HIV, alcohol dependence, and the criminal justice system: a review and call for evidence-based treatment for released prisoners

Abstract

Background: People with both HIV and alcohol use disorders (AUDs) are disproportionately concentrated within the U.S. criminal justice system; approximately one-quarter of all people with HIV cycle through the system each year. HIV-infected prisoners with AUDs face many obstacles as they transition back to the community. Specifically, although they have impressive HIV treatment outcomes during the period of incarceration while they are free from alcohol. Upon release, however, they face inordinate challenges including relapse to alcohol use resulting in significant morbidity and mortality. Objective: To review the existing literature regarding the relationship of HIV and treatment for AUDs within the criminal justice system in an effort to determine “best practices” that might effectively result in improved treatment of HIV and AUDs for released prisoners. Methods: PubMed, PsychInfo and Medline were queried for articles published in English from 1990 to 2009. Selected references from primary articles were also examined. Results: Randomized controlled trials affirm the role of pharmacotherapy using naltrexone (NTX) as the therapeutic option conferring the best treatment outcome for AUDs in community settings. Absent from these trials were inclusion of released prisoners or HIV-infected individuals. Relapse to alcohol abuse among HIV-infected prisoners is associated with reduced retention in care, poor adherence to antiretroviral therapy with consequential poor HIV treatment outcomes and higher levels of HIV risk behaviors. Conclusions and Scientific Significance: Untreated alcohol dependence, particularly for released HIV-infected prisoners, has negative consequences both for the individual and society and requires a concentrated effort and rethinking of our existing approaches for this vulnerable population.