title: An integrated alcohol abuse and medical treatment model for patients with hepatitis C.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  This prospective cohort study examined the feasibility of a 24-week integrated alcohol and medical treatment to HCV-infected patients.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Duke Global Health Institute, Center for Health Policy and Inequalities Research, Duke University, 2812 Erwin Rd., #403, Durham, NC 27705, USA. rae.jean@duke.edu
authors.forename: Rae Jean
authors.initials: RJ
authors.lastname: Proeschold-Bell
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Patkar
authors.forename: Susanna
authors.initials: S
authors.lastname: Naggie
authors.forename: Lesleyjill
authors.initials: L
authors.lastname: Coward
authors.forename: Paolo
authors.initials: P
authors.lastname: Mannelli
authors.forename: Jia
authors.initials: J
authors.lastname: Yao
authors.forename: Patricia
authors.initials: P
authors.lastname: Bixby
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Muir
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000150:complications / Q000628:therapy*; D003376:Counseling; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011615:Psychotherapy, Group; D013695:Temperance