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- 23 - accessHealthNews.net Fall Special Edition 2021 Volume 8 | Issue No. 49 " The Intersection of Substance Use, HIV, and HCV: What Providers Need to Know" is the first webinar in a three-part series hosted by the Health Resources and Services Administration (HRSA) Office of Quality Improvement. Presenter Andrew Kurtz, LMFT, is a clinical specialist with UCLA's integrated substance abuse programs. During the presentation, Kurtz explored behavioral and health factors, such as prolonged alcohol consumption and its comorbidities, that can worsen the impact of HIV. "How do we think about treatment from a behavioral standpoint?" he asked. "We know these conditions respond really well to specific behavioral interventions, like motivational interviewing and cognitive behavioral interventions. That counseling component that can be delivered in different formats and in different settings really helps to enhance and improve the outcomes that we see across these different health conditions." The presentation focused not on the treatment for these conditions, but on screening and engagement recommendations to help providers effectively communicate with patients. Excessive alcohol consumption is a risk factor due to its physical and behavioral complications. Citing data from multiple studies, Kurtz urged providers to consider patients' drinking habits as it relates to overall health, especially for individuals who are at risk of contracting or are currently diagnosed with HIV. ALCOHOL NEURONAL ACTIVITY To understand the behavioral role alcohol plays, Kurtz broke down the process that occurs in the brain during alcohol use. There are four neurotransmitters involved in this process, which work in pairs. Endogenous opioids, which deaden pain and cause euphoria, partner with dopamine, which makes an individual happy. When an individual consumes alcohol, endogenous opioids are released into the pleasure centers of the brain. In response to this increased activity, dopamine is released. The dopamine makes the drinker feel good, reinforcing the behavior at a neurochemical level while increasing the likelihood it will recur. "The thought process is, this thing made me feel good so I'm going to do it over and over again, and this feeling will be replicated or compounded," Kurtz said. "That works for a period of time, but as we know with the substances we're talking about, that doesn't last forever." Dopamine is present in many other substances used recreationally including cannabis and some prescription medicines, playing a similar role. "Dopamine is highly implicated in a lot of the mechanisms in those substances that perpetuate or reinforce the use of those substances," he said. Dopamine is present in many other substances used recreationally including cannabis and some prescription medicines, playing a similar role. "Dopamine is highly implicated in a lot of the mechanisms in those substances that perpetuate or reinforce the use of those substances," Two other neurotransmitters, glutamate and Gamma- Aminobutyric Acid (GABA), also have complementary roles: glutamate speeds an individual up while GABA slows them down. When alcohol is consumed, GABA increases, slowing brain activity, leading to impaired motor coordination, cognition, and sensory areas, which affects vision, slurs speech, and slows reaction time. It also increases the likelihood of physical harm by increasing the risk of drunk driving, falling, or a physical altercation. Over time, the brain reacts to the overabundance of GABA by creating more receptors for glutamate. This increased effect energizes the system, restoring balance in the brain. In the short term, the individual experiences a dulling of pain and a feeling of euphoria. Over time, they replicate that behavior, drinking more and drinking often, in an attempt to keep experiencing that euphoric feeling. However, as GABA and glutamate continue to be overproduced in response to the alcohol consumption, it will begin to take more alcohol to override the balanced system and feel the same level of intoxication, thus building tolerance. "We're missing a significant portion of the population – an opportunity not only to diagnose, to identify, but to have a conversation about how to initiate treatment that's going to be beneficial," he said. "There are many ways to test, and we have to not only make those ways accessible, but to advertise that in a way that reduces stigma around getting tested. There's a lot of fear and anxiety about what it might mean to have a diagnosis or positive test come up. There's a lot of benefit to having that conversation early and, generally speaking, we haven't been great at that as a healthcare field." "The thought process is, this thing made me feel good so I'm going to do it over and over again, and this feeling will be replicated or compounded," Kurtz said. "That works for a period of time, but as we know with the substances we're talking about, that doesn't last forever." he said.

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