Dual diagnosis treatment as reasonable accommodation

The following article seems to state the obvious, and applies to why access to treatment for alcoholism/addiction in prison is so essential, especially for those prisoners with Hepatitis C. Alcoholics not actively engaged in a recovery program are very often excluded from treatment for their Hep C because they're considered a poor risk for getting and staying either sober or healthy. Many HCV treatment protocols require people who are chemically dependent to complete a substance abuse treatment program and demonstrate at least 6 months of clean time before they are considered as candidates for Hep C treatment.

Although the Arizona Department of Corrections has identified that some 75% of prisoners have significant substance abuse histories at intake (and acknowledges that most of their Hep C patients fall into that category), and approximately 25% require on-going mental health services (which they don't all get) only 2,067 prisoners in 2009 completed some kind of substance abuse treatment program in prison, out of a constantly changing population of about 40,000 at any given time.

Over 6,000 Arizona state prisoners in Jan 2010 were identified as HCV+; clearly not all are getting the substance abuse, mental health, or medical treatment they need to have a chance at clearing this virus before returning to the community - which for many may be the streets.

Hep C rates are highest among individuals who are dually diagnosed with both addictive and psychiatric disorders - those individuals have the hardest time gaining access to meaningful treatment resources of any kind, both in and out of prison. Therefore, they end up having higher relapse and recidivism rates, which make them even less likely than other prisoners to be considered for Hep C treatment.

Providing the HCV+ population with adequate substance abuse treatment appropriate for their psychiatric needs - prioritizing those with HCV as soon as they're diagnosed - seems to be a reasonable accommodation for helping them to be able to participate in treatment for their Hep C while they are still healthy enough to benefit from it, and have the necessary support and stability to succeed. Otherwise, it would seem, excluding them from consideration for Hep C treatment - which is a standard practice - is discriminatory, and condemns all dually diagnosed HCV+ prisoners to a lifetime of chronic (and infectious) hepatitis and its grisly outcomes...

----------------from Hepatitis C Research and News-------------

Alcoholic Liver Disease More Aggressive

Tuesday September 7, 2010

Although many advances have been made in the detection and treatment of chronic liver disease in the past 40 years, the prognosis for patients with alcohol liver disease has not improved significantly. While advances have improved the outcomes for non-alcoholic liver disease patients, outcomes for alcohol liver disease patients remain bleak.

Researchers believe the prognosis for alcohol-related liver patients would improve if as much effort was placed in treating their alcohol dependence as is spent treating their liver disease.

Advances in treatment for hepatitis C and autoimmune hepatitis have improved outcomes for those patients in the past 40 years, and new diagnostic tools have increased early detection of the development of cirrhosis. These changes have been effective in improving outcomes for non-alcohol-related chronic liver disease patients.

Prognosis Unchanged for Alcohol Liver Patients

A new Swedish study of 36,462 patients hospitalized with alcoholic liver diseases and 95,842 patients hospitalized with non-alcoholic liver diseases found that the prognosis for alcohol-liver disease patients has remained basically unchanged.

The main difference is the alcohol dependence of the alcohol liver disease patients, said lead researcher Knut Stokkeland, of the Visby Hospital in Sweden. Since almost all alcohol liver disease patients are also alcohol dependent or alcoholics it affects their prognosis.

"Alcohol dependence increases the risks of social problems, being a smoker, and severe psychiatric diseases," Stokkeland said in a news release. "It also inhibits staying sober, which may stop disease progression."

Need Treatment for Alcoholism

The researchers believe that patients with alcohol liver disease should receive more attention, specifically they should be offered treatment for their alcohol problem as well as for their liver disease. The problem, they said, is that the lack of coordination between the hepatology and gastroenterology specialists who treat the liver and those who treat substance abuse.

Because drinking alcohol doubles the risk of developing a serious liver problem, any efforts to reduce alcohol consumption would improve the outcomes for those with alcohol-related liver disease, the researchers concluded.

In short, if you or someone you know develops liver disease, the best thing they can do to improve their chances of surviving is to stop drinking immediately.