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