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by Suma Singh, M.D. Hepatitis
C is a widespread public health problem which affects nearly four million
in this country-- four times the number of HIV cases in the United States.
Injection drug use accounts for 80-90% of all cases. Fewer than 5%
get Hepatitis C from contaminated blood transfusions, tattoo needles,
sexual contacts, etc. Hepatitis
C is caused by a virus (HCV) that is transmitted easily through
contaminated blood. Studies
show that 60-80% of intravenous drug abusers become infected within six
months of first using. Most
people become Hepatitis C antibody-positive within six weeks of infection. HCV
causes inflammation of the liver, which can become chronic (i.e., lasting
longer than six months). Most people lead normal lives, but others
experience flu-like symptoms (fatigue,
loss of appetite, nausea, fever, headache, and abdominal pain).
Some people also get jaundice (yellowing of the eyes and skin, and
dark urine). If
Hepatitis C becomes chronic, it may progress into cirrhosis: scarring of
the liver due to long-term inflammation, which may seriously impair liver
function and lead to liver cancer. About
20% of those with Hepatitis C will develop cirrhosis over a period of ten
to forty years. Of these,
about 25% will ultimately need liver transplantation. Although
there is no vaccine yet, transmission can be prevented among household
contacts by using caution when handling anything that may have been
exposed to the blood of an infected person (razors, scissors,
toothbrushes, clippers, nail files, tampons, sanitary napkins, etc.).
Injection drug use, needle/ “rig” sharing, and high-risk sexual
behavior should be absolutely avoided.
People who have more than one sexual partner should use latex
condoms. It is considered
safe for infected women to become pregnant and to breast feed the infant.
Children born to mothers with Hepatitis C should be tested at one
year of age. There
is treatment for Hepatitis C, but “cure” rates vary. Treatment begins
with an evaluation (including a liver biopsy) by a liver specialist.
For addicts and drug abusers, at least six months of
abstinence/sobriety is required to assure a stable social and
psychological condition and to help minimize risks of re-exposure
following treatment. Interferon
and ribavirin are used in a six-month treatment course to rid the body of
HCV. These medications have many side effects, including flu-like
symptoms, vomiting, thinning of the hair, worsening depression, sudden
anemia, and birth defects. About
50-60% of patients respond to treatment initially, but only 10-40% stay
virus free. This dual combination of drugs is more effective than
interferon alone. People
with Hepatitis C need to
prevent further injury to the liver.
This includes vaccinating for
Hepatitis A and
B and avoiding
alcohol. Acetaminophen
(Tylenol�) and other medications that are concentrated in the liver
should be used only with the advice of a physician.
If liver function is
abnormal, other prescriptions may need to be adjusted by a physician to
prevent toxicity. In
addition, it is very important to lead as normal a life as possible, with
a well-balanced diet, exercise, and positive attitude. Early
intervention can help many people with Hepatitis C to lead healthier and
more normal lives. As many as 90% of
injection-drug users have Hepatitis C.
The risk with even a single episode of needle sharing is as great
as 50%. This means that many DADS clients have this silent disease and may not know it.
Educating people about risk
factors, symptoms, and treatment and urging medical follow-up is
essential. For more information about Hepatitis C, please refer to the following Centers for Disease Control and Prevention, Hepatitis Branch, website: http://www.cdc.gov/ncidod/
PERINATAL
SERVICES HELP PREGNANT AND PARENTING WOMEN RECLAIM By
Margaret Frausto, MS, RD It
was morning, and “Sandy”
was sick...really sick... from heroin withdrawal.
Her boyfriend always helped her shoot up, but he was arrested the
night before so Sandy had to learn quickly how to shoot up by herself so
she could feel better. Another
issue: Sandy was pregnant
with twins. Nine
years have passed and Sandy has been on methadone treatment for three
years and in the Perinatal Substance Abuse Program (PSAP) of Santa Clara
Valley’s Health & Hospital System for eight months.
