Digestive Diseases and Sciences

, Volume 57, Issue 4, pp 1083–1091 | Cite as

An Integrated Alcohol Abuse and Medical Treatment Model for Patients with Hepatitis C

  • Rae Jean Proeschold-BellEmail author
  • Ashwin A. Patkar
  • Susanna Naggie
  • Lesleyjill Coward
  • Paolo Mannelli
  • Jia Yao
  • Patricia Bixby
  • Andrew J. Muir
Original Article



Patients with chronic hepatitis C virus (HCV) infection have high rates of alcohol consumption, which is associated with progression of fibrosis and lower response rates to HCV treatment.


This prospective cohort study examined the feasibility of a 24-week integrated alcohol and medical treatment to HCV-infected patients.


Patients were recruited from a hepatology clinic if they had an Alcohol Use Disorders Identification Test score >4 for women and >8 for men, suggesting hazardous alcohol consumption. The integrated model included patients receiving medical care and alcohol treatment within the same clinic. Alcohol treatment consisted of 6 months of group and individual therapy from an addictions specialist and consultation from a study team psychiatrist as needed.


Sixty patients were initially enrolled, and 53 patients participated in treatment. The primary endpoint was the Addiction Severity Index (ASI) alcohol composite scores, which significantly decreased by 0.105 (41.7% reduction) between 0 and 3 months (P < 0.01) and by 0.128 (50.6% reduction) between 0 and 6 months (P < 0.01) after adjusting for covariates. Alcohol abstinence was reported by 40% of patients at 3 months and 44% at 6 months. Patients who did not become alcohol abstinent had reductions in their ASI alcohol composite scores from 0.298 at baseline to 0.219 (26.8% reduction) at 6 months (P = 0.08).


This study demonstrated that an integrated model of alcohol treatment and medical care could be successfully implemented in a hepatology clinic with significant favorable impact on alcohol use and abstinence among patients with chronic HCV.


HCV Alcohol-related disorders Delivery of health care Integrated care Hepatology clinic 



Integrated treatments require the support of all clinic staff. We wish to thank the medical providers of the Duke Liver Clinic, including Manal Abdelmalek, Elizabeth Goacher, Janet Jezsik, Keyur Patel, Dawn Piercy, and Hans Tillmann for their participation in the alcohol screening plan and recruitment of patients. We also thank Matthew Toth, MSW, for providing addictions treatment. The study was funded by NIH-NIAAA 1R21AA017252-01A1, “Integrated Intervention for Co-Occurring Alcohol Abuse and HCV.”


