Alcohol Use Reduction in Methadone Individuals With Hepatitis C Virus(HCV)
Alcohol Use Reduction in Methadone Individuals With Hepatitis C Virus(HCV)
The Alcohol Use Reduction in Methadone Individuals with HCV was designed to compare three
 different types of programs for methadone maintained men and women to determine which of the
 three programs is most effective for:1) reducing alcohol consumption; 2) improving knowledge
 of and attitudes toward the disease of hepatitis and the treatment of hepatitis; 3) improving
 willingness to seek medical care for hepatitis C; 4) completing the 3 sessions on alcohol use
 reduction; 5) completing the 3 session Hepatitis A and B vaccine; and 6) determining the
 number of self-reported 12 step alcohol treatment program sessions attended.
Nationwide, major strides have been made in treatment for HCV-infected patients using
 pegylated interferon and ribaviron; however use of these medications with HCV-infected opioid
 maintained (OM) IDUs in methadone maintenance (MM) treatment is problematic. Further, as many
 HCV-infected OM clients are continuing to drink alcohol, ongoing liver fibrosis and other
 social and behavioral consequences of alcohol use and abuse continue. Despite the fact that
 brief Motivational Interviewing (MI) has demonstrated effectiveness, these programs are not
 conducted in MM treatment settings. Moreover, the effectiveness of group delivery, as opposed
 to one-on-one delivery, of MI is unknown in terms of alcohol use reduction. In Phase I of
 this two-phased exploratory R21, a qualitative assessment will be conducted with 40 OM
 HCV-infected adults, 20 moderate alcohol users and 20 heavy alcohol users, equally divided by
 gender and readiness to change alcohol use, to explore with these clients: 1) factors
 impacting access to alcohol use reduction and health promotion services and free vaccination
 for HAV/HBV; and 2) strategies that MM staff can use to assist their clients in seeking
 services. Staff of a MM clinic will also explore the feasibility of providing these services.
 In Phase II, we plan to pilot an alcohol use reduction and liver health promotion
 intervention with 250 eligible, HCV-infected, alcohol-using OM clients receiving MM. Two
 intervention groups incorporating MI) will provide on-site brief MI (3 sessions) counseling
 to participants using either one-on-one delivery (MI-Single) or the group-delivery
 (MI-Group). In addition, each group will be offered the Liver Health Promotion (LHP) program,
 which includes a 30-minute health promotion education session, referral to a community
 12-Step alcohol outpatient program, and an offer for free screening for HAV/HBV, and the
 HAV/HBV vaccination series, if eligible (defined as being HAV and/or HBV seronegative). All
 these services will be integrated within participants' usual MM clinic onsite services. A
 third group, the Usual Care (UC) group will receive the same components offered to the
 intervention groups except for a time balanced on-site brief 3 session health promotion
 counseling as opposed to the MI. The short-term goals of the proposed study are to refine
 strategies that can be fully tested in a large-scale intervention trial. The long-term goals
 are to contribute to knowledge about promoting alcohol-related health-seeking and treatment
 completion behaviors in MM clinic settings that serve OM HCV-positive clients, so that
 population-specific intervention strategies can be developed.
Inclusion Criteria:

 -  Eligible participants will be 18 - 55 years of age, enrolled at the participating
 methadone maintenance clinic for the past 2 months, and moderate to heavy alcohol
 users within the last 3 months

 Exclusion Criteria:

 -  Individuals who are not within the age range, have not been enrolled in a methadone
 maintenance clinic for the past 2 months and were not moderate to heavy alcohol users
 within the last 3 months