.  Substance abuse naturally leads the user to a negative or discouraging perspective on life.  Josh’s HIV positive diagnosis simply increases that negativity.  Failure to solve either problem reinforces Josh’s negative attitude.  You can help Josh avoid negativity and embrace positive thinking by replacing your own negative attitude with positive suggestions, positive thinking, and promoting self affirmation."

♦ Step #3 - Technique:  Promoting Self Affirmation
In addition to avoiding nagging and preaching and encouraging honesty and positive thinking, a third technique caregivers can use for helping an HIV positive friend or family member in overcoming substance abuse is promoting self affirmation.  As you know, self affirmation is addressed at support groups for substance abuse regularly.  Here are some steps I gave Evelyn to help promote Josh’s self affirmation. 

1. First, I stated, "First, encourage Josh to begin to love himself.  You can suggest to Josh that he make a private statement of self affirmation to himself at the beginning of each day.  For example, Josh might choose to say, ‘I’m a really special person.’  If you can suggest to Josh to love and accept himself, you might also be able to help him win the battle of self-hate that can cause continued substance abuse."

2. Second, I explained to Evelyn how she could lead by example regarding self affirmation.  I stated, "Demonstrate self love in your own life.  Just remember that being a role model doesn’t mean preaching.  The choices you make and the way you treat yourself can speak volumes about self love.  And Finally offer positive affirmation to Josh.  Let him know that you believe that he is good and therefore worthy of your love and attention."  Think of your Josh.  Could your client benefit from having his or her caregiver promote self affirmation?

♦ Step #4 - Supporting the Process of Change
The fourth step I gave Evelyn for taking an active role in helping Josh to overcome substance abuse was supporting the process of change.  When you discuss supporting the process of change with your clients or with caregivers, what is your therapeutic focus?  With Evelyn, I started with patience.  I stated, "Change must come one step at a time over a period of weeks, months, or even years.  Therefore, patience can be very important."  Next, I talked about discouraging procrastination.  Would you agree that discouraging procrastination means encouraging action and persistence? 

Evelyn and I discussed a third method for supporting the process of change at a later session.  Josh had experienced his first success on the way to overcoming substance abuse.  Evelyn stated, "Josh quit drinking for two days.  He slipped and drank Wednesday night, but he did go two whole days."  How would you have responded?  I stated, "Good.  Now consider talking to Josh about his accomplishment.  Evaluate what has been given up, what has been accomplished, and what has changed. Find out if Josh felt the results from both his decision to quit drinking and his decision to relapse." 

Evelyn evaluated Josh’s small accomplishment and then helped him set goals for additional changes.  With help from his support group, Josh knew that failure often comes from trying to accomplish more than is possible.  Think of your Josh.  Does your HIV positive client have a substance abuse problem?  Could your client’s caregiver use the steps in this section to help your client overcome substance abuse?

In this section... we discussed overcoming substance abuse.  Four steps you might encourage your client to take if their HIV positive friend or family member has a substance abuse problem are avoiding nagging and preaching, encouraging honesty and positive thinking, promoting self affirmation, and supporting the process of change. 

In the next section, we will discuss the last weeks of life.  Three techniques caregivers can use for providing care to themselves and the HIV positive friend or relative during the last weeks of life are providing comfort and rest, managing visitation, and the Moving Beyond Guilty Feelings Technique." 

Peer-Reviewed Journal Article References:
Breslow, A. S., & Brewster, M. E. (2020). HIV is not a crime: Exploring dual roles of criminalization and discrimination in HIV/AIDS minority stress.Stigma and Health, 5(1), 83–93.

Chesin, M. S., Brodsky, B. S., Beeler, B., Benjamin-Phillips, C. A., Taghavi, I., & Stanley, B. (2018). Perceptions of adjunctive mindfulness-based cognitive therapy to prevent suicidal behavior among high suicide-risk outpatient participants. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 39(6), 451–460.

Ingersoll, K. S., Dillingham, R. A., Hettema, J. E., Conaway, M., Freeman, J., Reynolds, G., & Hosseinbor, S. (2015). Pilot RCT of bidirectional text messaging for ART adherence among nonurban substance users with HIV. Health Psychology, 34(Suppl), 1305–1315.

Magidson, J. F., Andersen, L. S., Satinsky, E. N., Myers, B., Kagee, A., Anvari, M., & Joska, J. A. (2020). “Too much boredom isn’t a good thing”: Adapting behavioral activation for substance use in a resource-limited South African HIV care setting. Psychotherapy, 57(1), 107–118.

Patton, R., Blow, F. C., Bohnert, A. S. B., Bonar, E. E., Barry, K. L., & Walton, M. A. (2014). Prevalence and correlates of transactional sex among an urban emergency department sample: Exploring substance use and HIV risk. Psychology of Addictive Behaviors, 28(2), 625–630.

What are four steps caregivers can take if their HIV positive friend or family member has a substance abuse problem? To select and enter your answer go to Test.

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