Table 2.
Establish a climate of mutual respect |
Maintain a professional approach that reflects the aim of enhancing patients’ well being; avoid creating an atmosphere of blame or judgment |
Educate patients about their medical status, proposed treatments, and their side effects |
Include patients in decision making |
If possible, establish a multidisciplinary team consisting of primary care physicians, HIV specialists, psychiatrists, social workers, and nurses |
Have a single primary care provider coordinate the care delivered by such a team to maximize consistency and continuity |
Define and agree on the roles and responsibilities of both the health care team and the patient |
Set appropriate limits and respond consistently to behavior that violates those limits |
Minimize barriers to participation (penalties for missed visits, and so forth) |
Recognize that patients must set their own goals for behavior change and work with patients to achieve commitment to realistic goals for healthier behaviors |
Acknowledge that abstinence is not always a realistic goal; emphasize risk- reduction measures for patients who continue to use drugs |
Acknowledge that sustaining abstinence is difficult and that success may require several attempts |
Be familiar with local resources for the treatment of drug users |
Pitfalls to avoid |
Unrealistic expectations |
Frustration |
Anger |
Moralizing |
Blame |
Withholding therapy |
Data from O’Connor et al.,45Batki and Sorensen,46Wartenberg,47and Selwyn and O’Connor.48