Integrated Multidisciplinary Management of Alcohol-Associated Liver Disease

Abstract

Alcohol-associated liver disease (ALD) is one of the most common liver diseases and indications for liver transplantation (LT). Alcohol use disorder (AUD), a frequent accompaniment in ALD patients, may also be associated with psychiatric comorbidities such as depression and anxiety. Identification of ALD at an earlier stage, and treatment of AUD may help prevent progression to advanced stage of ALD such as cirrhosis and alcoholic hepatitis. Screening for alcohol use and AUD treatment in ALD patients is often not performed due to several barriers at the level of patients, clinicians, and administrative levels. This review details the integrated multidisciplinary care model especially on the specific role of the hepatologist, psychiatrist, addiction counselor, and social worker in providing complete management for the dual pathology of liver disease and of AUD. Laboratory assessment, pharmacological and behavioral therapies, and recommended assessments for follow-up care by the respective specialists is outlined. We provide perspective along with the literature support, with the goal of providing team based comprehensive care of patients with ALD.

Alcohol-associated liver disease and behavioral and medical cofactors: unmet needs and opportunities

“…Establishing multidisciplinary care clinics is a critical next step to better understanding and addressing the intertwined pathophysiology of ALD and chronic diseases through a collaborative team of hepatologists, pharmacists, addiction psychologists, and psychiatrists. Models for integrative ALD care clinics have been proposed, and real-life examples include the Delivery of Early Liver Transplant for Alcoholic Hepatitis (DELTA) Center for Alcohol Research at Johns Hopkins University and Michigan Alcohol Improvement Network (MAIN) at the University of Michigan (46,(50)(51)(52). The overlap of ALD with chronic, behaviorally driven conditions such as obesity, heart disease, and diabetes is an understudied issue of massive and increasing significance in the US population, pressing the need to disseminate effective models for integrated research and care.…”

“…Ideally, integrated care teams with psychiatrists, psychologists, social workers, and hepatologists would see patients in the same clinical setting ( 46 ). Simply having one appointment in one place would address a range of logistical barriers to care, such as transportation, as well as stigma-related barriers that place the burden of finding AUD treatment on the ALD patient.…”

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…Thus, the stage of CLD was already significantly advanced. Nonetheless, it is quite a common feature that patients with ALD are rarely diagnosed at an early phase of this pathology [234][235][236]. Of note, ALD was identified as a risk factor of poor COVID-19 outcome in another survey on 80 subjects with CLD, too [237].…”