Alcohol Rehabilitation Research Articles

Providing Reproductive Health Promotion in Drug Treatment Clinics

Background and Purpose: Prenatal substance use continues to be a critical public health concern. Integrating reproductive health promotion with addiction treatment is a promising approach to addressing this issue. This study was designed to understand strengths and challenges of a pilot reproductive health program, consisting of preconception/interconception health classes, childbirth education classes, and access to free doula services, for people in addiction treatment. Methods: The study design was a qualitative formative evaluation. Observations of the program (n=9) were conducted along with interviews (n=12) with clients, counselors, and program facilitators. Results: Strengths included a good fit between the program and clients’ needs and commitment to further integrate the program. Challenges included inconsistent participation and issues of facilitator selection and training. Barriers were noted related to the complex and chaotic lives of the clientele. Techniques to address inconsistent participation through mandated attendance as well as rotating and reviewing content showed mixed success. Conclusion: The study found the program to be well-regarded by stakeholders, but several structural challenges were identified. Future programs should strive for greater integration between treatment providers and reproductive health facilitators. Research is also needed to assess the effectiveness of providing integrated reproductive health education to clients engaged in addiction treatment.

The pathway to care of patients with SUD who presented at addiction treatment centers (AMATEM) in Turkey

Aim Recent studies have shown that alcohol and drug use in Turkey is rising year on year. In order to prevent and treat substance use disorder (SUD), many Alcohol and Drug Research, Treatment and Training Centres (AMATEM) have been established in Turkey. The purpose of this study was to investigate the pathway to care of patients who presented at AMATEM. Method A total 235 patients with SUD between16-69 age groups who presented at AMATEMs in 2017 were included in this study. A sociodemographic form and a structured self-report questionnaire consisting of 36 items assessing the pathways of care were given to all the patients. Data were analysed with descriptive statistics using SPSS software. Results The majority of the patients included in the study were single (55%) and male (96%). Patients mostly had a secondary school level of education (51%) and social security (65%). The majority of the patients stated that they used more than one substance (44%), opiates (20%) or alcohol (18%). Conclusion This is the first study evaluating the pathway of care in patients with SUD in Turkey. It was observed that a significant majority of patients with SUD presented to AMATEMs and patients who applied to different health institutions stated that they were mostly informed about SUD and AMATEM. There were also patients with negative attitudes towards AMATEMs and non-medical treatment seeking behavior other than AMATEM. Families, relatives and friends of patients with SUD have an important place in reaching the treatment.

Factors Associated with Perceived Continuity of Care Among Patients Suffering from Mental Disorders.

This cross-sectional study identified variables associated with continuity of care among 327 patients with mental disorders receiving services from a variety of professionals in different Quebec settings. Based on the Andersen's Behavioral Model, a linear regression analysis was performed. Attention deficit and mood disorders were negatively associated with continuity of care, while substance use disorders and quality of life revealed positive associations. Consulting a psychologist was linked to weaker continuity of care whereas visiting a drug rehabilitation center, social support, and satisfaction with services were positively related. Fostering social support, comprehensive and integrated care, and facilitating access to psychologists could lead to improved continuity of care.

Comparing nutrient intake and body weight status amongst adolescent substance users, institutionalised abstainers and never users.

BackgroundImproved nutrition intake in drug rehabilitation programmes enhances quality sobriety and prevents relapses. However, little is known about the nutritional status of substance users and institutionalised abstainers. Previous nutritional studies have mainly focused on methamphetamine, whereas ketamine has not been investigated despite its popularity amongst adolescents.ObjectivesTo compare nutrient intake and underweight status amongst three groups of adolescents –current substance users, institutionalised abstainers and never users (controls) – and examine the association between ketamine use and nutrient intake.DesignThis is a cross-sectional questionnaire survey which was conducted using face-to-face interview. Substance users (n = 202) and never users (n = 100) were invited through the outreach social workers of three non-government organisations. Abstainers (n = 50) were recruited from three drug rehabilitation centres. Nutrient intake was assessed through two 24-h recalls. Other information collected included anthropometrics, socio-demographic characteristics and substance type used over the previous month.ResultsOnly 20.8 and 15.9% of male and female substance users met the daily energy requirements. Male users were less likely to meet the recommended intake of energy [odds ratio (OR) = 0.37] and protein (OR = 0.10) than controls. Overall, abstainers had better intake of beneficial nutrients than substance users. However, abstainers were more likely to overconsume harmful nutrients, such as cholesterol and sodium. Regarding weight status, female substance users (56.1%) were more likely to be underweight than abstainers (14.8%) (OR = 8.85). Amongst underweight female substance users, 52.2% were still trying to lose more weight. Moreover, ketamine users tended to have lower intake of nutrients from animal sources than the users of other drugs.ConclusionsAdolescent substance users are at risk of energy and nutrient inadequacy. Misconceptions about body weight are disseminating amongst them. The study findings provide valuable information for frontline workers taking care of young substance users and for institutions providing residential rehabilitation programmes.

