In the Journals

Text message intervention improves alcohol abstinence after liver transplantation

Patients who received text message intervention regarding alcohol use after liver transplantation had better treatment outcomes than those who received standard care, and they reported high satisfaction with the intervention, according to a recently published study.

“Survival rates of patients who resume excessive drinking posttransplant are significantly lower than those of abstinent patients or patients who have a minor lapse post-transplant,” Kelly S. DeMartini, MD, of Yale University School of Medicine, Psychiatry, and colleagues wrote. “Abstinence duration of less than 6 months pre-transplant best predicts posttransplant alcohol outcomes. Consequently, most transplant centers require a minimum of 6 months of alcohol abstinence prior to putting candidates on the active UNOS waiting list. Exceptions to this rule can be made, however, highlighting the urgent need to develop interventions that can reduce relapse to alcohol in liver transplant candidates.”

DeMartini and colleagues designed the pilot study to compare the feasibility and efficacy of text message intervention against alcohol relapse for 8 weeks after liver transplantation. Participants included 15 liver transplantation candidates who reported more than one instance of drinking in the last year and had a diagnosis of alcoholic liver disease.

The researchers assigned eight patients to the text message group and seven patients to receive standard care; however, one patient in the standard care group died shortly after baseline.

The text messages addressed five factors: identification of cravings; mood; identification of high-risk situations; coping strategies against cravings and drink refusal skills; and exercise and diet.

Of the six patients in the text message group who completed intervention satisfaction ratings, most were very satisfied with the intervention, looked forward to receiving the messages, found it easy to respond, and read the messages regularly.

Most patients reported the frequency of the daily texts was appropriate (88%) while one patient said there were too few. Overall, patients found that three texts per week was appropriate and that the messages helped with abstinence, coping with cravings and with stress. While not significant, the researchers did observe a trend for decreased cravings and increased abstinence self-efficacy.

At 8 weeks, none of the patients in the text-message group had positive urine ethyl glucuronide results, whereas two of the six patients in the standard care group tested positive for alcohol use.

“Maintenance of sobriety for ALD liver transplant patients is a site-specific requirement for UNOS listing at many transplantation centers in the United States,” the researchers wrote. “A mobile, SMS-based intervention for alcohol relapse prevention shows promise for reducing alcohol consumption and maintaining lower stress levels. Further development of behavioral alcohol interventions for this vulnerable population remains an urgent clinical need; mobile interventions may provide a beneficial care adjunct.” – by Talitha Bennett

Disclosure: DeMartini reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Patients who received text message intervention regarding alcohol use after liver transplantation had better treatment outcomes than those who received standard care, and they reported high satisfaction with the intervention, according to a recently published study.

“Survival rates of patients who resume excessive drinking posttransplant are significantly lower than those of abstinent patients or patients who have a minor lapse post-transplant,” Kelly S. DeMartini, MD, of Yale University School of Medicine, Psychiatry, and colleagues wrote. “Abstinence duration of less than 6 months pre-transplant best predicts posttransplant alcohol outcomes. Consequently, most transplant centers require a minimum of 6 months of alcohol abstinence prior to putting candidates on the active UNOS waiting list. Exceptions to this rule can be made, however, highlighting the urgent need to develop interventions that can reduce relapse to alcohol in liver transplant candidates.”

DeMartini and colleagues designed the pilot study to compare the feasibility and efficacy of text message intervention against alcohol relapse for 8 weeks after liver transplantation. Participants included 15 liver transplantation candidates who reported more than one instance of drinking in the last year and had a diagnosis of alcoholic liver disease.

The researchers assigned eight patients to the text message group and seven patients to receive standard care; however, one patient in the standard care group died shortly after baseline.

The text messages addressed five factors: identification of cravings; mood; identification of high-risk situations; coping strategies against cravings and drink refusal skills; and exercise and diet.

Of the six patients in the text message group who completed intervention satisfaction ratings, most were very satisfied with the intervention, looked forward to receiving the messages, found it easy to respond, and read the messages regularly.

Most patients reported the frequency of the daily texts was appropriate (88%) while one patient said there were too few. Overall, patients found that three texts per week was appropriate and that the messages helped with abstinence, coping with cravings and with stress. While not significant, the researchers did observe a trend for decreased cravings and increased abstinence self-efficacy.

At 8 weeks, none of the patients in the text-message group had positive urine ethyl glucuronide results, whereas two of the six patients in the standard care group tested positive for alcohol use.

“Maintenance of sobriety for ALD liver transplant patients is a site-specific requirement for UNOS listing at many transplantation centers in the United States,” the researchers wrote. “A mobile, SMS-based intervention for alcohol relapse prevention shows promise for reducing alcohol consumption and maintaining lower stress levels. Further development of behavioral alcohol interventions for this vulnerable population remains an urgent clinical need; mobile interventions may provide a beneficial care adjunct.” – by Talitha Bennett

Disclosure: DeMartini reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.