Integrated approaches to reduce alcohol use in people with liver disease: a scoping review and quantitative analysis

Alcohol-associated liver disease (ALD) and alcohol use disorder (AUD) are interconnected and highly prevalent. Integrating substance use disorder (SUD) treatment into medical clinics may increase access to specialized care and improve liver-related outcomes.

A scoping review and quantitative analysis were completed on published literature before 4 September 2024. Included articles described SUD treatment integrated in medical settings for adults with liver disease and alcohol use. Specific focus in the analysis was placed on integrations that utilized telehealth formats, facilitated access to medications for AUD (MAUD), and intervened in liver transplant populations.

Twenty-three full-length manuscripts and 10 conference abstracts met the inclusion criteria. Fourteen articles discussed MAUD access in ALD populations. Nine utilized telehealth interventions, and 12 focused on pre- and post-liver transplant populations considered high-risk for returning to alcohol use. Nine full-length manuscripts were included in a quantitative analysis, which showed a 9.7% risk difference (95% CI: 5.9-13.4) in any alcohol use, favoring integrated care over treatment as usual.

Integrated care for AUD and concurrent ALD populations can effectively reduce returns to alcohol use and be successfully integrated in a medical setting. The core ingredient of such interventions was the inclusion of an addiction medicine specialist into a medical setting, rather than an outside referral. Strategic telehealth utilization can further reduce geographic and specialty-specific barriers to SUD care in medically ill populations. More consensus is needed on key components, processes, and optimal outcomes for such integrated programs for people with concurrent liver disease and AUD.