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Hepatitis and Substance Abuse Withdrawal Treatment

Hepatitis is a condition that involves inflammation of the liver.1 There are several distinct hepatitis viruses, and most research to date has centered on those distinguished by the letters A, B, C, D, and E.1 Hepatitis A and E are typically brought on by the consumption of contaminated water or food, while forms B, C, and D are mainly transmitted through contact with the blood or bodily fluids of an infected person. Hepatitis doesn’t always arise as a result of viral infection. For example, alcoholic hepatitis is an extremely prevalent form of alcoholic liver disease, and is brought on by heavy drinking over a long period of time.

Substance abuse is mainly associated with the hepatitis B and C viruses, as well as alcoholic hepatitis. Signs and symptoms of hepatitis B and C include fatigue, jaundice, nausea, vomiting, stomach pain, and dark urine.1 Symptoms of alcoholic hepatitis can include enlargement of the liver and spleen, fever, malnutrition, abdominal pain and swelling, gastrointestinal bleeding, jaundice, and loss of brain functioning.2

Drug and alcohol abusers who are infected with hepatitis may require specialized treatment during withdrawal.

Why Get Tested for Hepatitis?

Man with liver pain from hepatitisSubstance abuse contributes to the high numbers of hepatitis cases in the country. According to the National Institute on Drug Abuse, between 850,000 and 2.2 million people are currently infected with hepatitis B (HBV), and around 3.5 million people are infected with hepatitis C (HCV) in the United States.3 Also, according to the American Liver Foundation, up to 35% of heavy drinkers develop alcoholic hepatitis.13

Sharing needles can expose a person to hepatitis and other viruses. In 2016, a total of 472 people with acute hepatitis B and 767 people with acute hepatitis C reported engaging in intravenous drug use.4 People who are under the influence of drugs and alcohol may also suffer from impaired judgment and consequently make risky decisions (e.g., have unsafe sex) that can lead to disease transmission.

Unfortunately, the sometimes stealthy nature of hepatitis can delay early treatment and other preventive/supportive measures.

Heavy drinkers are also at risk of developing alcoholic hepatitis.2,12 While many people who drink to excess don't show signs of the condition for about 5 years, some cases have been reported after only 3 months of excess drinking.2

Getting tested for hepatitis is important because of the potential health consequences related to the condition. Hepatitis that is left untreated can lead to cirrhosis, which is a condition marked by scarring of liver tissue and a resultant loss of hepatic function. Chronic hepatitis and cirrhosis are also associated with a specific type of liver cancer known as hepatocellular carcinoma.3 In severe cases of alcoholic hepatitis, the mortality rate is as high as 50%. For those who keep drinking after developing the condition, as many as 40% will develop cirrhosis.12

As it is often asymptomatic, many people who have hepatitis remain unaware of the condition until it progresses to the point of cirrhosis or other serious related conditions. Unfortunately, the sometimes stealthy nature of hepatitis can delay early treatment and other preventive/supportive measures. Over the next 40 to 50 years, complications related to just one form of hepatitis (HCV) are expected to cause the deaths of over 1 million people.3

Getting Tested

The Centers for Disease Control and Prevention (CDC) recommends that drug users (current and former) get tested for hepatitis B and C.3 Hepatitis screening involves initial antibody tests, which can determine if a person has been exposed to the virus.5 If the antibody test is positive, a person will then undergo further testing to determine whether he or she is currently infected with the virus.

If testing reveals a current infection, additional testing will be performed to determine the health of the liver. For help finding free local testing, see the CDC’s GetTested webpage.

Because of the high risk of hepatitis transmission among drug users, many detoxification centers and addiction rehabs also provide hepatitis screening and testing, as well as HIV/AIDS testing.

Does Hepatitis Make Withdrawal Worse?

Hepatitis may be associated with its own set of symptoms that, when added to the list of potentially troublesome withdrawal symptoms, can make things extremely uncomfortable for those in early recovery. It may also create a more complicated withdrawal experience and require closer, more involved medical care.

In some cases, hepatitis and drug withdrawal may give rise to a similar set of symptoms, which can compound or intensify the presentation of both conditions. For example, withdrawal from alcohol and opioids can cause nausea, vomiting, and stomach pains, symptoms common to hepatitis B and C.1,6 Experiencing symptoms of hepatitis and withdrawal at the same time can make for an especially grueling detox, but qualified professionals working to manage withdrawal in a medical detox can ease the experience significantly.

People who have recently discovered they have hepatitis may also struggle with feelings of depression about learning of their diagnosis. Withdrawal from certain drugs, including stimulants like cocaine and methamphetamine, can also result in severe depression and suicidal thoughts.6 People experiencing anxiety, mood changes, and depression as a result of withdrawal while struggling to cope with their medical illness may have a more difficult time managing their mental health symptoms. Medical detox treatment programs are safe places for a person with depression or other mental health concerns because symptoms can be monitored and medications may be prescribed to manage them. They also provide a supervised environment where the risk of self-harm is significantly reduced.

Drug withdrawal may also have the potential to weaken a person’s immune system, which could worsen the course of viral hepatitis. Morphine withdrawal, in particular, has been found to suppress certain anti-viral immune factors which could lead to increased hep C virus replication in the body.7 Because experiencing drug withdrawal and medical issues at the same time can be complicated, people undergoing detox with hepatitis may fare better in an inpatient medical environment.

