In the Journals

Less than 15% of veterans with cirrhosis receive alcohol use disorder treatment

Most veteran with cirrhosis and coexisting alcohol-use disorder did not receive behavioral or pharmacotherapy treatment for alcohol use during 6 months of follow-up, according to data published in Hepatology.

“Despite the importance of treating alcohol use disorder (AUD) in the context of cirrhosis, relatively little work has assessed the uptake of evidence-based AUD treatments in patients with this common disorder,” Shari S. Rogal, MD, MPH, from the VA Pittsburgh Healthcare System, and colleagues wrote. “Behavioral therapies are considered to be the cornerstone of AUD treatment in patients with alcohol-related liver disease and several forms of such therapy can be successful in patients with coexisting AUD and cirrhosis. Pharmacotherapy combined with behavioral therapy is considered to be the best treatment for AUD in general populations.”

Researchers identified 93,612 veterans with a diagnosis of cirrhosis between 2011 and 2015, of whom 35,682 met the criteria for newly-diagnosed AUD.

Researchers analyzed the 180 days after first diagnosis of AUD and found that 5,088 (14%) received any AUD treatment with 4,461 (12%) receiving only behavioral therapy and 159 (0.4%) receiving pharmacotherapy alone. Just 1% (n = 468) received a combination of behavioral and pharmacotherapy.Adjusted multivariable models of AUD treatments showed younger age (aOR = 0.96; 95% CI, 0.95-0.96), AUD Identification Test Consumption (AUDIT-C) screening scores (aOR = 1.09; 95% CI, 1.07-1.1), and mood disorders (aOR = 1.56; 95% CI 1.4-1.74) all had an independent association with any treatment including behavioral only, pharmacotherapy only, or both.

Patients who were black (aOR = 1.26; 95% CI, 1.09-1.46), homeless (aOR = 1.76; 95% CI, 1.49-2.08), had other substance use disorders, or PTSD (aOR = 1.14; 95% CI, 1.01-1.27) were less likely to receive behavioral therapy.

Veterans who received any AUD treatment had lower odds for decompensation (aOR = 0.63; 95% CI, 0.52-0.76).

Additionally, AUDIT-C scores independently correlated with mortality (aOR = 1.06 per point; 95% CI, 1.04-1.09) and decompensation (aOR = 1.04 per point; 95% CI, 1.02-1.05) after controlling for demographic and liver-related variables and comorbidities.

“Despite the theoretical risks of AUD pharmacotherapy, we found that such treatments were not associated with worsened short-term outcomes in this large retrospective study,” the researchers wrote. “In fact, we found that any treatment was associated with decreased decompensation, even controlling for degree of alcohol use. ... Future work would benefit from prospective measurement of drinking behaviors over time, which could not be reliably obtained from our administrative dataset.” – by Talitha Bennett

Disclosures: Rogal reports that the study was supported by AHRQ K12 HS019461 and by a Competitive Pilot Project Fund Grant from VA VISN 4.

Most veteran with cirrhosis and coexisting alcohol-use disorder did not receive behavioral or pharmacotherapy treatment for alcohol use during 6 months of follow-up, according to data published in Hepatology.

“Despite the importance of treating alcohol use disorder (AUD) in the context of cirrhosis, relatively little work has assessed the uptake of evidence-based AUD treatments in patients with this common disorder,” Shari S. Rogal, MD, MPH, from the VA Pittsburgh Healthcare System, and colleagues wrote. “Behavioral therapies are considered to be the cornerstone of AUD treatment in patients with alcohol-related liver disease and several forms of such therapy can be successful in patients with coexisting AUD and cirrhosis. Pharmacotherapy combined with behavioral therapy is considered to be the best treatment for AUD in general populations.”

Researchers identified 93,612 veterans with a diagnosis of cirrhosis between 2011 and 2015, of whom 35,682 met the criteria for newly-diagnosed AUD.

Researchers analyzed the 180 days after first diagnosis of AUD and found that 5,088 (14%) received any AUD treatment with 4,461 (12%) receiving only behavioral therapy and 159 (0.4%) receiving pharmacotherapy alone. Just 1% (n = 468) received a combination of behavioral and pharmacotherapy.Adjusted multivariable models of AUD treatments showed younger age (aOR = 0.96; 95% CI, 0.95-0.96), AUD Identification Test Consumption (AUDIT-C) screening scores (aOR = 1.09; 95% CI, 1.07-1.1), and mood disorders (aOR = 1.56; 95% CI 1.4-1.74) all had an independent association with any treatment including behavioral only, pharmacotherapy only, or both.

Patients who were black (aOR = 1.26; 95% CI, 1.09-1.46), homeless (aOR = 1.76; 95% CI, 1.49-2.08), had other substance use disorders, or PTSD (aOR = 1.14; 95% CI, 1.01-1.27) were less likely to receive behavioral therapy.

Veterans who received any AUD treatment had lower odds for decompensation (aOR = 0.63; 95% CI, 0.52-0.76).

Additionally, AUDIT-C scores independently correlated with mortality (aOR = 1.06 per point; 95% CI, 1.04-1.09) and decompensation (aOR = 1.04 per point; 95% CI, 1.02-1.05) after controlling for demographic and liver-related variables and comorbidities.

“Despite the theoretical risks of AUD pharmacotherapy, we found that such treatments were not associated with worsened short-term outcomes in this large retrospective study,” the researchers wrote. “In fact, we found that any treatment was associated with decreased decompensation, even controlling for degree of alcohol use. ... Future work would benefit from prospective measurement of drinking behaviors over time, which could not be reliably obtained from our administrative dataset.” – by Talitha Bennett

Disclosures: Rogal reports that the study was supported by AHRQ K12 HS019461 and by a Competitive Pilot Project Fund Grant from VA VISN 4.