Editor’s note: Today we feature a post from colleagues at the U.S. Department of Veterans Affairs (VA), one of the federal partners working to implement the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. The Plan includes several actions related to educating healthcare providers and persons living with viral hepatitis about the importance of reducing or eliminating alcohol use since it is a co-factor that hastens the progression of liver disease. In this post, the VA describes many of the steps they have undertaken in this regard.
Drinking alcohol is widespread in our society and is associated with many social activities. But for some, drinking can reach problematic levels that negatively impact health, quality of life and relationships. For people with liver disease, including viral hepatitis, reducing or abstaining from alcohol is one very important way to potentially slow or even stop the progression of liver disease. Of the over 6.1 million Veterans in Veterans Affairs (VA) care in 2011, 170,119 have been diagnosed with chronic hepatitis C (HCV), and over half (55%) of those individuals had been diagnosed with an alcohol use disorder in their life. Heavy drinking can increase the risk of developing cirrhosis in people with hepatitis C, so interventions to limit or abstain from alcohol can reduce the severity of liver disease and improve overall quality of life. Although HCV antiviral therapy in the age of direct acting antivirals (DAA) is a significant advance in the management of HCV, it may not be an option for all patients with HCV for a variety of reasons. Addressing alcohol use and pursuing other ways to keep the liver healthy is imperative for all hepatitis C patients, both for those who will undergo HCV treatment and those who will not.
There are many resources available to help with problem drinking and VA provides many options to help Veterans address this issue. In order to train providers to meet this need, VA has initiated a Postdoctoral Psychology Fellowship in HIV/HCV focused on training psychologists to address the specific mental health needs of Veterans living with these chronic illnesses. In addition, VA has trained over 430 front line HCV clinicians in the delivery of brief alcohol interventions. Brief alcohol intervention training in VA is evidence-based and gives health care providers the skills to have a productive and motivational dialogue with HCV patients who are drinking alcohol at unsafe levels. In addition, each VA medical center has a substance use treatment program that typically consists of group and some individual counseling.
For those not quite ready to commit to a substance use treatment program, there are often drop-in support groups that are offered through local VAs, Vet Centers or community supportive partners. Twelve-step groups like Alcoholics Anonymous (AA) can also offer a range of support with options for meetings throughout the day and on weekends. There are also medications that can help curb cravings for alcohol that patients can discuss with their medical providers. While many people can benefit from working with a therapist or a group on problem drinking, some would rather try to cut down or stop drinking on their own. Making small but sustainable changes over time can be important in tackling difficult-to-change behaviors like excessive drinking. There are helpful resources on the VA’s hepatitis website, including specific information about alcohol and hepatitis C.
VA is committed to providing high quality care to those with chronic hepatitis. Addressing alcohol use in those with chronic hepatitis is one important focus of these efforts. Through the training of VA HCV providers from a variety of disciplines in the delivery of brief interventions for drinking and integrated care of the whole patient, VA is leading the way in providing comprehensive care to persons with HCV.