Integrated Alcohol Use Disorder and Liver Disease Management

Hanna Blaney; Adelina Horhat; Abdulmalik Saleem; Gerald S. Winder; Jessica Mellinger; Juan P. Arab

doi:10.1055/a-2717-3496

Seminars in Liver Disease, Table of Contents

Semin Liver Dis
DOI: 10.1055/a-2717-3496

Review Article

Integrated Alcohol Use Disorder and Liver Disease Management

Authors

Hanna Blaney ^*

¹Medstar Transplant Hepatology Institute, MedStar Georgetown University Hospital, Washington, District of Columbia
Adelina Horhat ^*

²Department of Hepatology, Paris-Est Créteil University, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Paris, France
Abdulmalik Saleem

³Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
Gerald S. Winder

⁴Department of Psychiatry and Behavioral Medicine, Henry Ford Health, Detroit, Michigan
Jessica Mellinger

⁵Division of Gastroenterology and Hepatology, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan
Juan P. Arab

⁶Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia

⁷Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile

Abstract

Alcohol-associated liver disease (ALD) is a leading cause of liver disease worldwide, caused by hazardous alcohol use. Many patients with ALD also have alcohol use disorder (AUD), a chronic mental health condition characterized by a cluster of behavioral, cognitive, and physiological symptoms that indicate continued alcohol use despite significant alcohol-related problems. Comprehensive care of ALD often requires treatment of AUD, and evidence has demonstrated that treating the latter improves patient outcomes. However, only a minority of patients with AUD/ALD receive treatment. Integrative care models where hepatologists work alongside AUD specialists have been developed. These partnerships have been associated with improved outcomes, including decreased rates of return to alcohol use, decreased healthcare utilization, and even improved mortality. We review the epidemiology, diagnosis, and treatment of AUD and ALD, examples of successful integrated care models, and outcomes. We also discuss knowledge gaps and areas where future research is needed, including the role of integrated care in the peri-transplantation period for ALD, harm reduction approaches, and the need for efforts to support collaboration for integrative care. In conclusion, the dual pathologies of AUD and ALD necessitate multidisciplinary care, and integrated care models have been shown to be both feasible and effective.

Keywords

alcohol-associated liver disease - alcohol use disorder - integrated care

Full Text

References

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