Rance Jake, Treloar Carla
Addiction. 2014 Mar;109(3):452-9. doi: 10.1111/add.12392.
To explore identity transformation among service users attending opiate substitution therapy (OST) clinics following the introduction of hepatitis C (HCV) care and treatment.
An interview-based substudy of the Australian ETHOS (Enhancing Treatment for Hepatitis C in Opiate Substitution Settings) project.
Three OST clinics and one community health centre (operating a public OST) in New South Wales, Australia. Participants were interviewed at the recruitment sites.
The sample consisted of 57 OST service users concurrently living with HCV, 16 staff, including specialist HCV clinicians, and three peer-support workers, employed on the ETHOS project.
Semi-structured interviews.
Service-user participants largely welcomed the introduction of HCV treatment as a practical, clinical intervention that also intimated a more comprehensive, holistic form of care. Negative stereotypes characteristic of OST settings-of limited, routinized clinical exchanges and minimal social-care interaction-were unsettled, opening up the possibility of new relations between staff and service users. The shift in the dynamic of the clinical encounter to address health in addition to dependence appeared to catalyse transformative possibilities not only for the therapeutic alliance but also for service-user understandings of self and identity.
Trial introduction of HCV care and treatment in selected Australian opiate substitution therapy (OST) clinics may have facilitated alternative, 'non-addict' identities to emerge from a clinical setting where the stigmatizing figure of 'the drug user' has traditionally prevailed.
探讨在引入丙型肝炎（HCV）护理与治疗后，接受阿片类药物替代疗法（OST）门诊治疗的服务对象的身份转变情况。
澳大利亚ETHOS（在阿片类药物替代治疗环境中加强丙型肝炎治疗）项目的一项基于访谈的子研究。
澳大利亚新南威尔士州的三家OST门诊和一家社区卫生中心（提供公共OST服务）。研究对象在招募地点接受访谈。
样本包括57名同时感染HCV的OST服务对象、16名工作人员（包括HCV专科临床医生）以及3名受雇于ETHOS项目的同伴支持工作者。
半结构化访谈。
服务对象参与者普遍欢迎引入HCV治疗，认为这是一种切实可行的临床干预措施，也意味着更全面、整体的护理形式。OST环境中常见的负面刻板印象——有限且常规化的临床交流以及极少的社会护理互动——被打破，为工作人员与服务对象之间建立新关系创造了可能性。临床诊疗中除了关注成瘾问题还关注健康的这种动态转变，似乎不仅促进了治疗联盟的转变，也促使服务对象对自我和身份的认知发生转变。
在澳大利亚部分阿片类药物替代疗法（OST）门诊试行引入HCV护理与治疗，可能促使在传统上以“吸毒者”这一污名化形象为主导的临床环境中出现替代性的“非成瘾者”身份。
