Some Changes May Be in Order

Drugs and Alcohol: Use or Chemical Dependence?

This article is reprinted from Positive Options: A Handbook For People Living With HIV, published by Body Positive, Inc. It contains comprehensive and hopeful information for people who are HIV-positive. To find out how to order the book, please call the Body Positive helpline at (800)566-6599.

The purpose of this article is to give you information about the relationship of drugs, alcohol, and tobacco to HIV and to provide suggestions for readers who wish to stop using any of these substances. It will also offer suggestions for reducing, where possible, the harm involved in use of these substances. For some readers this will be new information; others could probably write a book on this topic alone.

Most of us have used substances, even if only once in a while. There are as many reasons for using alcohol, drugs, tobacco, and sugar as there are people. It is not "wrong" or "right" to have a drink or smoke cigarettes. It is important to understand that some people use drugs or alcohol in a way that interferes with their lives. Our point is not to say that "Four beers is okay, but shooting heroin is not." If you're HIV-positive, you need to know that there are a number of ways that using substances can potentially stress your immune system. While using, it is easy to find yourself in a situation where you are likely to have unprotected sex (and expose yourself to more HIV or other sexually transmitted diseases). Street drugs in particular may be "cut" with other ingredients which can hurt your immune system. Some studies seem to point to alcohol and substances as temporarily suppressing the immune system, even in people who are not HIV-positive.

There are probably as many definitions of "addiction" and abuse as there are substances to abuse. Misunderstandings occur when we get lost in quibbling over "how much" and "how many times" we take a substance. In addition, many of us have cultural, religious, and social baggage about drug and alcohol use. A more useful way to decide if you are chemically dependent is to consider whether an "impairment" or "negative consequence" occurs as a result of use. This can happen in our physical, emotional, and/or social functioning. Sometimes we notice the effects of alcohol or drugs on our lives; sometimes others point it out to us. The range of use includes "experimentation" (use a few times to discover the effect), "regular" or "social use" (use without impairment or negative consequences), "problem use" (impairment in one area of functioning), and "addiction" or "addictive disease" (the inability to stop using or to stay stopped despite negative consequences in one or more areas of one's life). This includes compulsive use and the loss of control over use.

Chemical dependency is a progressive disease; once you have reached a later stage, you cannot go back to social use.

Let's use a mood altering substance like coffee as an example: Imagine a woman who enjoys coffee but when she is under stress tends to drink cup after cup. Now let's say that she has started a new job, and she finds that she needs six or more cups of coffee to get through the day. She starts to notice chest pains, and her stomach feels acidic all the time. Her doctor tells her to cut back to two cups a day. She promises to drink less but finds that it is so hard to get started in the morning that "I'll just have an extra cup, to get me going." She gets together with several friends twice a week, and since they are all having coffee, "it feels odd to ask for herbal tea." Soon she finds that she is drinking more coffee than before. Her family, concerned for her health, has switched to decaffeinated coffee, so that she won't be tempted at home. But it "doesn't taste the same," so she has taken to sneakily adding real instant coffee to the decaffeinated coffee jar. One day her spouse finds the empty jars of caffeinated coffee in the household trash and confronts her. She claims some other family member must have left them. This causes an argument. She is angry both at them and herself. Her sensitivity to coffee and her relationship with it have moved from "social use" to "negative consequences." We see negative consequences for her health, social, and emotional functioning. If she were sensitive to alcohol and used it in order to cope, gradually drinking her way to unemployment, a broken marriage, and liver problems, we would consider her to be "chemically dependent" or "an alcoholic."

How To Reduce Harm To Your Health:

  1. Use less

  2. Use less often

  3. Take vitamins and

  4. Drink lots of water

  5. Practice safer sex

  6. Don't share injection equipment

  7. Try less harmful methods of using

  8. Detox when you can

Things To Keep In Mind About Quitting:

  1. Don't attempt during particularly stressful times

  2. Don't quit everything at once (alcohol, coffee, cigarettes)

  3. Use stress reduction techniques

  4. Reward yourself

  5. Use deep breathing and
    visualization techniques

Exploring the Effects of Alcohol, Tobacco, and Drug Use on HIV Infection

No matter what your level of use, it is important to consider the effects of various substances on the body. One way to see their effects on the immune system is to look at increases and decreases in T-cells, one of the immune system's more important types of cells. Generally, the more T-cells one has, the better one's immune system is working:

  • Cocaine stresses the body. Although the high is short, some parts of the body are still affected for four to five weeks or more. Even monthly use keeps the body off balance. People who stop using it often see a rise in T-cells.

  • Street drugs are "cut" with substances that are a burden to the immune system. Injecting these substances increases the burden.

  • Using drugs and alcohol can make it easier to forget to practice safer sex. Even if one's partner is also HIV-positive, it is important to practice safer sex to avoid getting more HIV (or different types of HIV). In addition, it's possible to get other sexually transmitted diseases (STDs), such as herpes or syphilis. Additional diseases add to the work your immune system has to do.

Treatment Options:

  1. See a counselor

  2. 12-step programs (AA, etc.)

  3. Detox

  4. Outpatient treatment

  5. Residential rehab

  6. Methadone treatment

  7. Acupuncture

  8. Relapse prevention

Reducing the Harm of Alcohol, Tobacco, and Drug Use (Harm Reduction)

Limiting the negative consequences of use depends largely on the substance used. In general, try to use less, use less often, and in the least harmful way. Try to reduce harm by replacing, when possible, the vitamins and nutrients lost by use. Keep hydrated by drinking plenty of water.

