Acknowledging the fact that older adults with HIV have significant histories of substance use is the first step toward providing supportive care for they as they age. Older people living with HIV have higher rates of substance use (tobacco, alcohol and other drugs) than their HIV-negative peers. The older adult with HIV had used historically both legal (tobacco and alcohol) and illicit substances (cocaine, amphetamine, THC, pain killers etc.). Their use has decreased significantly when compared to their younger years. Yet many continue to evidence addictions which is supported by some research reports that show almost half are enrolled in recovery programs.
Managing and resolving substance use issues is a high priority especially for the older adult with HIV. Substance use occurs in the context of managing multimorbidity. Substances can interact with other medications (including antiretroviral therapy-ART) thereby minimizing their efficacy. Also, substance use is a prime predictor of nonadherence to ART and all other medications. There is substantial risk of substances having dangerous interactions with the often-long list of medications the older adult with HIV. Their use clearly increases the risk for falls as well as poor self-care management.
It may be difficult, but it is bottom line essential for you to be frank with your doctor about which substances you are using and how often. This will allow for better treatment decisions and referrals. In addition, if you experience an acute health crisis your physician and other care providers will be aware of their possible use. They can make better decisions regarding your acute and chronic care avoiding medications or treatments that might be counterproductive of even life threatening.
Reducing and eliminating the use of substances that are injurious to your health is critical, especially as you age. Each substance contributes to the overall inflammatory cascade in the body which increase risk for multiple comorbidities. The importance of community-based recovery programs must be recognized. You and others who are managing substance use know how valuable and critical the programs can be. Encouraging and helping others to use these programs is an important adjunct. In fact, possible social networks emerge from such programs as well as group therapies led by professionals.
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