Psychotherapy for Alcohol Use Disorder Is Associated With Reduced Risk of Incident Alcohol-Associated Liver Disease

Vannier, Augustin; Przybyszewski, Eric M.; Shay, Jessica E.S.; Patel, Suraj J.; Schaefer, Esperance A.; Goodman, Rachel; Luther, Jay

doi:10.1016/j.cgh.2022.08.001

Cited by 13 publications

(17 citation statements)

References 27 publications

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“…An additional two records were added after reviewing the reference lists of relevant review articles. One hundred and forty‐six articles were reviewed in full text and 23 studies were eligible for inclusion in the review 16,29–50 (Figure 1). One study reported on two distinct cohorts 42 (a retrospective cohort with prospective validation) which were treated as separate populations.…”

Section: Resultsmentioning

confidence: 99%

“…Six NRSIs reported exclusively on clinical outcomes 16,37,45,46,49,50 and four reported exclusively on alcohol intake outcomes 35,38–40 . The remaining seven studies reported both outcome categories 36,41–44,47,48 …”

Section: Resultsmentioning

confidence: 99%

“…Ten NRSIs examined the impact of psychological treatments or alcohol rehabilitation 16,35,36,[39][40][41][42][43]45,49 (Table 2). For the purpose of this analysis, these psychological therapies were grouped together and considered to have a class effect.…”

Section: Non-randomised Studies Of Interventionsmentioning

confidence: 99%

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Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol‐associated hepatitis

Oldroyd,

Greenham,

Martin

et al. 2023

Aliment Pharmacol Ther

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SummaryBackgroundAlcohol use is the most important factor in determining the prognosis of patients with alcohol‐related cirrhosis and alcohol‐associated hepatitis.AimTo conduct a systematic review of interventions for alcohol use disorder specific to patients with cirrhosis or alcohol‐associated hepatitis.MethodsWe searched five databases between inception and November 2022. The primary outcomes were abstinence, hepatic decompensation and mortality. We included randomised and non‐randomised studies. Risk of bias was assessed using validated tools. Where possible, meta‐analysis was performed.ResultsTwenty‐three studies met the inclusion criteria including six randomised trials and 17 non‐randomised studies of interventions. These included 104,298 patients with a mean/median age range from 44 to 65, of whom 75% were male. Interventions included psychological therapy, pharmacological therapies, specialist clinics, patient education and low alcohol drinks. Baclofen was the only intervention to demonstrate a statistically significant impact on the primary outcomes in a randomised trial (abstinence OR: 6.3, 95% CI: 2.4–16.1). Three non‐randomised studies reported reductions in episodes of hepatic decompensation that were significant in multivariate models. This was in response to psychological therapy, use of any pharmacotherapy, and use of any treatment. A meta‐analysis of non‐randomised studies that examined the impact of psychological therapies revealed statistically non‐significant improvements in abstinence (4 studies, OR: 1.87, 95% CI: 0.38–9.23) and mortality (4 studies, OR: 0.47, 95% CI: 0.12–1.77).ConclusionsBaclofen is the only intervention with randomised trial evidence for significant benefit in patients with cirrhosis. Non‐randomised studies also point to non‐pharmaceutical interventions possibly improving clinical outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol‐associated hepatitis

Oldroyd,

Greenham,

Martin

et al. 2023

Aliment Pharmacol Ther

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“…[8,11] Regardless of the type of therapy, psychotherapy for patients with AUD has been found to decrease the progression ALD and lower rates of decompensation for those with underlying cirrhosis. [3] The NIAAA provides additional information online for patients and families looking for more information and assistance in obtaining these resources (https://alcoholtreatment.niaaa.nih.gov/).…”

Section: Cognitive Behavioral Therapymentioning

confidence: 99%

“…Excessive alcohol use is a significant cause of liver disease and a common indication for liver transplant in the United States. Studies have shown that AUD treatment with psychotherapy or medication decreases incidence of alcohol-associated liver disease (ALD) and lowers rates of decompensation in those with underlying cirrhosis 3,4 . Given this, hepatologists are uniquely positioned to help patients with harmful alcohol use; however, few feel adequately trained to do so 5 …”

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confidence: 99%

Alcohol use disorder: Recognition, testing, and initial management strategies

Boschuetz

German

2023

Clinical Liver Disease

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Alcohol use is common around the world, and its use is growing, especially in the United States, where an epidemiological study found that rates of alcohol use, high-risk drinking (defined as 4 or more drinks on any day for women and 5 or more for men), and alcohol use disorder (AUD) had increased by 11.2%, 29.9%, and 49.4%, respectively, between 2001 and 2012 to 72.7% of respondents using alcohol, 12.6% partaking in highrisk drinking, and 12.7% meeting criteria for AUD. [1] Notably, these increases were greatest among women, older adults, and racial and ethnic minorities. [1] The harmful use of alcohol has resulted in ~3 million deaths and over 130 million disability-adjusted life years annually from various causes, including injury, cardiovascular disease, malignancy, and digestive diseases. [2] Excessive alcohol use is a significant cause of liver disease and a common indication for liver transplant in the United States. Studies have shown that AUD treatment with psychotherapy or medication decreases incidence of alcohol-associated liver disease (ALD) and lowers rates of decompensation in those with underlying cirrhosis. [3,4] Given this, hepatologists are uniquely positioned to help patients with harmful alcohol use; however, few feel adequately trained to do so. [5] ALCOHOL USE DISORDER AUD can be defined as a condition characterized by the inability to stop or control alcohol use despite adverse consequences. It is defined by behavioral and physical symptoms, including withdrawal, tolerance, and cravings. [6] It is a spectrum that varies from mild to severe based on the number of criteria experienced, with a diagnosis of AUD being made if the patient has had 2 or more of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria shown in Table 1 in the last 12 months.

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Integrated Multidisciplinary Care Model to Manage the Dual Pathology of Alcohol Use Disorder and of Liver Disease

Singal,

Vatsalya,

Agrawal

2024

Clinics in Liver Disease

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Psychotherapy for Alcohol Use Disorder Is Associated With Reduced Risk of Incident Alcohol-Associated Liver Disease

Cited by 13 publications

References 27 publications

Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol‐associated hepatitis

Systematic review: Interventions for alcohol use disorder in patients with cirrhosis or alcohol‐associated hepatitis

Alcohol use disorder: Recognition, testing, and initial management strategies

Integrated Multidisciplinary Care Model to Manage the Dual Pathology of Alcohol Use Disorder and of Liver Disease

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