Characteristics of homeless HIV-positive outreach responders in urban US and their success in primary care treatment.

Homeless HIV+ persons with persistent mental illness and substance use disorders need services, but are hard to reach and enrol into treatment. Connecting them to services is a major challenge of the AIDS epidemic. This report describes characteristics of homeless HIV+ substance abusers who responded to outreach and enrolled in integrated treatment services. The target population was urban, homeless, HIV+ individuals with substance dependence and/or mental illness diagnoses. Health and physical functioning were measured using a refinement of the Medical Outcomes Study Health Survey. Questions based on the PRIME-MD measured subjects' mental health status. Outreach occurred at shelters, soup kitchens, and on the streets. The outreach team consisted of a nurse, substance abuse counsellor, and a formerly homeless person. Outreach contacted 3,059 individuals; 1,446 entered the clinic, 110 of 206 eligible candidates enrolled in the study, and 82.7% of study participants completed 12-month follow-up interviews. Enrollees exhibited 5th percentile composite health scores. They reported heavy street drug use and unmet service needs particularly for housing and financial assistance. Outreach successfully recruited targeted individuals into treatment. They stayed in treatment and demonstrated improvements on measures of physical and mental health 12-months later.

Effectiveness of outreach to homeless substance abusers.

Substance abuse is a frequent and complicating feature of homelessness. Barriers to service access have prevented homeless individuals from receiving substance abuse care. Outreach to homeless persons is a mechanism for identifying homeless substance abusers and engaging them in treatment. This study describes a program of substance abuse treatment conducted by a medical care provider for homeless persons in Baltimore, Maryland and compares characteristics of outreach recipients to those of walk-in clients. The study also examines the differences in drug abuse pathology and selected treatment outcomes among homeless and non-homeless clients and the extent to which homeless persons are unidentified in the drug abuse treatment reporting system of the state. Homelessness is about 5.5 times more prevalent in the clientele of drug abuse treatment programs than is reflected in the statewide substance abuse management information system of Maryland. Composite scores on the Addiction Severity Index for homeless individuals are significantly higher (reflecting more serious problems) on every measure in the interview, compared to non-homeless individuals. Except for residential treatment settings, homeless persons demonstrate a shorter length-of-stay in substance abuse treatment than housed clients. Our outreach effort successfully located its targets. Outreach clients reported significantly higher levels of substance abuse than walk-in clients. In addition 42.3% of outreach contacts became service recipients. These findings indicate that outreach can be a successful method of targeting and engaging a segment of homeless substance abusers who are otherwise difficult to engage in treatment.

Addictions training for physicians and other licensed health care professionals in Maryland.

Physicians and other health care providers have multiple opportunities in the course of a typical practice year to identify and treat individuals who abuse alcohol and other drugs. Although substance abuse is very common in clinical practice, providers routinely fail to intervene in a timely fashion due to negative attitudes, incomplete knowledge, and poorly developed practice skills. Over the past ten years, addictions training of licensed health care providers nationally and in Maryland has improved significantly. This article describes recent national training trends and current educational programs statewide for medical students, physicians in residency and fellowship programs, and licensed providers in dentistry, nursing, pharmacy, psychology, and social work. Several strategies for improving professional training in addictions in the future are discussed and the importance of shifting to an interprofessional training model is emphasized.

Alcohol and the steady-state disposition kinetics of methadone in rats.

In order to examine whether alcohol alters the steady-state disposition of chronic or acute doses of methadone, three groups (N = 5 each) of male Sprague-Dawley rats were administered oral doses of methadone daily for 14 days. Group 1 received oral doses of alcohol twice daily whereas groups 2 and 3 were given isocaloric sucrose. Water was provided ad libitum and food consumption was controlled by paired feeding. On day 15, all of the animals were given the last dose as C14 methadone. Group 2 received a concurrent dose of alcohol but groups 1 and 3 received isocaloric sucrose. Blood was drawn at timed intervals for 48 hr. Methadone and its major metabolite (M1) in plasma were separated by thin-layer chromatography and underwent liquid scintillation counting. The elimination half-life (t1/2, beta) and the area under the plasma concentration-time curve (AUC) of methadone and M1 were determined in all of the three groups. Group 1 demonstrated the smallest AUC and the shortest t1/2 for methadone and M1 (p less than .05). Group 2 displayed the highest amount of unchanged methadone (p less than .05) in the first 2 hr after administration, but its t1/2 and AUC of methadone and M1 were not significantly different from those of group 3. These data may help explain why there is a high incidence of heavy drinking among methadone-maintained patients.