Management of alcohol use disorder: a gastroenterology and hepatology-focused perspective.

Luis Antonio Díaz, Gustavo Ayares, Lorenzo Leggio, Sabine Weber, Juan Pablo Arab, Gerald Scott Winder, Ramon Bataller, Patrick S Kamath, Daniel König, José Miguel Fuentealba, Valeria Vázquez

Journal: The lancet. Gastroenterology & hepatology 2025;10(5):475-490

PMID: 39956128

Full Text on Elsevier Science View on PubMed

Abstract

Alcohol use disorder is a prevalent and major but preventable cause of morbidity and mortality worldwide, causing several important health consequences, including chronic liver disease. Despite its substantial effects, most clinicians do not adequately assess alcohol intake in clinical practice, and there are several barriers to providing integrated management to patients with alcohol use disorder. Standardised questionnaires, such as the Alcohol Use Identification Test (AUDIT), can facilitate the identification of individuals at risk of alcohol use disorder, and alcohol biomarkers such as phosphatidylethanol aid in quantifying levels of alcohol consumption. Non-pharmacological interventions-including brief interventions, twelve-step facilitation, motivational enhancement therapy, contingency management, and cognitive behavioural therapy-are effective for patients with alcohol use disorder, regardless of the presence of advanced liver disease. Pharmacological treatments should be considered according to the severity of liver disease and other comorbidities, safety profile, and local availability. The management of patients with alcohol use disorder and associated liver disease should ideally be performed in the setting of integrated multidisciplinary teams.

Address: Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; MASLD Research Center, Division of Gastroenterology and Hepatology, University of California San Diego, San Diego, CA, USA.; Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Austria.; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.; Escuela de Medicina, Universidad Finis Terrae, Santiago, Chile.; Escuela de Medicina, Instituto Tecnológico de Monterrey, Monterrey, Mexico.; Liver Unit, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.; Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.; National Institutes of Health, Baltimore, MD, USA; National Institute on Drug Abuse, Baltimore, MD, USA; National Institute on Alcohol Abuse and Alcoholism, Baltimore, MD, USA.; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Stravitz-Sanyal Institute of Liver Disease and Metabolic Health, Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA. Electronic address: [email protected].

DOI: 10.1016/S2468-1253(24)00380-7

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MeSH Terms: Humans, Alcoholism, Gastroenterology, Cognitive Behavioral Therapy, Alcohol Drinking