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

• Published in: Addiction (Abingdon, England) Vol. 118; no. 3; pp. 425 - 437
• Main Authors: Donaldson, Sarah R., Radley, Andrew, Dillon, John F.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01-03-2023; John Wiley and Sons Inc
• Subjects: Addictions; Adolescent; Antiviral agents; Antiviral Agents - therapeutic use; Antiviral drugs; Change agents; Citizenship; Community; Connectedness; Drug abuse; Drug use; Female; Health behavior; Hepacivirus; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - epidemiology; Hepatitis C, Chronic - drug therapy; High risk; Humans; Identity; Intervention; Medical treatment; Narratives; Public health; Recovery; Recovery (Medical); Redemption; Review; Reviews; Risk behavior; Social factors; Social interactions; social network; Social support; Stigma; Substance abuse; Substance abuse treatment; Substance Abuse, Intravenous - epidemiology; Substance use; Substance-Related Disorders - drug therapy; Systematic review; Women; social network; substance use; stigma; hepatitis C; identity; Citizenship; recovery
• ISSN: 0965-2140; 1360-0443
• DOI: 10.1111/add.16031

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 s, 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.