Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis

Mellinger, Jessica L.; Winder, Gerald Scott; DeJonckheere, Melissa; Fontana, Robert J.; Volk, Michael L.; Lok, Anna S.; Blow, Frederic C.

doi:10.1016/j.jsat.2018.05.003

Cited by 80 publications

(73 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Treatment and characterization of AUD, assessment and reinforcement of motivation to abstain, and identification of patients at risk of relapse require the concerted commitment of physicians, psychologists, psychiatrists, and socio‐educational support, along with self‐help groups and the patients’ families if available. Because hepatology care may be the “best moment” to influence not only the liver disease course, but also the underlying AUD, clinicians with a dual expertise in both hepatology and alcohology (the “hepato‐alcohologist”) should play a preeminent role.…”

Section: Resultsmentioning

confidence: 99%

“…Evidence for the efficacy of associating medications is increasing, but unfortunately, severe liver dysfunction often hampers their use in end‐stage ALD. This accounts for, but it is not the sole cause of, underusing AUD treatment in many actively drinking patients with ALD . Indeed, many barriers to treatment exist, often related to patient misconceptions such as inaccurate perception of medication side effects and belief that an advanced liver disease would frustrate the treatment of alcohol use.…”

Section: Treatment Of Aud In End‐stage Aldmentioning

confidence: 99%

“…Indeed, many barriers to treatment exist, often related to patient misconceptions such as inaccurate perception of medication side effects and belief that an advanced liver disease would frustrate the treatment of alcohol use. The most common barriers to treatment include unwillingness to undergo therapy, financial or insurance constraints, and logistic difficulties . In a cohort of patients awaiting LT transplantation, most denied craving for alcohol or believed that treatment of AUD was necessary.…”

Section: Treatment Of Aud In End‐stage Aldmentioning

confidence: 99%

See 2 more Smart Citations

Diagnosis and Treatment of Alcohol Use Disorder in Patients With End‐Stage Alcoholic Liver Disease

2019

View full text Add to dashboard Cite

Between 14%‐30% of the world’s population is affected by alcohol use disorder (AUD), and excessive alcohol consumption represents the most common cause of liver disease in the western world. The clinical picture of alcoholic end‐stage liver disease is rendered extremely complex, as manifestations such as alcohol withdrawal syndrome, craving and physical dependence, as well as extrahepatic alcohol‐related diseases merge with the complications of advanced cirrhosis. This makes AUD recognition and assessment difficult and its management arduous as many drugs commonly used to treat complications such as alcohol withdrawal syndrome are often contraindicated by the presence of hepatic encephalopathy or hepatorenal syndrome. Reaching and maintaining abstinence represents the mainstay of managing patients with AUD and end‐stage liver disease. Psychosocial interventions are an essential component of treatment to reach these goals. However, these interventions alone often prove insufficient in AUD patients and even more frequently in those with end‐stage liver disease because of inadequate adherence due to poor functional and physical status. Pharmacological treatments need to be associated, but the available options are greatly limited in end‐stage liver disease because many GABA‐Ergic drugs can favor the development of hepatic encephalopathy, whereas drugs undergoing extensive liver metabolism should be avoided or used with the greatest caution. Because of these limitations, the management of end‐stage AUD is extremely challenging and requires an integrated multidisciplinary approach.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Treatment Of Aud In End‐stage Aldmentioning

confidence: 99%

Section: Treatment Of Aud In End‐stage Aldmentioning

confidence: 99%

See 1 more Smart Citation

Diagnosis and Treatment of Alcohol Use Disorder in Patients With End‐Stage Alcoholic Liver Disease

2019

View full text Add to dashboard Cite

show abstract

“…Patients with ALD often express resistance to treatment of AUD, for reasons that they no longer have cravings for alcohol, skepticism regarding the available treatments, or being too sick for participation in counseling sessions. ( 10,11 ) We need to convince ourselves first and overcome other infrastructure barriers before convincing our patients about the value of treatment of AUD as a basis for improving their outcomes and survival.…”