Does the effectiveness of mutual aid depend on compatibility with treatment philosophies offered at residential rehabilitation services?

BackgroundResidential rehabilitation treatment (including both Therapeutic Communities (TC) and non-TC rehabs) is a key component of service delivery for people seeking treatment for substance use disorders in Australia and globally. While mutual aid is often associated with better long-term outcomes, there is little evidence about whether inconsistencies between residential rehabilitation philosophies and particular types of mutual aid influence subsequent engagement and treatment outcomes. ObjectiveTo assess the uptake of mutual aid groups (12-step and other) on individuals leaving TC (n = 58) or non-TC (n = 78) residential treatment, and measure its impact on substance use outcomes. MethodsUsing secondary analysis of existing data, the current paper reports on 12-month outcomes from a prospective cohort study of 230 individuals entering specialist alcohol and other drug residential rehabilitation treatment in two Australian states. ResultsParticipants who attended TC settings were more likely to attend non-spiritual mutual aid groups (i.e., SMART Recovery) than non-TC residents. Engaging in mutual aid groups was associated with significantly improved outcomes for the non-TC residents only, where it significantly predicted abstinence (OR = 5.8, CI = 1.5–18.46) and reduced frequency of use of participants’ primary drug of concern (OR = 8.6, CI = 2.6–28.6). Conclusions/ImportanceAlthough 12-step is the most readily available and accessible form of mutual aid in Australia and benefited those attending non-TC residential rehabilitation, individuals exiting a TC program (whether they have completed treatment or not) may benefit from other forms of post-treatment recovery support, including alternative forms of peer-based support. The findings suggest treatment outcomes may be enhanced when the philosophies of residential treatment and post-discharge mutual aid are more compatible.

An exploration of the understandings of drug use from young drug users’ perspectives in the Western Cape: implications for primary prevention

ABSTRACTThe high rate of substance abuse among youth in South Africa is a clear indication of the level to which this issue has infiltrated the South African society. Drug abuse at an early age has been associated with problems, such as risky sexual behaviours, health problems, depression, crime, and ultimately drug addiction, which often occur at a later stage. There are many interrelated reasons and risk factors for drug use among youth and studies have mostly focussed on familial and other broader social environments such as peer/neighborhood factors for use. Less attention has been focussed on the internal or psychological factors at play in the lives of young users. This study aimed to fill this gap by exploring young drug users’ perceptions of the internal or psychological factors cited as their reasons for drug use. A better understanding of the internal risk factors that influence adolescent drug use is crucial for the development of effective prevention strategies. A qualitative method of inquiry was applied to gather in-depth data from a purposive sample of 41 young (14–19 years of age) drug users, at five drug treatment centres in the Western Cape. The findings of this study revealed that internal factors such as a permissive and/or positive attitude towards drugs, a deficit in social skills; a lack of self-esteem, and poor/maladaptive coping mechanisms were at play in the lives of the adolescents in this study. Implications for primary prevention were considered, as these findings underscore the need to consider these internal risk factors when developing interventions to reduce adolescent drug abuse.

Perception of alcohol policies by consumers of unrecorded alcohol - an exploratory qualitative interview study with patients of alcohol treatment facilities in Russia