  1. 1.
    Wise M, Bialek S, Finelli L, Bell BP, Sorvillo F. Changing trends in hepatitis C-related mortality in the United States, 1995–2004. Hepatology. 2008;47:1128–1135.PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization. Global alert and response: Hepatitis C. Retrieved May 15th, 2011 from; 2002.
  3. 3.
    Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.PubMedGoogle Scholar
  4. 4.
    Poynard T, Bedossa P, Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet. 1997;349:825–832.PubMedCrossRefGoogle Scholar
  5. 5.
    Wiley TE, McCarthy M, Breidi L, McCarthy M, Layden TJ. Impact of alcohol on the histological and clinical progression of hepatitis C infection. Hepatology. 1998;28:805–809.PubMedCrossRefGoogle Scholar
  6. 6.
    Mochida S, Ohnishi K, Matsuo S, Kakihara K, Fujiwara K. Effect of alcohol intake on the efficacy of interferon therapy in patients with chronic hepatitis C as evaluated by multivariate logistic regression analysis. Alcohol Clin Exp Res. 1996;20:371A–377A.PubMedCrossRefGoogle Scholar
  7. 7.
    Okazaki T, Yoshihara H, Suzuki K, et al. Efficacy of interferon therapy in patients with chronic hepatitis C: comparison between non-drinkers and drinkers. Scand J Gastroenterol. 1994;29:1039–1043.PubMedCrossRefGoogle Scholar
  8. 8.
    Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009;49:1335–1374.PubMedCrossRefGoogle Scholar
  9. 9.
    McHutchison JG, Manns MP, Muir AJ, et al. Telaprevir for previously treated chronic HCV infection. New Eng J Med. 2010;362:1292–1303.PubMedCrossRefGoogle Scholar
  10. 10.
    Poordad F, McCone J, Bacon BR, et al. Boceprevir for untreated chronic HCV genotype 1 infection. New Eng J Med. 2011;364:1195–1206.PubMedCrossRefGoogle Scholar
  11. 11.
    Weisner C, Mertens J, Parthasarathy S, Moore C, Lu Y. Integrating primary medical care with addiction treatment. JAMA. 2001;286:1715–1723.PubMedCrossRefGoogle Scholar
  12. 12.
    McManus S, Hipkins J, Haddad P, Guthrie E, Creed F. Implementing an effective intervention for problem drinkers on medical wards. Gen Hosp Psychiat. 2003;25:332–337.CrossRefGoogle Scholar
  13. 13.
    Reiff-Hekking S, Ockene JK, Hurley TG, Reed GW. Brief physician and nurse practitioner-delivered counseling for high-risk drinking. Results at 12-month follow-up. J Genl Intern Med. 2005;20:7–13.CrossRefGoogle Scholar
  14. 14.
    Fleming M, Brown R, Brown D. The efficacy of a brief alcohol intervention combined with %CDT feedback in patients being treated for type 2 diabetes and/or hypertension. J Stud Alcohol. 2004;65:631–637.PubMedGoogle Scholar
  15. 15.
    Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acq Immun Def Synd. 2007;46:443–450.CrossRefGoogle Scholar
  16. 16.
    Saunders JB, Aasland OG, Babor TF, De La Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88:791–804.PubMedCrossRefGoogle Scholar
  17. 17.
    Conigrave KM, Saunders JB, Reznik RB. Predictive capacity of the AUDIT questionnaire for alcohol-related harm. Addiction. 1995;90:1479–1485.PubMedCrossRefGoogle Scholar
  18. 18.
    National Institute of Alchohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide. Retrieved May 15th, 2011 from; 2005.
  19. 19.
    Beck AT, Wright FD, Newman CF. Cocaine abuse. In: Freeman A, Dettilio F, eds. Comprehensive casebook of cognitive therapy. New York, NY: Plenum; 1992:1185–1192.Google Scholar
  20. 20.
    Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York, NY: Guilford Press; 1991.Google Scholar
  21. 21.
    Prochaska JO, DiClemente CC. Toward a comprehensive model of change. In: Miller WR, Heather N, eds. Treating addictive behaviors: process of change. New York, NY: Plenum Press; 1986:3–27.Google Scholar
  22. 22.
    McGahan P, Griffith J, Parente R, McLellan A. Addiction severity index composite scores manual. Philadelphia, PA: Department of Veterans Affairs Medical Center; 1986.Google Scholar
  23. 23.
    McLellan AT, Kushner H, Metzger D, et al. The fifth edition of the addiction severity index. J Subst Abuse Treat. 1992;9:199–213.PubMedCrossRefGoogle Scholar
  24. 24.
