Addiction in Gastrointestinal and Liver Disorders

Addiction intersects with a wide range of gastrointestinal (GI) and liver diseases, impacting the development of disease and long-term outcomes. This review highlights the most clinically relevant substance use disorders (SUDs) in gastroenterology and hepatology, including alcohol use disorder (AUD), opioid use disorder, and cannabis use disorder. AUD can lead to alcohol-associated liver disease, which is one of the primary causes of liver disease in the United States and is currently the leading indication for liver transplantation. AUD is also associated with the development of GI malignancies. Opioid use disorder is associated with impaired foregut motility, opioid-induced constipation, narcotic bowel syndrome, and increased risk of hepatitis C virus in the setting of injection drug use. Cannabis use disorder is associated with cannabis hyperemesis syndrome, and synthetic cannabinoids have demonstrated hepatotoxic effects. Effective management of SUDs in GI and liver diseases requires a multidisciplinary approach that incorporates behavioral interventions and pharmacotherapy. Medications for alcohol use disorder and opioid use disorder are underutilized despite strong evidence for safety and efficacy, even in patients with hepatic dysfunction. Gastroenterologists and hepatologists are often well-positioned to identify and address SUD early and should strive to provide coordinated care that improves both addiction and GI-related/liver-related outcomes.