BackgroundOver the last decade Russia has introduced various policy measures to reduce alcohol consumption and alcohol-related harm at the population level. Several of these policies, such as higher pricing and taxation or restrictions of availability, may not work in the case of unrecorded alcohol consumption; they may encourage consumers to switch to unrecorded alcohol and even increase consumption. In the present qualitative interview study we explore the perception of the recently implemented alcohol policies by patients diagnosed with alcohol dependence in two Russian cities in the years 2013–2014 and shed light on possible entry-points to prevention.MethodsSemi-structured in-depth expert interviews were conducted with 25 patients of state-run drug and alcohol treatment centers in two Russian cities in 2013 and 2014. The interviews were analyzed using thematic content analysis.ResultsAll of the interviewed participants have consumed unrecorded at some point with the majority being regular consumers, mostly switching between recorded and unrecorded alcohol depending on the situation, as predominantly defined by available money and available sources of alcohol. Low price and high availability were reported as the main reasons for unrecorded consumption. Participants voiced a general mistrust of the recently implemented alcohol regulations and viewed them largely as ineffective. They expressed particular concerns over price increases and restriction of night sales of alcoholic beverages. Substantial shifts within the unrecorded alcohol market were reported, with a decreasing availability of home-made beverages in favor of alcohol surrogates in the form of non-beverage alcohol, medicinal and cosmetic compounds. At the same time consumption of home-made alcoholic beverages was seen as a strategy to avoid counterfeit alcohol, which was frequently reported for retail sale.ConclusionsDespite the alcohol policy changes in the last years in Russia, consumption of unrecorded alcohol remained common for people with alcohol dependence. Reduction of availability of unrecorded alcohol, first and foremost in the form of cheap surrogates, is urgently needed to reduce alcohol-related harm. Implementation of screening and brief interventions for excessive alcohol consumption in various contexts such as primary healthcare settings, trauma treatment services or the workplace could be another important measure targeting consumers of unrecorded alcohol.

Staff perceptions of prescription and over-the-counter drug dependence services in England: a qualitative study

BackgroundDependence to prescription and over-the-counter (OTC) drugs represents an increasing public health and clinical problem both in England and internationally. However, relatively little is known about those affected, particularly in relation to their management at drug dependence treatment centres. This study aimed to explore the views and experiences of health care professionals (HCPs) working in formal drug treatment services in relation to supporting clients with prescription and OTC drug dependence.MethodsAn exploratory, qualitative design was used involving semi-structured telephone interviews. 15 staff were recruited using purposive sampling to represent a variety of different professional roles, funding (NHS, charity and local government) and geographical locations across England. Transcribed interviews were analysed using Braun and Clarke’s six stage thematic analysis.ResultsCurrent services were considered to be inappropriate for the treatment of OTC and prescription drug dependence, which was perceived to be a significantly under-recognised issue affecting a range of individuals but particularly those taking opioid analgesics. Negativity around current treatment services involved concerns that these were more suited for illicit drug users and this was exacerbated by a lack of specific resources, funding and commissioning. There was a perceived variation in service provision in different areas and a further concern about the lack of formal treatment guidelines and care pathways. Participants felt there to be stigma for affected clients in both the diagnosis of OTC or prescription drug dependence and also attendance at drug treatment centres which adversely impacted service engagement. Suggested service improvements included commissioning new specific services in general practices and pain management clinics, developing national guidelines and care pathways to ensure equal access to treatment and increasing awareness amongst the public and HCPs.ConclusionsThis study reveals considerable negativity and concern about current treatment services for prescription and OTC drug dependence in England from the perspective of those working in such services. Policy and practice improvement are suggested to improve outcomes for this neglected group in relation to increasing funding, guidelines and awareness.

A study of psychological pain in substance use disorder and its relationship to treatment outcome.

Substance Use Disorder (SUD) is a major public health concern affecting an estimated 22.5 million individuals in the United States. The primary aim of this study was to characterize psychological pain in a cohort of patients participating in outpatient treatment for SUD. A secondary aim was to determine the relationships between pre-treatment assessments of psychological pain, depression, anxiety and hopelessness with treatment retention time and completion rates. Data was analyzed from 289 patients enrolled in an outpatient community drug treatment clinic in Southern California, U.S. A previously determined threshold score on the Mee-Bunney Psychological Pain Assessment Scale (MBP) was utilized to group patients into high and low-moderate scoring subgroups. The higher pain group scored higher on measures of anxiety, hopelessness and depression compared to those in the low-moderate pain group. Additionally, patients scoring in the higher psychological pain group exhibited reduced retention times in treatment and more than two-fold increased odds of dropout relative to patients with lower pre-treatment levels of psychological pain. Among all assessments, the correlation between psychological pain and treatment retention time was strongest. To our knowledge, this is the first study to demonstrate that psychological pain is an important construct which correlates with relevant clinical outcomes in SUD. Furthermore, pre-treatment screening for psychological pain may help target higher-risk patients for clinical interventions aimed at improving treatment retention and completion rates.