Why Should I Get Medical Detox?

Professional detox treatments include social (or nonmedical) detox and medical detox programs:6

  • Social detox programs provide a supportive and therapeutic environment for people to detox without medical treatment. These programs offer therapy sessions and support groups aimed at helping people cope with their addictions.
  • Medical detox programs offer 24-hour supervision with medical management of withdrawal symptoms. Often in a hospital or other inpatient/residential settings, these programs are staffed with doctors and nurses who can monitor withdrawal symptoms, check vital signs, and administer medications and other treatments as needed. These programs may also provide therapy and support groups in addition to medical treatment.

Medical detox programs are generally recommended over social detox programs for individuals withdrawing from alcohol and sedatives because of the risk for severe complications like seizures, hallucinations, and delirium.6 Medical detox is often recommended for withdrawal from opioids, like heroin, oxycodone, and hydrocodone, because withdrawal from these drugs can cause severe discomfort and the relapse risk is high.6

Medical detox programs can provide the proper treatment that a person needs to manage withdrawal, while also addressing any issues related to hepatitis or other medical conditions. People with hepatitis B and C are vulnerable to conditions like liver cancer and cirrhosis,3 and people with chronic alcoholic hepatitis may be at higher risk of developing infections such as bacterial pneumonia and septicemia.2 These and similar issues may require more acute medical care—something that medical detox programs are equipped to deliver.

What Will Treatment Entail?

Doctor comforting patientDrug abusers who also have hepatitis may require close monitoring throughout the detox and continued rehabilitation process to help prevent relapse, ensure compliance to the treatment program, and prevent the progression of the virus.3

Someone with viral hepatitis can take medication for the disease while also undergoing detoxification and rehabilitation from substance abuse. Hepatitis C can be treated with a combination of the medications ribavirin and interferon, which increase the body’s immune response.5 Interferon is also available as a longer-acting weekly injection called pegylated interferon.5 Hepatitis B can be treated using interferon, pegylated interferon, or antiviral drugs, such as lamivudine, adefovir, or telbivudine.11 Failure to treat hepatitis can lead to serious health consequences, such as progressive liver damage.5

The type of addiction treatment a person receives during and after detox will depend upon the type of drug used. Addiction to drugs such as cocaine and marijuana are treated primarily by psychological counseling and behavioral therapy approaches (such as cognitive-behavioral therapy) because there are no accepted medications that help with recovery from these substances.Addiction to alcohol and opioids can be treated with a combination of therapy and medication.8  Medications available for opioid addiction include methadone, buprenorphine, and naltrexone. Methadone and buprenorphine may be prescribed during detoxification to prevent withdrawal symptoms and decrease cravings. There is some evidence that naltrexone can help reduce drug cravings, but the drug is not used to treat withdrawal.

Buprenorphine, methadone, and naltrexone can may be used simultaneously with drugs that treat hepatitis, so treatment for both the virus and addiction can begin at the same time.9.10 However, a person’s liver functioning should be carefully monitored by a medical professional while on these medications. Methadone is contraindicated for patients with severe liver disease.10

Medications used for the treatment of alcoholism include disulfiram, naltrexone and acamprosate.8 Disulfiram and naltrexone can be toxic to the liver and may be especially harmful to those with serious liver problems.9 Acamprosate may help reduce prolonged withdrawal symptoms like anxiety and insomnia and is considered safe for hepatitis patients.9

Treatment for viral hepatitis may also involve vaccines to prevent further illness. Vaccines are currently available to prevent hepatitis A, B, and E infection.1 There is currently no vaccine available for hepatitis C, so people with other strains of hepatitis may still be vulnerable to contracting hepatitis C, especially if they abuse intravenous drugs.1

If you are struggling with hepatitis and need help to overcome substance dependence, there are numerous detox and treatment programs around the country staffed with qualified medical providers who can give you the whole-body care you need. Ask for help today.

References

  1. World Health Organization. (2016). What is hepatitis?.
  2. Basra, G., Basra, S., & Parupudi, S. (2011). Symptoms and signs of acute alcoholic hepatitisWorld Journal of Hepatology3(5), 118-120.
  3. National Institute on Drug Abuse. (2018). Viral hepatitis- A very real consequence of substance use.
  4. Centers for Disease Control and Prevention. (2018). Viral hepatitis surveillance United States, 2016.
  5. Sylvestre, D. (2007). Hepatitis C for addiction professionalsAddiction Science & Clinical Practice4(1), 34-42.
  6. Center for Substance Abuse Treatment. (2015). Detoxification and substance abuse treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  7. American Journal of Pathology. (2005). Hepatitis C complicated by morphine withdrawal.
  8. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide.
  9. Addolorato, G., Mirijello, A., Leggio, L., Ferrulli, A., & Landolfi, R. (2013). Management of alcohol dependence in patients with liver disease. CNS drugs, 27(4), 287-299.
  10. Soleimanpour, H., Safari, S., Nia, K. S., Sanaie, S., & Alavian, S. M. (2016). Opioid drugs in patients with liver disease: A systematic reviewHepatitis Monthly16(4).
  11. S. Department of Veterans Affairs. (2018). Viral hepatitis: Hepatitis B entire lesson.
  12. National Institute on Alcohol Abuse and Alcoholism. (2009). The Epidemiology of Alcoholic Liver Disease.
  13. American Liver Foundation. (n.d.). Brochures and Handouts.
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