abuse treatment.

If substance abuse treatment slots remain unavailable, alcohol and drug counselors should refer

clients who need medical care to primary medical care services. Clients who display more acute

symptoms or conditions should probably be referred to an emergency department. However,

emergency department care typically is limited to wound care and provision of nutritional

supplements. Clients who do not have acute symptoms or conditions but need medical care

should be referred for primary medical care, either to their own physicians or to primary medical

care clinics or services.

Primary medical care

Primary medical care should consist of a comprehensive physical exam, treatment for HIV/AIDS

(e.g., combination therapy), and treatment for opportunistic infections. In particular, chronic

substance use can result in significant weight loss, lack of appetite, poor digestion, substandard

elimination, kidney and liver dysfunction, and weakened immune system functioning.

See Chapter 2 for more information about medical care of clients with HIV/AIDS.

Mental health care

A diagnosis of mental illness may reflect the client's affective and mood responses to this

medical judgment, may be a consequence of self-medication, or may reflect neurological

complications of HIV/AIDS, as well as an underlying mental health disorder. Mental health care

should consist of both a neuropsychiatric workup and full mental health status examinations (see

Chapter 3). Service providers should be alert to and notify clients and psychiatrists that

complications may arise from the use of prescription medication for mental health problems and

interactions between drug residue in the body and medications for HIV/AIDS and opportunistic

infections.

Nutritional care

Substance-abusing clients living with HIV/AIDS are typically mal- or undernourished because of

street lifestyles, the effects of HIV disease, and the physical effects of substance abuse. This

combination typically results in diminished appetite, weight loss (especially of lean muscle

mass), poor hygiene, immune suppression, protein deficiencies, vitamin and mineral exhaustion,

and anemia. In addition, providers should be aware that apparent lack of nutrition is not

associated with digestive disease or parasites.

Good nutrition is a fundamental part of overall medical care. It improves strength, energy,

longevity, and quality of life; increases muscle mass and body weight; decreases likelihood of

hospitalization and length of stay; and slows progression of HIV to AIDS.

Without adequate nutrition, HIV/AIDS clients can easily develop malnutrition. Various causes of

malnutrition and weight loss include

Inadequate intake of food



Anorexia