Genotype distribution of HCV among the populations of IDUs and non-IDUs in Hainan

Objective To define the main gene subtypes and HCV-Ab, HCV-RNA of hepatitis C virus (HCV) infectors among inject drug users (IDUs) and non-inject drug users (non-IDUs) in Hainan Province. Methods The HCV-RNA(s) of 581 samples, that were from Methadone Maintenance Treatment Clinics, drug treatment center and Hainan Provincial People’s Hospital Infection Department, were extracted, amplified in the HCV Core-E1 region by RT-PCR and nested-PCR, and determine the HCV genotype distribution. Based on whether or not absence of intravenous drug abuse, the subjects were divided into IDUs group and non-IDUs group, statistical analysis was made on the demographic data. Results Among 802 methadone maintenance treatment outpatients and drug addicts in Hainan Province, 309 were HCV-Ab positive, with the HCV-Ab positive rate of 38.53%, and 215 were HCV-RNA positive, with the positive rate of 69.58%. And 251 patients tested HCV-RNA positive in Hainan People’s Hospital, 466 patients tested positive for HCV-RNA. Of the 581 HCV-Ab positive cases, 466 of them HCV-RNA positive cases.And 448 out of the 466 sampleswere successfully sequenced and genotyped as follows,the subtypes and proportion among 320 IDUs were found as 6a (58.75%) in mainly, and followed by 3b (16.88%), 3a (15.63%), 1a (4.38%), 1b (2.81%) and non-6a (0.93%); 128 non-IDUs were 1b (30.47%), 6a (28.12%), 3b (10.16%), 3a (3.91%), 1a (7.03%) and non-6a (14.84%), the difference was statistically significant ( P <0.01). Conclusion The spontaneous clearance rate of HCV infection in IDUs population was high in Hainan Province, 6a is the main subtype among IDUs, followed by 3b. There is a range transmission of HCV subtypes other than 6a in different regions. 摘要： 目的 了解海南省静脉吸毒人群 (inject drug users, IDUs) 中HCV-Ab、HCV-RNA的情况, 以及IDUs与非静 脉吸毒人群 (non-inject drug users, non-IDUs) 中丙型肝炎病毒 (Hepatitis C virus, HCV) 亚型分布特点。 方法 从海南省 的美沙酮维持治疗门诊、戒毒所和海南省人民医院住院患者中选择HCV-Ab阳性者检测HCV-RNA, 对HCV-RNA阳性 者抽取血清进行RT-PCR及巢式PCR扩增Core-E1区并测定其核酸序列、确定其基因亚型。根据是否存在静脉吸毒行 为分为IDUs组和non-IDUs组, 然后并对两组的资料统计分析。 结果 海南省802例美沙酮维持治疗门诊、戒毒所吸毒 者中HCV-Ab阳性309例, HCV-Ab阳性率38.53%, 其中215例HCV-RNA阳性, 阳性率为69.58%。海南省人民医院就 诊HCV-RNA阳性者251例, 共466例HCV-RNA检测阳性。466例HCV-RNA阳性者中448例样本成功测序和基因分 型及具体如下：IDUs组 (320例) 中6a (58.75%) 是最主要的基因型, 其次是3b (16.88%) 、3a (15.63%) 、1a (4.38%) 、1b (2.81%) 和非6a (0.93%) ; 而non-IDUs 组 (128 例) 中最主要的基因亚型是1b (30.47%), 其次是6a (28.12%) 、3b (10.16%) 、3a (3.91%) 、1a (7.03%) 和非6a (14.84%), 两组亚型之间的差异具有统计学意义( P <0.01)。 结论 海南省IDUs 人群中HCV感染后自发清除率较高, 其感染的主要亚型为6a, 其次为3b; 但有些地区的IDUs人群中存在其他亚型的小 范围流行。

The cost-effectiveness of an HCV outreach intervention for at-risk populations in London, UK.

