Gaps in Receipt of Alcohol Treatment Services Among Adults with Hepatic Steatosis

The burden of concurrent alcohol use in adults with hepatic steatosis is not clear given challenges in accurate alcohol use assessment. We aim to evaluate the consistency of screening for alcohol use, the distribution of alcohol use categories, gaps in receipt of alcohol treatment services, and association of treatment access with drinking patterns over time.

Consecutive adults with steatotic liver disease (controlled attenuation parameter scores > 263 dB/m) seen in hepatology clinics at a single Veterans Affairs Health System between 1/1/2020-12/31/2025 were classified into three alcohol use categories using Alcohol Use Disorder Identification Test-Concise (AUDIT-C) scores: no alcohol, mild-moderate, and hazardous. Receipt of medications for alcohol use disorder or other inpatient/outpatient alcohol treatment services were evaluated.

Among 608 adults with steatotic liver disease (93.8% men, mean age 63.9 years), 91.6% had an AUDIT-C within 6 months of elastography, among whom 46.3% reported no alcohol use, 39.1% mild-moderate alcohol, and 14.5% hazardous alcohol. Among patients with mild-moderate or hazardous alcohol use, 13.4% received pharmacotherapy or alcohol treatment services during a median follow-up of 27.1 months. Receipt of alcohol treatment was associated with decline in AUDIT-C scores during follow-up.

Among adults with steatotic liver disease reporting mild-moderate or hazardous levels of alcohol use, less than 1 in 7 received any form of alcohol treatment; yet such treatment was impactful among those who accessed it. Greater awareness and implementation of routine alcohol screening with timely linkage to alcohol treatment services is urgently needed for patients with chronic liver disease.