Treatment of substance abuse in patients with HIV infection.

The dual diagnosis of AIDS and substance abuse raises serious clinical and ethical issues for health care providers. Often, there are barriers to the diagnosis and referral for substance abuse treatment in people with HIV infection. Countertransference is one such barrier. Important educational needs of patients can be overlooked or not fully addressed. Essential information needs to be conveyed, regardless of whether or not a patient seeks substance abuse treatment. Early intervention and treatment are essential to minimize risk for HIV infection and transmission to others. Specific clinical issues that practitioners often address for patients with AIDS or ARC are appropriate interventions for denial of the HIV-related diagnosis coupled with the denial of substance abuse, difficulties in pain management, the difficulties of family and loved ones, the need for substance abuse relapse prevention, and the need for coordination of care among agencies.