BackgroundHCV disproportionately affects marginalized communities such as homeless populations and people who inject drugs (PWID), posing a challenge to traditional health services. The HepFriend initiative in London is a model of care utilizing HCV outreach screening and peer support to link vulnerable individuals to HCV treatment in secondary care.ObjectivesTo assess the cost-effectiveness of the HepFriend initiative from a healthcare provider perspective, compared with standard-of-care pathways (consisting of testing in primary care and other static locations, including drug treatment centres, and linkage to secondary care).MethodsCost-effectiveness analysis using a dynamic HCV transmission and disease progression model among PWID and those who have ceased injecting, including housing status and drug treatment service contact. The model was parameterized using London-specific surveillance and survey data, and primary intervention cost and effectiveness data (September 2015 to June 2018). Out of 461 individuals screened, 197 were identified as HCV RNA positive, 180 attended secondary care and 89 have commenced treatment to date. The incremental cost-effectiveness ratio (ICER) was determined using a 50 year time horizon.ResultsFor a willingness-to-pay threshold of £20000 per QALY gained, the HepFriend initiative is cost-effective, with a mean ICER of £9408/QALY, and would become cost saving at 27% (£10525 per treatment) of the current drug list price. Results are robust to variations in intervention costs and model assumptions, and if treatment rates are doubled the intervention becomes more cost-effective (£8853/QALY).ConclusionsNew models of care that undertake active case-finding with enhanced peer support to improve testing and treatment uptake amongst marginalized and vulnerable groups could be highly cost-effective and possibly cost saving.

Factorial validity of a substance-use stigma scale in methamphetamine-using adults in China

BackgroundDespite the large number of individuals who use substances of abuse and the stigma of such behaviors in China, scales have not been developed and validated for assessing substance-use stigma. Given its importance for targeting interventions, the aim of the present study was to validate a Chinese substance-use stigma measure including three dimensions of substance-use-disorder-related stigma (personal stigma, perceived stigma and social distance) by modifying a pre-existing scale measuring mental illness-related stigma and social distance. MethodsA convenience sample of eight-hundred-and-twelve individuals with substance abuse (aged 18–68 years) from different drug rehabilitation centers completed a self-reported survey including their demographics and drug use, and the stigma and social distance scales. The adapted, translated from English to Chinese, and back-translated scales were an 18-items stigma scale including personal stigma and perceived stigma subscales and a 5-items one domain social distance scale. Confirmatory factor analysis and multigroup confirmatory factor analysis tested factorial validity and measurement invariance of the scales, respectively. ResultsFor the stigma scale, by deleting one low correlation dimension (named “weak-not-sick”), personal stigma and perceived stigma showed acceptable fit indices and internal consistency with two dimensions (named “dangerous/unpredictable” and “social discrimination”), separately. The social distance scale showed good fit indices and internal consistency as a separate facet of stigma-related substance-use problems. Invariance of the model across drug-rehabilitation centers was found. ConclusionsThe Chinese substance-use stigma scale may serve as a valuable tool for better understanding substance-use stigma among adults in China who abuse substances.

2898. Achieving Hepatitis C SVR12 of 95% in Mono-Infected Patients with Severe Comorbidities Using Volunteer Staff and Minimal Clinic Visits and Phlebotomy

BackgroundHCV is the most common chronic bloodborne infection in the United States with an estimated 3.5 million infected. With direct-acting antivirals, cure can be achieved in 8 to 12 weeks. To achieve WHO elimination targets by 2030 (>90% reduction in incidence) requires increased detection, access to care, and simpler treatment protocols that patients, challenged by substance use and mental health disorders, can readily complete.MethodsIn 2016, Wake County, NC began HCV testing at 32 sites finding prevalence >10% at 5 shelters and drug treatment centers. An adapted simplified HCV treatment protocol, used in the high prevalence settings of Ukraine and Burma, was implemented at the Open Door Clinic – a free clinic for uninsured persons living in poverty in Wake County. After initially using genotype-specific therapy, we switched to pan-genotypic sofosbuvir/velapatisvir (SOF/VEL) for 12 weeks. Clinic visits were limited to pre-treatment and 12 weeks after treatment completion. Patients were contacted weekly via text to check on their health and adherence.ResultsThirty HCV mono-infected patients have initiated treatment including 9 women. 21 were infected by IDU, 5 by transfusion, 3 by sex with an infected partner, and 5 have unknown risk. In genotype (GT) testing 22 have GT1, 3 GT 2, and 4 GT3. Major comorbidities include 24 with current or recent IDU, alcohol dependency, psychotic depression or schizophrenia, or missing all medical appointments other than the HCV. Twenty-seven of 30 have completed their prescribed course of HCV therapy and 20 have achieved an SVR at 12 weeks. The 1 patient who failed was admitted to the hospital 4 times in the first 6 weeks of treatment and did not take his medication consistently. An additional 2 remain on treatment and 6 are awaiting results of testing done at 12 weeks post-therapy completion. One patient died within 2 weeks of initiating therapy due to a perforated duodenal ulcer.ConclusionUsing targeted on-site HCV testing, we identified high prevalence sites. Implementing a simplified HCV treatment program reduces patient and clinic burden and resulted in 95% achieving SVR12 despite severe comorbidities. Expansion of this program to other clinics in Wake County is underway.Disclosures All Authors: No reported Disclosures.

