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. 2023 Mar;118(3):425-437.
doi: 10.1111/add.16031. Epub 2022 Sep 5.

Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review

Sarah R Donaldson  1   2 , Andrew Radley  1   2 , John F Dillon  1   3
Affiliations

Transformation of identity in substance use as a pathway to recovery and the potential of treatment for hepatitis C: a systematic review

Sarah R Donaldson et al. Addiction. 2023 Mar.

Abstract

Background and aim: People who inject drugs are at high risk of contracting hepatitis C (HCV). The introduction of direct acting antiviral (DAA) drugs to treat HCV has the potential to transform care; however, uptake of DAAs has been slower than anticipated. The strong link between HCV and injecting drug use frames HCV as a shameful, stigmatising disease, reinforcing an 'addict' identity. Linking HCV care to a recovery journey, 'clean' identity and social redemption may provide compelling encouragement for people to engage with treatment and re-evaluate risk and behaviours, reducing the incidence of HCV re-infection. The aim of this review was to identify actions, interventions and treatments that provide an opportunity for a change in identity and support a recovery journey and the implications for HCV care.

Methods: Databases (MEDLINE, EMBASE, PsycINFO, ProQuest Public Health, ProQuest Sociological Abstracts, CINAHL and Web of Science) were searched following our published strategy and a grey literature search conducted. A narrative synthesis was undertaken to collate themes and identify common threads and provide an explanation of the findings.

Results: Thirty-two studies fulfilled the inclusion criteria. The narrative synthesis of the studies identified five over-arching analytical themes: social factors in substance use and recovery, therapeutic communities, community treatment, online communities, and finally women and youth subsets. The change from an 'addict' identity to a 'recovery' identity is described as a key aspect of a recovery journey, and this process can be supported through social support and turning point opportunities.

Conclusions: Recovery from addiction is a socially mediated process. Actions, interventions and treatments that support a recovery journey provide social connections, a recovery identity and citizenship (reclaiming a place in society). There is a gap in current literature describing how pathways of care with direct acting antivirals can be designed to promote recovery, as part of hepatitis C care.

Keywords: Citizenship; hepatitis C; identity; recovery; social network; stigma; substance use.

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Conflict of interest statement

S.R.D. declares receipt of research grants from Gilead and Camurus; A.R. declares receipt of research grants from AbbVie, BMS, Pfizer, Gilead and Camurus. Lecture fees and honorariums are from AbbVie and Gilead. J.F.D. declares receipt of research grants, lecture fees and honorariums from AbbVie, BMS, Gilead, MSD, Roche and Camurus. The funder had no role in the design, execution, interpretation or writing of the study.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) search diagram
See this image and copyright information in PMC

References

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    1. European Monitoring Centre for Drugs and Drug Addiction . Hepatitis C among drug users in Europe: epidemiology, treatment and prevention Luxembourg: Publications Office of the European Union; 2016.

Publication types

Substances