Cover Story

Alcoholic Liver Disease: Clinician Collaboration Needed to Encourage Abstinence

Alcoholic liver disease is one of the most common forms of liver disease in the world and, in 2012, approximately 3.3 million global deaths were attributed to alcohol consumption. Alcohol-related health disorders are often determined by the amount and duration of alcohol consumption. To date, the most effective way to prevent alcohol-related health disorders and alcoholic liver disease is abstinence, according to experts.

“Treatment for alcoholic liver disease is really founded on alcohol abstinence first, and supportive care for the complications,” Helen S. Te, MD, FAASLD, FAST, AGAF, associate professor of medicine, and medical director of the adult liver transplantation center for liver diseases, The University of Chicago, told Healio Gastroenterology. “Alcohol abstinence provides the best chance at improving outcome, above any other interventions.”

Lorenzo Leggio, MD, PhD, MSc, clinical investigator and chief of the section on clinical psychoneuroendocrinology and neuropsychopharmacology, National Institute on Alcohol Abuse and Alcoholism and National Institute on Drug Abuse, National Institutes of Health, agreed that abstinence is needed to prevent further liver damage in ALD.

“Long-term abstinence is preferable and recommended,” Leggio said. “A brief intervention may be an opening to starting a discussion with a patient and helping them to realize that they need to reduce drinking. On top of brief intervention, you can also add an adjunct treatment,” a number of which are approved in the U.S. and in Europe for alcoholic disorders.

Helen S. Te

Ashwani K. Singal, MD, MS, FACG, assistant professor at the University of Alabama at Birmingham, told Healio Gastroenterology abstinence is most important and certain medications used with behavioral or motivational therapy for abstinence have shown success, but there is a high chance for relapse.

“Abstinence or cessation of alcohol use is the single most important effective intervention for ALD. These approaches are effective to achieve abstinence in 50% to 70% of cases. However, the efficacy is short lasting and the relapse rates of alcohol use can be as high as 50% after discontinuation of respective treatment,” Singal said.

Clinician Collaboration

Although a hepatologist or liver specialist can recommend abstinence and assist with medical complications from ALD, they are not experts in alcoholism or alcohol addiction; therefore, an addiction specialist and other specialists should be considered when a patient is diagnosed with ALD. However, integrating a hepatologist, addiction specialist, psychologist and other specialists into a personalized health program for a patient with ALD can be a difficult task.

“This is still a challenge and it’s no one’s fault,” Leggio said. “Not everybody can be an expert at everything. However, we need to become more and more aware of ALD and understand we all need to work together to help a patient stop drinking.”

Multiple specialists are needed for this patient population due to their varying levels of expertise, according to Leggio.

“Hepatologists are needed for their expertise in liver damage, addiction psychiatrists or specialists are needed for their expertise in addiction, psychologists are needed for their expertise in behavior and can contribute to behavior treatments,” adding that social workers could be helpful as well.

Singal said a psychologist can have a vital role in managing a patient with ALD, but this collaboration is lacking at many liver centers.

“Psychologists can play an important role in the management of these patients and we know this historically from alcoholics deriving benefit in controlling this behavior by enrolling in the alcohol rehabilitation programs and attending the Alcoholic Anonymous meetings. However, most liver centers — including those with special expertise on alcoholic liver disease — do not work in tandem with psychologists to manage these patients,” Singal said. “Clearly this is an unmet need and area of future research to examine potential barriers to this collaborative approach in the management of patients with alcoholic liver disease.”