Treating alcohol use disorders in patients with alcoholic liver disease

Total alcohol abstinence is the cornerstone of treatment for patients with alcohol use disorders and alcoholic liver disease.
Total alcohol abstinence is the cornerstone of treatment for patients with alcohol use disorders and alcoholic liver disease.

Total alcohol abstinence remains the cornerstone of treatment for patients with alcoholic liver disease (ALD), and a combination of psychosocial interventions, pharmacologic therapy, and medical management is the most effective management strategy, according to a study published in the Journal of Hepatology.

The factors that contribute to ALD include the duration and amount of alcohol intake, hepatitis virus infection, interaction with host factors, gender, genetic and nutritional factors, and comorbidities, noted Giovanni Addolorato, from the Catholic University of Rome, and colleagues.

Screening and brief intervention in the early stages of an alcohol use disorder (AUD) before liver disease can form allow clinicians to identify and offer treatment to patients with mild and moderate forms of AUD. Severe cases should be referred for more specialized treatment.

Psychosocial interventions include cognitive behavior therapy, peer-support groups, and family therapy. Benzodiazepines are the best course of action in pharmacologic therapy, as they are able to prevent symptoms of alcohol withdrawal. Pharmacotherapies may promote abstinence, reduce alcohol intake, and reduce lapse and relapse. Patients affected by early stages of ALD can be treated with benzodiazepines, as well as baclofen as long as liver function is monitored closely. The use of most of these drugs is not supported in patients affected by advanced liver disease.

Patients with AUD and any stage of ALD should be monitored by a team of hepatologists with expertise in addiction medicine as well as mental health professionals, which will provide medical management, screening for comorbidities, treatment for AUDs, and referring patients to support programs (ie, Alcoholics Anonymous) and to liver transplant centers in cases of advanced ALD.

According to the researchers, none of the aforementioned treatments would be possible without total alcohol abstinence. Once abstinence is achieved,  the combination of psychosocial interventions, pharmacologic therapy, and medical management seems to be the most effective management strategy for AUD patients with ALD.

Reference

  1. Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J Hepatol. http://dx.doi.org/10.1016/j.jhep.2016.04.029

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