  • Move to a less harmful mode of use. Swallowing a drug is less harmful than smoking, smoking is less harmful than injection, skin popping is less harmful than mainlining, and pharmaceutical drugs are "cleaner" than powdered street drugs which can be "cut" with harmful ingredients.

  • If you inject drugs, use a needle exchange program to get sterile injection equipment. If that's not an option, then use bleach to clean your syringe and don't share water, cookers, or cottons. Use full-strength bleach. Make sure that you keep the bleach in the syringe at least 30 seconds each time, and shake it or tap it to loosen any dried blood. Use rubbing alcohol to clean your injection site before and after you get off.

  • If you smoke tobacco, think about quitting. The American Cancer Society has a low-cost course on how to quit. You can also ask your doctor about a prescription for the nicotine patch to decrease cravings. An aqua filter cigarette holder (you can buy them in drug stores) can reduce the tar and irritation to your throat even if you're not ready to quit completely.

  • Detox when you can to lower your tolerance.

  • Keep getting medical attention and practice safer sex.

What Are My Options?

If your body isn't chemically dependent on drugs and alcohol, you may be able to stop use on your own. This will probably produce some stress, even if you are not chemically dependent. Think about your overall level of stress and do not try to quit when stress is already high. In addition, keep in mind that trying to stop smoking at the same time you quit alcohol or drugs may be a set up. It is not wise to attempt to quit all three at once. It might be better to put off quitting cigarettes until you are clean and sober. Actively use stress-reduction techniques to help you handle this period. Stress-reduction techniques include exercise, massage, safer sex, and bubble baths. Drink lots of water and fruit juices or herbal tea to flush out your system. Reward yourself by reinvesting drug, alcohol, or cigarette money on healthy or favorite foods or relaxing activities. Deep breathing (while visualizing the toxins leaving your body as you exhale) can help send a powerful message to your immune system.

Getting Help

The best way to assess your use of alcohol or drugs and which form of treatment would be best for you is to speak to a substance-abuse counselor. A counselor trained in substance abuse can give you referrals appropriate to your specific economic and treatment needs. Easy referrals for a confidential and cost-free appointment with a counselor include: hotlines, HIV service providers, aids task forces, or treatment programs. The reality is that you will probably have some difficulty getting into treatment because there are more people who want treatment than there are treatment spaces available. This means you will have to be persistent and determined to get treatment. When you are tempted to give up, go back to your stress management tools (see above), like exercise, bubble baths, massage, etc.

Some treatment options include:

  • Self-help programs and 12-step fellowships: You do not have to be an alcoholic or a drug addict to attend AA (Alcoholics Anonymous) or NA (Narcotics Anonymous). Anyone can attend open meetings. There is no charge, no obligation, and no appointment is necessary. Meetings occur at all hours of the day, in many languages, citywide. Special meetings often exist for people living with HIV, for those who are also mentally ill, non-smokers, women, and/or gay and lesbian people. Call AA or NA for information (see the "Resources" section for their numbers).

  • Detoxification: Provides 7- to 29-day inpatient services to monitor the effects of withdrawal or treat medical consequences and provide short-term counseling and referrals. AA often provides information about available beds.

  • Outpatient Treatment: Offers group and individual counseling and treatment, often providing flexible hours for working people.

  • Residential Rehabilitation and Therapeutic Communities (TCs): Provide longer-term, more intensive treatment. All residential programs have staff trained about HIV, and there is now a therapeutic community which is solely for HIV-positive people (HELP/Project Samaritan).

  • Methadone Treatment: Provides methadone, a synthetic opiate, as a substitute for heroin. Most forms of methadone treatment are out-patient Ð you visit each day or a couple of times a week to get your methadone. Some treatment centers gradually decrease the dosage of methadone (called methadone to abstinence) while others simply maintain the dosage at a level allowing one's life to stabilize (methadone maintenance).

  • Acupuncture: An increasing number of programs provide acupuncture, which has been shown to reduce drug cravings.

Most drug-treatment program staff are trained about HIV, and many centers have employees who focus on the needs of HIV-positive clients, run support groups, give workshops, etc.

Relapse and Relapse Prevention

Relapse is the term used to describe going back to drug or alcohol use after having stopped. Lots of things can trigger a relapse, and people who are recovering from substance abuse need to be constantly on their toes to guard against picking up again. Stress can easily be used to justify using -- and there may be a little voice in your head saying that finding out that you are HIV-positive is a perfect reason to use (or to increase the amount of drugs or alcohol that you are already using). STOP RIGHT THERE! There are hundreds of thousands of men and women who are HIV-positive living each day in sobriety. It's not hard to find one -- go to a meeting; they'll be there. Ask for help. If you are chemically dependent, you have at least two diseases to deal with: HIV and addiction. HIV does not make addiction or craving go away. Most of us do not suddenly make major changes. If it were that easy, everyone who had ever had a hangover would never drink again. Do not give up or beat yourself up. Learn from your mistakes. Intensify or seek support and treatment and get on with your life. If you are already getting help, this is a good time to run to your counselor and sponsor, not from them. Remember: you do not have to go through this alone; join the countless recovering people who are living with HIV and growing in self-knowledge, spirituality, and self-respect. Good luck!

Author Information: Patrice LaMariana coordinates HIV services for the Center for Urban Community Services at The Times Square and provides training and consultation on HIV and TB in New York City and upstate New York. She holds a Master's degree from Hunter Institute of Health Sciences and has worked with chemically dependent people since 1982.

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