She also has a five-year-old son and an eight-month-old daughter
besides her nine-year-old twins. Sandy
states, “The counselors at PSAP have helped me understand how to take
better care of myself and my family.
I want to give my children all of the things I never had....” PSAP
was created in 1987 to address the growing need for appropriate and
effective chemical dependency treatment for pregnant and parenting
women. The goal is to
promote healthy mothers and babies by providing tools for recovery from
alcohol, tobacco, and other drugs.
PSAP’s intensive outpatient services include individual and
group counseling, women’s health classes, court-approved parenting
courses, literacy guidance, Twelve Step study, and more.
The program is fully staffed by licensed social workers, MFCCs, a
parent educator, a health educator, a psychiatric nurse, child
development specialists, and literacy experts.
Clients are medically monitored by a physician specializing in
the treatment of addiction. PSAP even offers transportation to clients and free on-site
day care for children under five while the client attends the day
program. Any
woman in Santa Clara County who has substance abuse issues and who is
pregnant or parenting young children may enroll.
Most women are in treatment for six to twelve months.
PSAP accepts Medi-Cal; otherwise, fees are based on clients’
ability to pay. Many
clients attend by court order, but Sandy enrolled voluntarily.
She is now taking GED classes through the literacy program and
eventually plans to work in an office setting.
What did Sandy never
have that she wants to give to her children?
“A mom, a safe place to live, an education, and love.” For
more information about PSAP, please call Margaret Frausto, Health
Education Specialist, at 408-885-4069. _ AGENCY PROFILES By
Dana Bishop, Program Director ARH/House
on the Hill (HOTH) offers a unique recovery opportunity for addicted
mothers with young children. ARH’s
philosophy is evident in the staff’s dedication to extend recovery
beyond the individual, to the family.
HOTH provides residential recovery services, life skills,
parenting, and a child-development program in a curriculum of
parent/child-oriented groups, activities, and classes. The
goal of the program is for addicted mothers to develop both their
recovery and life skills to become more empowered to return to the
family and community--drug free and able to cope with life issues.
A major part of this process is the joy of being an integral part
of her own recovery and that of her child and her family. HOTH provides
for a longer-term residency for mothers who may need up to six months to
reach their goals.
The
children’s curriculum is designed to assess their special needs and to
gain access to appropriate children’s services.
Mothers learn to address these needs appropriately through the
program curriculum and through guided,
hands-on experience. HOTH
has been accepted by the VMC Foundation’s Board of Directors for a
three-year capital fundraising campaign, which is already in progress.
HOTH’s goal is to expand treatment capacity by nearly forty more
beds. ARH/HOUSE
ON THE HILL _
CROSSROADS:
Crossroads
provides transitional housing for recovering alcoholics and addicts in
Santa Clara County. There are
eight homes--mostly in San Jose The
other five homes provide longer-term transitional housing for treatment
graduates from this and other local counties. All residents of these
households are voluntary clients (i.e.,
these houses do not accept Court-ordered clients) and the average
length of stay is about one year. CROSSROADS _ ASAM DIMENSIONS Over
the past three years, DADS has worked steadily to develop a
client-centered system of care. To
this end, Adult Managed Care focuses
on high-quality, individualized, assessment-based treatment.
Because
substance-abuse disorders have biopsychosocial causes, assessment and
treatment must be addressed in many dimensions. DADS uses the six
dimensions of the American Society of Addiction Medicine’s
(ASAM) Patient Placement Criteria to determine clients’ level of
functioning. These
dimensions are: suicidal
behavior while under the influence (Dimension 5); or who live in a
dangerous setting (Dimension 6) may need a safe, structured environment
like residential treatment, where the emphasis is on stabilizing them. The
ASAM Patient Placement Criteria were first released in 1991.
Addiction treatment specialists, counselors, psychologists, social
workers, and physicians worked collaboratively to develop a common
language and guidelines for all substance-abuse professionals.
