Excerpt

The main objective of this Treatment Improvement Protocol (TIP) is to improve care for clients with substance abuse disorders (SUDs) by increasing knowledge of viral hepatitis among staff in behavioral health programs that provide substance abuse treatment. Some surveys have shown that substance abuse treatment providers are not well informed about viral hepatitis. Clients often perceive that counselors do not have the information they need. With up-to-date information, counselors, health professionals, and administrators in SUD treatment settings can encourage clients to understand the serious nature of hepatitis, risk factors, the importance of liver wellness, screening, treatment options, and ways to avoid spreading—or contracting—hepatitis.

Other behavioral health treatment providers (e.g., counselors in mental health treatment settings, nurses, mid-level providers) will also find useful information in this TIP. Information is provided in lay terms so that it can be understood by readers who do not have medical training.

Contents

• What Is a TIP?
• Consensus Panel
• Foreword
• 1. Overview of Viral Hepatitis
  • Introduction
  • Purpose of and Audience for the TIP
  • Terminology
  • The Liver
  • What Is Viral Hepatitis?
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Other Types of Viral Hepatitis
  • Co-Infection with Different Types of Viral Hepatitis
  • Co-Infection with Viral Hepatitis and HIV
  • Chapter Summary
• 2. Screening for Viral Hepatitis
  • The Treatment Program’s Role in the Screening Process
  • Antigens and Antibodies
  • Hepatitis A Screening
  • Hepatitis B Screening
  • Hepatitis C Screening
  • Counseling Practices That Educate, Support, and Motivate Clients Undergoing Screening
  • Chapter Summary
• 3. Evaluation of Chronic Hepatitis
  • The Medical Evaluation
  • Liver Panel
  • Viral Load Tests
  • Genotype Test
  • Liver Biopsy
  • Chapter Summary
• 4. Helping Clients Make Medical Decisions About Hepatitis Treatment
  • The Counselor’s Role
  • Factors to Consider About Hepatitis Treatment
  • Counseling Clients Diagnosed With Chronic Hepatitis
  • Supporting the Decision to Treat Hepatitis
  • Special Populations: Barriers to Hepatitis Treatment
  • Chapter Summary
• 5. Hepatitis Treatment
  • Overall Treatment Recommendations
  • Treatment for Hepatitis A
  • Treatment for Hepatitis B
  • Treatment for Hepatitis C
  • People Receiving Medication-Assisted Treatment for Opioid Dependence
  • People Who Relapse to Substance Use
  • People Who Have HCV/HIV Co-Infection
  • People Who Have Co-Occurring Behavioral Health Disorders
  • Chapter Summary
• 6. Counseling Approaches for People Who Have Viral Hepatitis
  • The Need for Counseling Strategies
  • Ensuring Safety
  • Providing Reliable Information
  • Building the Therapeutic Relationship
  • Helping Clients Understand Their Diagnoses
  • Incorporating Client Needs in Substance Abuse Treatment Planning
  • Developing a Prevention Plan
  • Using Motivational Approaches
  • Confronting the Social Factors of Hepatitis
  • Addressing Relapse
  • Building Support Systems
  • Providing Effective Case Management
  • Chapter Summary
• 7. Adding or Improving Hepatitis Services: A Guide for Administrators
  • Program Assessment and Planning
  • Screening for Viral Hepatitis
  • Medical Evaluation and Diagnosis
  • Treatment for Chronic Hepatitis
  • Prevention and Vaccination
  • Education
  • Support Services
  • Outreach
  • Integrating Hepatitis Interventions With Existing HIV Services
  • Developing Policies and Procedures
  • Evaluation
  • Successful Implementation
  • Legal and Ethical Issues
  • Chapter Summary
• Appendix A Bibliography
• Appendix B Glossary
• Appendix C Hepatitis Resources
• Appendix D Managing Side Effects of Hepatitis C Antiviral Treatment
• Appendix E Medicinal Plants/Alternative Treatments Potentially Harmful to People Who Have Hepatitis
• Appendix F Mental Health Treatment Considerations for People Who Have Chronic Viral Hepatitis C
• Appendix G Motivational Interviewing and Counseling Resources
• Appendix H Sources for Financial Assistance
• Appendix I Hepatitis C Training Programs for Substance Abuse Treatment Program Staff
• Appendix J Stakeholders Meeting Participants
• Appendix K Field Reviewers
• Appendix L Acknowledgments

This publication was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the Knowledge Application Program (KAP), a Joint Venture of The CDM Group, Inc., and JBS International, Inc., under contract numbers 270-04-7049 and 270-09-0307, with SAMHSA, U.S. Department of Health and Human Services (HHS). Christina Currier served as the Government Project Officer.

Suggested citation:

Substance Abuse and Mental Health Services Administration. Addressing Viral Hepatitis in People With Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 53. HHS Publication No. (SMA) 11-4656. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS.