Alcohol-associated liver disease (ALD) is a major driver of global liver related morbidity and mortality. There are 2.4 billion drinkers (950 million heavy drinkers) and the lifetime prevalence of any alcohol use disorder (AUD) is 5.1%-8.6%. In 2017, global prevalence of alcohol-associated compensated and decompensated cirrhosis was 23.6 million and 2.5 million, respectively. Combined, alcohol-associated cirrhosis and liver cancer account for 1% of all deaths worldwide with this burden expected to increase. Solutions for this growing epidemic must be multi-faceted and focused on both population and patientlevel interventions. Reductions in ALD-related morbidity and mortality require solutions that focus on early identification and intervention, reducing alcohol consumption at the population level (taxation, reduced availability and restricted promotion), and solutions tailored to local socioeconomic realities (unrecorded alcohol consumption, focused youth education). Simple screening tools and algorithms can be applied at the population level to identify alcohol misuse, diagnose ALD using non-invasive serum and imaging markers, and risk-stratify higher-risk ALD/AUD patients. Novel methods of healthcare delivery and platforms are needed (telehealth, outreach, use of non-healthcare providers, partnerships between primary and specialty care/tertiary hospitals) to proactively mitigate the global burden of ALD. An integrated approach that combines medical and AUD treatment is needed at the individual level to have the highest impact. Future needs include (1) improving quality of ALD data and standardizing care, (2) supporting innovative healthcare delivery platforms that can treat both ALD and AUD, (3) stronger and concerted advocacy by professional hepatology organizations, and (4) advancing implementation of digital interventions. (Hepatology 2021;73:2039-2050.A lcohol-associated liver disease (ALD) is a major driver of global liver-related morbidity and mortality. Around the world, in 2016, alcohol use was associated with 3 million deaths (5.3% of all deaths), surpassing hypertension and diabetes combined. (1,2) The purpose of our review is three-fold. First, we briefly review the global burden of ALD and place it in the context of relevant changes anticipated to drive future trends. Second, we discuss populationlevel screening for ALD and AUD for early recognition and management. Finally, we discuss strategies for mitigating the impact of ALD at the global level and offer focused solutions for delivering health care services at the regional and individual level.
CURReNt aND FUtURe BURDeN oF alD alcohol Use and MisuseIn 2016, 2.4 billion people consumed alcohol (1.5 billion males and 0.9 billion females), and approximately 39.5% of these were heavy episodic