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Pharmacologic options are limited, with multiple current trials underway for both methamphetamine and cocaine dependence.[49] In a double-blind, placebo-controlled, randomized trial conducted from 2012 to 2015, a 12-week course of extended-release naltrexone did not appear to reduce amphetamine use among dependent persons.[] In a similar randomized, controlled trial, a 12-week course of aripiprazole, when given over 12 weeks, did not significantly reduce methamphetamine use.[51] Mirtazapine has demonstrated efficacy in reducing methamphetamine use in two separate trials.[52] Bupropion and modafinil have also demonstrated benefits in small trials.[53,54] A combination of high-dose bupropion plus high-frequency extended-release naltrexone demonstrated benefit in a trial of 403 participants.[55] HCV Treatment in Persons who Consume Alcohol Impact of Alcohol Use on Liver Fibrosis in Persons with Chronic HCV Several studies have shown that heavy alcohol consumption (at least 60 grams/day in men and 40 grams/day in women) accelerates the progression of HCV-related hepatic fibrosis (Figure 5).[56,57] A typical alcoholic drink (12 ounces of beer, 5 ounces of wine, and 1.5 ounces of whiskey) contains 12 grams of alcohol

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