Under-reporting of alcohol and substance use versus other psychiatric symptoms in individuals living with HIV

Abstract

Substance use is known to negatively impact outcomes in patients living with HIV by decreasing adherence to and effectiveness of antiretroviral therapies. Alcohol and other drug abuse and dependence are widespread among HIV-positive individuals, though reported rates vary greatly by study, suggesting the possibility of under-reporting. The extent to which patients minimize symptoms and the factors that influence reporting remain to be determined. The present study sought to gauge the degree to which substance use is under-reported in a primary care HIV clinic by evaluating the influence of anonymity versus confidentiality of self-report on endorsement rates. Patients (n=55) currently receiving medical treatment completed a confidential questionnaire assessing the presence of alcohol abuse, other drug misuse, and Generalized Anxiety Disorder (GAD). Another group of 55 patients completed a comparable survey, but did so anonymously. The two groups were similar in terms of demographic characteristics, but self-report of substance use differed depending on how symptoms were assessed, with anonymous questionnaires yielding significantly (p<.05) higher rates, compared to confidential surveys. Under-reporting appeared specific to alcohol and substance use, with no statistically significant differences between anonymous and confidential surveys in the proportion of patients endorsing symptoms of GAD. The fact that the screener specifically designed to identify patients in need of further evaluation produced lower rates of reported alcohol and drug use suggests that more work is needed to identify appropriate tools for accurately assessing substance use in HIV-positive patients so that adequate services and referrals can be offered to those in need.

Comparison of Traditional and Novel Self-Report Measures to an Alcohol Biomarker for Quantifying Alcohol Consumption Among HIV-Infected Adults in Sub-Saharan Africa

“…Under-reporting is common in populations where drinking is prohibited, among HIV-infected patients (Bilal et al, 1990, Hormes et al, 2012), and in SSA (Michalak and Trocki, 2009). New HIV patients are especially likely to under-report drinking in fear of being denied ART (Sorsdahl et al, 2012, Papas et al, 2012).…”

Attitudes and Training Needs of New England HIV Care and Addiction Treatment Providers

“…44, 45 Underreporting of alcohol use by patients, particularly in response to perceived stigmatization and pressure by clinicians, has been reported. 46 Where treatment decisions are linked to the demonstration of abstinence, as in consideration for hepatitis C treatment, underreporting may be more common. 47 The challenges in performing an effective assessment of alcohol use are compounded by the lack of time available in most clinical encounters to address these challenging issues.…”

Concordance between self-reported substance use and toxicology among HIV-infected and uninfected at risk youth

“…Although under-reporting of substance use has been documented for adults with HIV (Hormes et al, 2012), few studies have reported validity of substance use self-report in an adolescent population with HIV. Murphy and colleagues (2000), in a study of high-risk youth age 13–20 both with and without HIV, used ACASI to query participants regarding the timing of their last marijuana use and compared their self-report with urine cannabinoid testing, about which participants had been informed in advance.…”