    Rikoon SH, Cacciola JS, Carise D, Alterman AI, McLellan AT. Predicting DSM-IV dependence diagnoses from addiction severity index composite scores. J Subst Abuse Treat. 2006;31:17–24.PubMedCrossRefGoogle Scholar
  25. 25.
    Pessione F, Ramond MJ, Peters L, et al. Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis. Effect of alcoholic hepatitis, smoking and abstinence. Liver Int. 2003;23:45–53.PubMedCrossRefGoogle Scholar
  26. 26.
    Pal HR, Yadav D, Mehta S, Mohan I. A comparison of brief intervention versus simple advice for alcohol use disorders in a North India community-based sample followed for 3 months. Alcohol Alcohol. 2007;42:328–332.PubMedGoogle Scholar
  27. 27.
    Patkar AA, Thornton CC, Mannelli P, et al. Comparison of pretreatment characteristics and treatment outcomes for alcohol-, cocaine-, and multisubstance-dependent patients. J Addict Dis. 2004;23:93–109.PubMedCrossRefGoogle Scholar
  28. 28.
    Hassan MM, Hwang L-Y, Hatten CJ, et al. Risk factors for hepatocellular carcinoma: synergism of alcohol with viral hepatitis and diabetes mellitus. Hepatology. 2002;36:1206–1213.PubMedCrossRefGoogle Scholar
  29. 29.
    Pessione F, Degos F, Marcellin P, et al. Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C. Hepatology. 1998;27:1717–1722.PubMedCrossRefGoogle Scholar
  30. 30.
    Romero-Gómez M, Grande L, Nogales MC, Fernández M, Chavez M, Castro M. Intrahepatic hepatitis C virus replication is increased in patients with regular alcohol consumption. Digest Liver Dis. 2001;33:698–702.CrossRefGoogle Scholar
  31. 31.
    McHutchison JG, Everson GT, Gordon SC, et al. Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. N Engl J Med. 2009;360:1827–1838.PubMedCrossRefGoogle Scholar
  32. 32.
    Kwo PY, Lawitz EJ, McCone J, et al. Efficacy of boceprevir, an NS3 protease inhibitor, in combination with peginterferon alfa-2b and ribavirin in treatment-naive patients with genotype 1 hepatitis C infection (SPRINT-1): an open-label, randomised, multicentre phase 2 trial. Lancet. 2010;376:705–716.PubMedCrossRefGoogle Scholar
  33. 33.
    McHutchison JG, Lawitz EJ, Shiffman ML, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. New Eng J Med. 2009;361:580–593.PubMedCrossRefGoogle Scholar
  34. 34.
    Moyer A, Finney JW, Swearingen CE, Vergun P. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations. Addiction. 2002;97:279–292.PubMedCrossRefGoogle Scholar
  35. 35.
    Sylvestre D, Loftis J, Hauser P, et al. Co-occurring hepatitis C, substance use, and psychiatric illness: treatment issues and developing integrated models of care. J Urban Health. 2004;81:719–734.PubMedCrossRefGoogle Scholar
  36. 36.
    Knott A, Dieperink E, Willenbring ML, et al. Integrated psychiatric/medical care in a chronic Hepatitis C clinic: effect on antiviral treatment evaluation and outcomes. Am J Gastroenterol. 2006;101:2254–2262.PubMedCrossRefGoogle Scholar
  37. 37.
    Dieperink E, Ho SB, Heit S, Durfee JM, Thuras P, Willenbring ML. Significant reductions in drinking following brief alcohol treatment provided in a Hepatitis C clinic. Psychosomatics. 2010;51:149–156.PubMedGoogle Scholar
  38. 38.
    Becker M. The health belief model and personal health behavior. Thorofare, NJ: Slack; 1974.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Rae Jean Proeschold-Bell
    • 1
    Email author
  • Ashwin A. Patkar
    • 2
  • Susanna Naggie
    • 3
    • 4
  • Lesleyjill Coward
    • 5
  • Paolo Mannelli
    • 2
    • 6
  • Jia Yao
    • 1
  • Patricia Bixby
    • 7
  • Andrew J. Muir
    • 3
    • 5
  1. 1.Duke Global Health Institute, Center for Health Policy and Inequalities ResearchDuke UniversityDurhamUSA
  2. 2.Duke Addictions Program and Substance Abuse Consultation ServicesDuke University Medical CenterDurhamUSA
  3. 3.Duke Clinical Research Institute, Duke School of MedicineDuke University Medical CenterDurhamUSA
  4. 4.Division of Infectious DiseaseDuke University/Durham VA Medical CenterDurhamUSA
  5. 5.Department of GastroenterologyDuke University Medical CenterDurhamUSA
  6. 6.Department of Psychiatry and Behavioral SciencesDuke University Medical CenterDurhamUSA
  7. 7.Department of MedicineDuke University School of MedicineDurhamUSA

Personalised recommendations