Section: Figmentioning

confidence: 99%

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

Lucey

Singal

2020

Hepatology

View full text Add to dashboard Cite

A lcohol-associated liver disease (ALD) contributes to 50% of cases of cirrhosis worldwide. (1) Despite this burden of disease, the resources devoted to either research into or treatment of ALD have lagged compared with liver diseases from other etiologies. (2,3) Progress has been hampered by the isolation of addiction medical services from internal medicine, family medicine, and gastroenterology-hepatology. As a result, around the world, ALD is recognized late in its course, even in specialist centers. (4) Furthermore, most patients with a new diagnosis of ALD report prior interactions with health care providers over their lifetime, when opportunities for screening for alcohol use disorder (AUD) and detecting ALD at an early stage were missed. (5) Recent guidelines into the management of ALD have highlighted the need for better communication between practitioners in addiction, and those in general and specialized medicine and surgery. (2,3) However, we take hope from two papers in this issue of Hepatology that point to the future for better care for patients with ALD. (6,7) In the first study, Preoschold-Bell et al. compared Screening, Brief Intervention, and Referral to Treatment (SBIRT) with SBIRT and enhanced treatment of AUD, with an aim to reduce alcohol consumption in patients with hepatitis C virus (HCV) infection. (7) Subjects attending three out-patient clinics from October 2014 to September 2017 were identified as candidates for the study using the AUD Identification Test questionnaire. The primary outcome of abstinence from alcohol at 6 months improved similarly in both groups. For example, abstinence at month 6 in the SBIRT-only group improved to 20.5% from 7.1% at day 0, and the SBIRT plus intensive treatment of AUD group improved to 23.3% from 4.2% at baseline. Similar results were obtained for evaluation on heavy drinking days, number of heavy drinking days per month, decreasing the amount of alcohol consumption per week, and use of other recreational drugs. This study makes the important point that improvements in drinking behavior are possible with concerted medical intervention. It should be acknowledged that this study included patients with mild AUD, limiting the applicability to the patients usually seen in liver units. Furthermore, all patients in this study received screening for AUD, raising awareness, which is not the standard of care for HCV infection treatment in routine practice. Apart from SBIRT, two other psychosocial interventions for managing more severe AUD or alcohol dependence include cognitive behavioral therapy (12-step abstinence-based program that involves Alcoholics Anonymous, focusing on identifying triggers that endanger relapse and how to deal with these) and motivational enhancement therapy (technique dealing with the patient dilemma, focusing on the decision to stop or modify drinking behavior).

show abstract

“…AUDIT-C screening Comorbid depression 56%-64% of patients with cirrhosis have comorbid depression, (10,11) which has been linked to impaired self-management and reduced adherence to treatment in other chronic diseases. (11,12) Psychiatry collaboration; optimized therapy; PHQ-9 screening…”

Section: Optimized Therapymentioning

confidence: 99%

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

Saleh¹,

Bloom

Grzyb

et al. 2020

Hepatol Commun

View full text Add to dashboard Cite

The complexity of cirrhosis requires patients and their caregivers to be well educated to improve outcomes. Data are lacking regarding how to best educate patients and their caregivers in the setting of cirrhosis. Our aim is to understand (both through existing literature and by asking patients and their caregivers) how patients learn about their disease, barriers in their education and disease management, and self‐management strategies. We performed a structured search of published articles in PubMed (1973 to 2020) using keywords “cirrhosis” plus “barriers”, “education”, “self‐management”, or “self‐care”. Additionally, we conducted a focus group of a representative sample of patients and their caregivers to understand how knowledge about cirrhosis is found and incorporated into self‐management. Of 504 returned manuscripts, 11 pertained to barriers in cirrhosis, interventions, or educational management. Barriers are well documented and include disease complexity, medication challenges, comorbid conditions, and lack of effective education. However, data regarding addressing these barriers, especially effective educational interventions, are scarce. Current strategies include booklets and videos, patient empowerment, and in‐person lectures. Without widespread use of these interventions, patients are left with suboptimal knowledge about their disease, a sentiment unanimously echoed by our focus group. Despite linkage to subspecialty care and consistent follow‐up, patients remain uncertain about their disease origin, prognosis, and therapies to manage symptoms. It is clear that more data are needed to assess effective strategies to address unmet educational needs. Existing strategies need to be blended and improved, their effectiveness evaluated, and the results distributed widely.

show abstract

Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis

Cited by 80 publications

References 26 publications

Diagnosis and Treatment of Alcohol Use Disorder in Patients With End‐Stage Alcoholic Liver Disease

Diagnosis and Treatment of Alcohol Use Disorder in Patients With End‐Stage Alcoholic Liver Disease

Integrated Treatment of Alcohol Use Disorder in Patients With Alcohol‐Associated Liver Disease: An Evolving Story

How Do Patients With Cirrhosis and Their Caregivers Learn About and Manage Their Health? A Review and Qualitative Study

Contact Info

Product

Resources

About