298. Collocation of Hepatitis C Care Continuum with MAT for High-Prevalence, High-Risk Population

BackgroundThe hepatitis C virus (HCV) epidemic in the United States disproportionately impacts people who inject drugs (PWID) who account for 80% of new infections and have a high prevalence of chronic infection. Baltimore City has the highest case rate of HCV in the state of Maryland with over 25% of new cases statewide occurring in the city. Only 10% of PWID have access to directly acting antiviral (DAA) therapy and are cured of HCV. Medication-assisted treatment (MAT) is currently offered in isolated facilities with limited access to other specialty care. In this study, we collocated HCV care continuum in a MAT facility offering opioid agonist therapy and psychosocial interventionsMethodsCollocation of HCV care was initiated in an MAT (methadone and buprenorphine) clinic, the University of Maryland Drug Treatment Center (UMDTC) serving over 700 patients, for Opioid Use Disorder (OUD) in Baltimore City (Figure 1). Screening for HCV was expanded through health education of patients and staff and expanded testing. HCV antibody-positive patients were linked to care with an experienced HCV provider or referred to hepatologists (decompensated cirrhosis).ResultsMost of the attendees were African-American with an average age of 52 years. 354 out of 701 clients attending clinic for methadone/suboxone (50.5%) were screened for HCV. Of the 251 patients who were hepatitis C antibody positive (70% of tested), 54 had undetectable HCV RNA. 46 had no HCV RNA labs available. 151 of the remaining HCV Ab positive patients who had a detectable HCV RNA result were evaluated for treatment (Figure 2). At initial assessment, 45 (48%) with liver fibrosis staged greater than F3, including 25 (27%) with cirrhosis. Sixty-four patients initiated DAA therapy. Fifty-four patients completed treatment (84%). Forty patients achieved sustained virologic response (100%) and 14 patients who completed treatment await SVR labs.ConclusionCollocation of HCV care continuum in MAT setting is an effective way to achieve micro elimination of HCV. The follow-up of this marginalized population still remains challenging given the high rates of homelessness and incarceration. In this regard, coordinated care between MAT settings and prisons are likely to demonstrate successful elimination of hepatitis C. Disclosures All authors: No reported disclosures.

Improving access to care for people who inject drugs: Qualitative evaluation of project ITTREAT-An integrated community hepatitis C service.

Achieving hepatitis C virus (HCV) elimination by 2030 requires an increased linkage to care for people who inject drugs (PWID). Project ITTREAT was established to mitigate barriers to HCV care by providing an integrated service within a local drug and alcohol treatment centre. This study aimed to explore the experiences of clients and staff involved in Project ITTREAT and assess the facilitators and barriers to a community-based HCV service. Between October 2014 and April 2016, drug and alcohol treatment attendees were interviewed using one-to-one semi-structured interviews. Drug and alcohol treatment staff took part in focus groups. All data were recorded, transcribed verbatim and analysed using thematic content analysis. Fifteen drug and alcohol treatment attendees with current/previous HCV infection were interviewed, and 15 staff members contributed across two focus groups. Drug and alcohol treatment staff and attendees reported that Project ITTREAT facilitated access to HCV care by mitigating previous negative hospital-based experiences. Other key facilitators were positive narratives around HCV care, and drug and alcohol treatment attendees being well engaged in their drug/alcohol recovery. Barriers included a lack of stability in drug and alcohol treatment attendees, negative discourse around testing/treatment and stigma associated with attending the drug and alcohol treatment to access HCV treatment in some who had successfully achieved drug rehabilitation. Our findings indicate the positive impact of an integrated and personalized community-based service delivered by a dedicated hepatitis nurse. This played a crucial role in reducing barriers to HCV care for PWID. Our work also highlights areas for future investment including non-DAT-based community services and increasing awareness of new treatments amongst this cohort.

Hepatitis C Virus Screening Among Adolescents Attending a Drug Rehabilitation Center.

