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Study will seek to break cycle of chemical dependence and incarceration

After serving time, prisoners battling heroin addiction, mental illness and HIV face many challenges as they re-enter society. As part of an effort to make this transition easier on both the prisoner and the community, researchers at the Yale University AIDS Program will study HIV prevention and drug treatment in soon-to-be released prisoners in Connecticut and Malaysia.

"Successful programmes are urgently needed to break the cycle of chemical dependence and incarceration," said principal investigator of the two grants, Frederick L. Altice, M.D., professor of medicine at the Yale School of Medicine. "Prisoners with drug dependence have high rates of incarceration, recidivism and are at high risk for transmitting HIV. These studies are designed to take a broader look at extending the benefits that prisoners received during incarceration."

The project is the first of its kind to be done outside of the United States on prisoners with opioid dependence. Altice and a multidisciplinary team from the University of Connecticut and the University of Malaysia will conduct a randomised controlled trial to compare the benefits of methadone and/or a specially designed HIV prevention method called Holistic Health Recovery Program, which incorporates both risk reduction and access to HIV care. It builds upon previous work in Connecticut that was funded by NIDA and the Centers for Disease Control and Prevention.

The study, CHOICES, will focus on inmates in New Haven, and Hartford, Connecticut. The unique, comprehensive care model addresses relapse to heroin use, severe mental illness, homelessness and risky HIV behaviours. "There has recently been a sea change as prison systems grapple with these problems and consider developing and testing programs like CHOICES to find solutions that target the needs of some of the most challenging populations," said Altice.

The researchers have previously demonstrated that even when prisoners received effective treatment in the prison setting, many of the health benefits were lost within three months after release. "Prisoners suddenly released to the community with two weeks of medications and a medical referral may find the health insurance they had prior to incarceration has been discontinued," said Altice. "In many cases, it may take weeks to months to regain the health entitlements."

Altice and his team will adapt evidence-based techniques that have worked in community settings for inmates nearing release-to stabilise the lives of those at high risk for addiction and for contracting and spreading HIV. All previous heroin users will receive buprenorphine, a treatment for opioid dependence Altice used with successful results for released HIV positive prisoners.

Additionally, a money manager will help each prisoner create a budget plan that reduces impulsive spending, especially on drugs. This portion of the study builds on work by fellow co-investigator, Marc Rosen, associate professor of psychiatry at Yale. A community outreach team will help prisoners stick to psychiatric treatment and medical care. These tactics, successful with mentally ill patients are now being adapted for released prisoners with substance abuse problems by the Yale team of investigators.

"Results from the CHOICES study will help inform public health professionals about how best to create prison-release programs for particularly challenging populations," said Altice. Other investigators on the grants include Michael Copenhaver from the University of Connecticut and Adeeba Kamarulzaman, M.D., and Hussain Habil, M.D., from the University of Malaysia.

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