Carolina Drug and Alcohol Resources (CADRE)
Substance abuse is associated with negative health outcomes including greater HIV risk behavior among both HIV negative and positive individuals. The purpose of this program is to provide a comprehensive continuum of substance abuse services from pretreatment to aftercare for individuals with HIV and minority men who have sex with men (MSM) regardless of HIV status in a Southern state highly affected by HIV. The program is expected to address the negative impacts of substance use on health outcomes, adherence, services utilization and HIV risk behavior.
The primary aim of the Carolina Alcohol and Drug Resources (CADRE) project is to enhance and expand the substance abuse services provided in the SAMHSA-funded Carolina Alcohol and Drug Expansion Team (CADET) program, which provided comprehensive substance abuse care for individuals with HIV living primarily in the Durham NC area. Services will be enhanced by adding peer outreach and navigation services to improve treatment engagement and participation and expanded to replicate the enhanced CADET service model in Charlotte NC and to add HIV/Hepatitis testing and care linkage and substance abuse care for minority MSM regardless of HIV status at both sites. The Charlotte Metropolitan area had the 10th highest HIV diagnosis rate in the US in 2009.
Our secondary aims are to:
1. increase the infrastructure of the targeted communities to provide a seamless continuum of substance use and HIV/Hepatitis care through education and community collaboration
2. determine the effect of the comprehensive substance abuse care services on outcomes including substance use, mental health, and HIV treatment adherence, HIV risk behavior, and access and utilization of substance abuse and HIV services and
3. determine the effect of the comprehensive substance use program on outcomes for minority MSM including on substance use, knowledge of HIV/Hepatitis status and service use.
The target population is minority individuals, primarily African-Americans, with HIV or at high-risk for HIV with a particular focus on minority MSMs. We plan to serve a total of 315 individuals (45 individuals in the first year and 90 per year for years 2 through 4). For individuals who are HIV-positive, we will provide one year of comprehensive services including:
1. peer outreach and peer navigation to facilitate and enhance treatment engagement,
2. individual and group substance abuse treatment using evidence-based models including our empirically validated modified intensive outpatient program (mIOP), Motivational Enhancement Therapy (MET), and Cognitive Behavior Therapy
3. ongoing recovery groups for individuals who have completed the intensive substance abuse treatment phase and
4. linkage to needed services such as case management, psychiatric care, HIV/Hepatitis medical care.
We are also targeting services for minority MSM of unknown HIV status to increase access and utilization of substance use services and identify HIV and Hepatitis status. These services will include HIV/Hepatitis testing and counseling, substance use treatment, peer navigation, ongoing substance abuse recovery groups and linkage to social services and other needed care.
Over 130 people have been enrolled and received some level of substance abuse treatment and/or supportive services to access substance abuse treatment in the first year and a half of service provision; topical treatment groups have been developed to meet the complex needs of this client population, and new access points for HIV and hepatitis C testing have been established.
Preliminary data indicate that participants in CADRE experience improved mental health outcomes and reduced substance use.
If proven effective, CADRE will provide new models of substance use treatment for people living with AIDS that incorporates peers support and social support to improve treatment outcomes.
Department & School
Health Policy, Center for
Duke Global Health Institute
- Substance Abuse and Mental Health Administration
- Carolinas Care Partnership
- Provided Services Organization