Hepatitis C virus (HCV) infection has a strong association with intravenous drug use (IVDU). IVDU is a growing public health concern, even in the adolescent population. To our knowledge, there are no published HCV screening studies targeting high-risk adolescents who attend drug rehabilitation centers.This study was designed to determine the seroprevalence of HCV infection utilizing point-of-care (POC) testing at an adolescent drug rehabilitation center and gain a preliminary understanding of the acceptance rate for HCV screening in this high-risk population. This single-center, observational study was conducted at a major drug rehabilitation center in northeast Ohio from July 2016 to June 2017. The consented adolescents who presented at the center were recruited to participate in HCV screening. The participants were administered a survey to assess their demographics and risk behavior profile followed by HCV testing utilizing a POC test. During the study period, 150 adolescents were admitted to the drug rehabilitation center, of whom 100 were approached and 85 agreed to participate. Forty percent of the participants (34/85) were females, and 78% (66/85) were white. HCV prevalence among participants was 5% (4/85), all of whom were females. History of heroin use was reported by 15% (13/85) and it was associated with HCV seropositivity; 100% (4/4) of all HCV-positive individuals reported the use of heroin vs only 11% (9/81) of HCV-negative individuals (P = .0004). Our study showed a high prevalence of HCV among adolescents attending a drug rehabilitation center with high acceptance of POC HCV testing.

Squamous cell carcinoma of the head and neck – screening in patients who misuse alcohol and tobacco in Switzerland: a prospective pilot study

Squamous cell carcinoma (SCC) of the head and neck is the sixth most common cancer worldwide. It is preceded by early asymptomatic lesions which, if identified early enough and removed, would prevent malignant transformation or avoid delaying diagnosis to advanced stages. Our aim was to evaluate the feasibility of a screening programme for SCC of the head and neck in a group of high-risk patients, and to investigate their addiction profile. Patients admitted to an inpatient alcohol addiction centre (n=101) were prospectively enrolled and asked to fill in a questionnaire about their use of tobacco and alcohol, and the presence of warning symptoms for SCC of the head and neck from 23 June 2014 to 21 January2016. Participants in the study had a physical examination by an alcohol addiction physician followed by a full examination of the head and neck by an otorhinolaryngologist to rule out premalignant or malignant lesions of the upper aerodigestive tract. Of the 101 patients, 62 (60%) had at least one warning symptom. Alcohol addiction physicians identified leukoplakia in six (6%) and erythroplakia in two. No pre-malignant or malignant lesions were confirmed on examination by the otolaryngologist. We were unable to draw conclusions about the cost-effectiveness or the yield of the screening programme. Despite our negative findings, we may need further investigation to clarify the relevance of such a programme on health-related outcome given the high compliance rate and minimal delay that was achieved by taking advantage of an in-patient alcohol rehabilitation centre.

2223 Zieve’s Syndrome: Case Report, Review of the Literature and Electronic Patient Database

INTRODUCTION: Zieve’s syndrome (ZS) is rare condition of alcoholic hepatitis, hyperlipidemia and hemolytic anemia1. Clinicians need to be aware of ZS for several reasons: First, hemolysis increases unconjugated bilirubin levels, leading to false elevation of the Maddrey’s discriminant function (MDF), which may lead to the unnecessary prescription of steroids.2 Second, the anemia that occurs from hemolysis may be misinterpreted as a gastrointestinal bleed, leading to extra endoscopic procedures. Finally, since patients can present with fever and abdominal pain, diagnosis may be construed for other causes such as sepsis or acute cholecystitis.2-5 CASE DESCRIPTION/METHODS: A 39-year-old female with long-standing alcohol abuse had three successive admissions resulting in refractory ZS. We performed a review of the literature to assess other case reports of patients with ZS. A total of 38 patients were included, 8 in women and 30 in men. Patients’ age ranged from 28 to 65 years old (mean 45.6 years). Average total bilirubin was 9.12. Average hemoglobin was 9.15. Average total cholesterol was 486. Average LDH was 243. Most patients did not receive prednisolone and fully recovered with strict alcohol cessation. A retrospective analysis using the IBM Explorys database of over 63 million de-identified, unique patients in the United States revealed that of 17,990 patients with alcoholic hepatitis, only 80 had ZS. The odds of a patient with alcoholic hepatitis also having hemolytic anemia is 7. ZS is rare, only seen in 0.4% of patient’s with alcoholic hepatitis. DISCUSSION: Our patient was 39, younger than the average age of 45.6 years. She was also female, a gender seen in a minority of previously reported cases. She had a total bilirubin 3 times above average, and a hemoglobin 33% lower than average. Despite 12 units of packed red blood cells, prednisolone, and pursuit of inpatient/outpatient alcohol rehabilitation, she ultimately succumbed to her liver injury 6 weeks after initially presenting to the hospital. This is the first reported case of death from ZS. Clinicians should maintain a high index of suspicion for ZS in patients with alcoholic hepatitis and transfusion refractory anemia. Evaluating for hemolysis and hyperlipidemia are recommended. Alcohol abstinence is essential. There is no role for steroids. Early diagnosis is essential. Our goal is that increased case reporting will raise clinician awareness.

