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 (Lead / Corresponding author), Andrew Radley, John F. Dillon

Research output: Contribution to journalReview articlepeer-review

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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.

Original languageEnglish
Pages (from-to)425-437
Number of pages13
Issue number3
Early online date22 Aug 2022
Publication statusPublished - Mar 2023


  • Identity
  • recovery
  • substance use
  • social network
  • citizenship
  • hepatitis C
  • stigma
  • identity
  • Citizenship

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Medicine (miscellaneous)


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