Now, more than twenty
states use some form of these criteria. Using the ASAM Dimensions and
Placement Criteria to determine public-sector clients’ level of care and
individualized treatment puts
Santa Clara County on the cutting edge of substance-abuse treatment. _ PERFORMANCE-BASED
CONTRACTING: In
July 1999, DADS contractors completed the first year of a new
performance-based reimbursement system.
In July 1998, the Managed-Care System implemented
a “quality
improvement score” -- a measure
of how well providers adhere
to certain operational guidelines. Now, the system is in the second phase
of performance measurement, leading to client outcomes measurement. They’ve
begun to use two client questionnaires to measure clients’ level of
functioning and substance-abuse status, both
at intake and discharge. The
Basis-32 (Behavioral and Symptom Identification Scale) allows clients to
report their degree of difficulty with a range of symptoms and problems.
The other questionnaire, a
modified version of GAIN (Global Appraisal of Individual Needs), assesses
their perceptions of alcohol and drug use.
Once these tools yield useful data--probably next fiscal year--they
will eventually be incorporated into the reimbursement system and
providers will be held accountable through their scores. Even before
these tools are integrated into the quality improvement score,
however, a client-satisfaction tool called the CSQ-8 has been used.
Providers have routinely administered this survey at discharge
since last summer. DADS
management and volunteers from providers are also translating these
questionnaires into Spanish and Vietnamese.
To improve the system continually, there will be ongoing
pilot-testing of promising self-report tools
to measure client status and recovery; these may either supplement
or replace BASIS-32 and GAIN. Using
these tools follows the progression toward true outcomes measurement,
which evaluates recovery both at discharge and after discharge. In fiscal
1999-2000, clients from several programs will be interviewed six months
following their treatment. Tracking outcomes over time will show the
system how effective its services are and how to deliver more
cost-efficient, high-quality care. COUNTY USES
ENVIRONMENTAL APPROACHES TO PREVENT VIOLENCE Alcohol
is an accepted part of our ceremonies, family lives, and community
activities. However, there is increasing awareness of the serious social
and health problems associated with drinking. When alcohol use is
inappropriate, its effects can be devastating--not only to the individual,
but also to families and communities. From a public-health perspective,
many prevention efforts focus on policy development to reduce the
incidence of alcohol-related problems such as impaired driving, sales to
minors or intoxicated people, and violence. With support and funding from the County’s Board of Supervisors, the Violence Prevention Council (VPC) has developed an Action Plan based on research into root causes, proven prevention strategies, and input from community experts. Many studies have found a consistent relationship between alcohol consumption and homicides, assaults, and trauma. Alcohol also contributes to the frequency and severity of other violent behaviors. The
VPC’s Alcohol Policy Sub-committee formulated
the following policy recommendations to encourage safe and
responsible alcohol practices by consumers and businesses alike: Alcohol
Taxes: Consider supporting
State and national efforts to keep alcohol-related tax revenues even
with inflation; Zoning
Ordinances: Consider assessing
and strengthening commercial zoning-district ordinances through the
conditional use permit process to prevent increased
alcohol outlet density; and Responsible
Beverage Service: Encourage and
support the development of consistent standards for the safe operation of
retail alcohol outlets. And,
consistent with the Constitutional protection afforded to commercial free
speech: Billboards:
Support a county-wide process to examine local policies regarding alcohol
advertising on billboards; Sponsorship:
Examine operational practices at the County Fairgrounds to identify ways
to reduce youth exposure to alcohol advertising; and Advertising:
Develop consistent standards for advertising space allowed in windows of
retail establishments. These
action steps involve convening alcohol policy groups to develop uniform,
model County standards and/or ordinances, following final approval by the
Board of Supervisors. For
more information about this project, or if you wish to
participate in the development of these action steps, call Rogelio
Balderas 408-378-6805. Archives of Previous
Newsletters The First Step To Alcohol & Drug
Screening, Information & Referral
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