309 Overcoming Brick and Mortar: Feasibility of Implementation of a Medication for Addiction Treatment and Linkage to Treatment Program by Leveraging Community Partnerships

Substance use disorder (SUD) annually costs the US over $440 billion. Medication for addiction treatment (MAT) helps manage withdrawal and cravings to reduce relapse and promote engagement in psychosocial interventions that promote healing. Implementing MAT and a linkage to treatment program in the hospital setting can improve care for SUD patients. Our Department of Emergency and Hospital Medicine implemented a protocol to screen and identify patients with SUD. A county-supported warm handoff approach began using screening, brief intervention, and referral to treatment to link patients with treatment options. Since 2017, a county-funded hospital opioid support team (HOST) provided a bedside level of care assessment and warm hand off to treatment. Also, a hospital-employed addiction recovery specialist (ARS), who is a licensed social worker and certified recovery specialist, provided bedside motivational interviews and care management. On July 1, 2018, a MAT program began with free county-supported interventions: seven-day discharge supply of buprenorphine and a transportation voucher. MAT is maintained by a partnership with a local drug and alcohol treatment center staffed by our MAT-trained toxicologists, where patients also receive individual/group counseling, certified recovery specialist support, and psychiatric treatment. Since January 2018, 1363 patients were linked to treatment through the ARS (218 patients) and HOST (1145 patients). Since July 2018, 123 patients were linked to treatment by the ARS: 54.97% to outpatient treatment, 10.48% to inpatient treatment, 4.22% discharged home with referral to inpatient treatment, 3.46% to a psychiatric/dual diagnosis facility, and 16.81% refused services. Over 70% of those evaluated by ARS since July 2018 were initiated on MAT. During January-March 2019, 62% of initiated patients received buprenorphine/naloxone, 15-17% received oral or intramuscular naltrexone, and up to 3% received acamprosate. Of those induced on MAT, 92 followed up at the MAT maintenance clinic during July 2018-March 2019, 71 of which received care management by the ARS. During July 2018-February 2019, most common dispositions by HOST were: 17.82% to detox facility, 11.2% to intensive outpatient treatment, and 9.52% to short- or long-term residential facility. An institutional linkage to treatment initiative with warm handoff to SUD treatment and induction/maintenance of MAT provides a solution that transcends the brick and mortar limitations of a hospital setting. HOST is a collaboration with local county drug and alcohol authority; and ARS combines care management and peer recovery support. Embedding MAT prescribers in a local drug and alcohol treatment facility ensures follow-up for hospital MAT initiated patients.

CONSENSUS ASPECTS OF COUNSELING SUPERVISION PRACTICES IN DRUG TREATMENT CENTRE

Purpose of the study: This study aims to examine aspects of counseling supervision practices in a drug treatment center in Malaysia. The aspects are served as facilitative factors for supervisor to practice counseling supervision in the drug abuse field.&#x0D; Methodology: Data were collected using a mixed-method explanatory sequential research design that involved 30 respondents. Two sets of questionnaires were used namely Supervisee Levels Questionnaires-Revised and Supervisee Needs Index. A semi-structured interview was conducted to selected respondents to further explain and justify the quantitative data.&#x0D; Main Findings: The findings show that most of the respondents scored highest at motivation subscale and supervisor competency for their supervisee levels and their needs index, respectively. Four themes namely a) attending courses periodically, b) in-house training, c) supervision from the upper management, and (d) consultation from other agencies were examined to corroborate the quantitative results.&#x0D; Social implications and novelty: The findings of this study would facilitate the supervisors to focus more on the aspects found in this study throughout their counseling supervision practices. Having identified aspects that should be focused on during supervision would be served as a fundamental framework for future studies pertaining to counseling supervision practices.&#x0D; Novelty/Originality of this study: This study examines consensus aspects of counseling supervision practices, of which limited studies available in Malaysia. Each aspect of counseling supervision found in this study can be further investigated for future studies.