An Integrated Alcohol Abuse and Medical Treatment Model for Patients with Hepatitis C
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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.
KeywordsHCV 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.”
- 2.World Health Organization. Global alert and response: Hepatitis C. Retrieved May 15th, 2011 from http://www.who.int/csr/disease/hepatitis/whocdscsrlyo2003/en/index8.html; 2002.
- 18.National Institute of Alchohol Abuse and Alcoholism. Helping patients who drink too much: a clinician’s guide. Retrieved May 15th, 2011 from http://pubs.niaaa.nih.gov/publications/practitioner/cliniciansguide2005/clinicians_guide.htm; 2005.
- 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.Miller WR, Rollnick S. Motivational interviewing: preparing people to change addictive behavior. New York, NY: Guilford Press; 1991.Google Scholar
- 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.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
- 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
- 38.Becker M. The health belief model and personal health behavior. Thorofare, NJ: Slack; 1974.Google Scholar