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Harm reduction

 
Addictions Treatment Center, VA Puget Sound Health Care System
Program name: Addictions Treatment Center, VA Puget Sound Health Care System
Population served: Veterans with substance use disorders
Eligibility: All veterans in addictions treatment
Region served: Pacific Northwest
Funding: Department of Veterans Affairs
Program started: 2003
Number of clients: 250 per year
Contact: Norah Sullivan, ARNP
VA Puget Sound Health Care System
1660 South Columbian Way
MS 116 ATC
Seattle, WA 98108
Phone: (206) 277-1263
Fax: (206) 764-2192
E-mail: norah.sullivan@med.va.gov
Website: None
Description:

All veterans entering the Addictions Treatment Center participate in a one hour hepatitis C education class provided by an addictions ARNP with particular focus on substance abuse. Vets then self-refer for individual evaluation for hepatitis A, B, and C status and treatment. Testing and vaccination are provided within the hospital, and if appropriate, treatment is provided within the addictions clinic. An addictions ARNP, trained by and collaborating with hepatologists, provides education and treatment, working closely with the addictions multidisciplinary treatment teams. All participants have case management provided by treatment teams and access to addictions psychiatrists. A period of abstinence is required prior to antiviral treatment.

Clinical outcomes thus far are that addictions staff report a positive effect of the class on abstinence motivation. Patients have demonstrated stability, commitment, and compliance with antiviral regimens. Frequent patient contact and inter-provider communication are critical for monitoring side effects, functional and psychiatric status. There have been few somatic complaints though many discontinue treatment due to the severity of side effects, and a strong reluctance to discontinue treatment is notable. Pre-existing PTSD and depression have been associated with increased irritability. Relapse and drug craving have not been problematic despite self-injections and possession of syringes. A single patient on antiviral treatment reported an increase in cravings which he attributed to a destabilized psychiatric disorder. Veterans on opiate substitution are often provided methadone tablets for PRN use without relapse or abuse.

Veterans voice a strong preference for treatment and describe strong support within addictions groups.


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