Program Development of Integrated Psychological Services for Hospitalized Patients with Intravenous Drug Use Histories.

Amid rising trends in opioid use, hospitalizations for health conditions secondary to intravenous drug use are becoming more common. Such patients often require prolonged hospitalizations and frequently present with substance use histories, co-occurring mental health diagnoses, and unique behavioral health needs. These issues can adversely impact completion of medical treatment and place added burden on hospital staff. There is a growing need for medical institutions to develop policies and procedures which address the specific emotional, behavioral, and substance use needs of this patient population. Because guidelines for doing so are sparse in the literature, this study outlines the University of Vermont Medical Center's process of developing an in-hospital care agreement intended to (1) increase patient access to in-hospital need assessments, psychotherapy, and medication for opioid use disorders, (2) increase referrals for opioid use treatment beyond hospitalization, (3) standardize staff response to common challenging behaviors, and (4) provide staff with education and support for interacting with patients in effective ways. The multidisciplinary process of developing this care agreement, its specific details, lessons learned, and anticipated future directions are also discussed.

Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS.

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.