E&S: Expanding Substance Use Care

Events & ServicesFor all of his hard work to stay clean and housed, Ray still didn’t have a home or financial and medical benefits, and still used speed to stay awake when he stayed on the street. He wanted a place to live so he could care for his boyfriend and their dog, but when he came to AHP, he was not hopeful. “No one really helps me anyway,” he lamented. Within six months, a case manager from ASAP—the Alliance Health Project’s pioneering AIDS and Substance Abuse Program—had helped Ray and his family (including the dog) move into a residential hotel. At the same time, an AHP psychiatrist helped Ray manage the depression that struck when his parents, angry after Ray came out to them, kicked him out of their house. ASAP was one of the first to offer HIV-related counseling to HIV-positive people who used substances. In the early days of the epidemic, these services were hospital-based. Since then, ASAP has expanded into the community. And the program’s longer name —ASAP Counseling and Case Management Services —reflects the team’s expanding focus beyond HIV alone to the broader LGBTQ communities.

Two ASAP programs highlight AHP’s expanded efforts to reach LGBTQ people. AHP was able to help Ray through its Assertive Case Management with Motivational Enhancement (ACM MI) program. ACM MI supports both gay and bi men and men who have sex with men who don’t identify as gay or bi by assisting them with access to medical care, permanent, affordable housing, and the complex menu of San Francisco’s social service system. ACM MI case managers and clients don’t just tackle practical issues, but, more importantly, the psychological issues related to being homeless, surviving without medical care, or struggling with mental health and substance use issues. At the same time as ASAP provides these crucial expanded frontline services, it also seeks to research and develop new models of care. The Minority AIDS Initiative, Targeted

Capacity Enhancement (MAI TCE) Drinking Study applies innovative counseling techniques to help gay and bi men and men who have sex with men who don’t identify as gay or bi reduce the frequency that they have had five or more drinking in one sitting in the prior 30 days. Research has identified such “binge drinking” as a driver for HIV infection. The MAI TCE study, which looks at how a single-session clinical intervention might raise a participant’s consciousness of how drinking can undermine a person’s sexual health decision making process, is open to individuals regardless of HIV status. Study staff meet help participants explore the ambivalence and rationalizations that are a normal part of changing behaviors that, however unhealthy, people value.

Both ACM MI and the MAI TCE Drinking Study work with individuals regardless of their level of commitment to change. They prioritize assisting individuals to better understand how current behaviors influence the success of short- and long-term goals. ACM MI case managers help clients develop the behavioral skills they need to create better and more complete lives. MAI TCE Drinking counselors create a safe place for clients to talk about how their assumptions affect drinking and sexual health decisionmaking. For more information about the Assertive Case Management–Motivational Interviewing Program or to enroll in the MAI TCE research study, please call 415-476-3902 and ask to speak with the triage clinician on duty.

This article is taken from AHP’s quarterly newsletter, Events & Services. Read more here:Events & Services, January–March, 2014