An Assessment of Concurrent Drug and Alcohol Use Among Patients Seeking Treatment for Hepatitis C

Background and Purpose:  Drug use is the leading risk factor for transmission and acquisition of hepatitis C virus (HCV) infection. Alcohol consumption, though not a risk factor for acquisition of HCV, exacerbates progression of liver damage in patients with HCV through direct toxic effects on hepatocytes. To date, research on drug and alcohol use in HCV has been limited to a handful of small survey studies focusing on behavior change resulting from receiving a positive HCV antibody test finding. These studies were limited in that the samples were confined to active drug users and they did not have confirmatory HCV RNA laboratory testing. To date, no studies have examined a sample of HCV treatment-seeking patients with confirmed seroconversion to investigate the current prevalence of drug and alcohol use. The purpose of this study was to assess the one-year prevalence of drug use and of concurrent alcohol use among HCV patients seeking HCV treatment from specialty HCV clinics.

Methods:  A sample of 309 patients with confirmed HCV RNA and seeking HCV treatment were recruited from two university-affiliated and one Veterans Affairs medical centers. Study participants completed structured diagnostic interviews and questionnaires covering their history of HCV and related psychosocial and treatment variables. The sample was divided into three groups based on drug use histories for comparison reported in this study using all of the above data. Group A were patients who were identified as having used drugs in the last year, Group B included patients who had previously used drugs but not in the last year, and Group C represented patients with no lifetime drug use. Univariate findings were summarized as numbers, proportions, means, standard deviations (SD), medians, and ranges. Dichotomous variables were compared across patient groups in pairs using chi-squared analysis, substituting Fisher’s exact tests when expected cell sizes were <5. 

Results: The prevalence of current drug use in the last year was 65% (201/309) among patients considering HCV treatment. More than one-fourth of the sample used drugs at some time in their lives but none in the last year. Only 7% (22/309) of patients reported no lifetime drug use. The prevalence of concurrent drug and alcohol use in the last year was 72% (145/201) and 52% (105/201) in the last month. Among the 86 former drug users, 30% used alcohol in the last month and 42% in the last year. Of the 22 patients with no history of drug use, use of alcohol was identified in 9% in the last month and 23% in the last year.

Conclusions and Implications: More than half of current drug users were still consuming alcohol in the last month despite the fact that they had all been informed of the potential for accelerated liver damage from continued alcohol use. This finding suggests that achieving abstinence from drug use does not necessarily imply that abstinence from alcohol has been obtained. Integration of substance treatment and HCV treatment into a unified disease management approach might increase treatment eligibility and compliance and improve disease outcomes.