Barriers to abstinence in alcohol related liver disease

Background and objectives Alcohol-related liver disease is a major public health concern, and continued alcohol use despite medical advice remains common. This study examined factors associated with ongoing alcohol use among patients with alcohol-related liver disease attending a tertiary care centre in north India. Methods A comparative cross-sectional study was conducted among 3759 adult male patients (mean age 43.8 ± 19.4 y) with alcohol-related liver disease. Patients were categorised as those with recent alcohol use (within the past 60 d) and those abstinent for more than 60 d. Data on alcohol use patterns, dependence severity, motivation to change, and perception of alcohol-related harm were obtained using structured assessments like the severity of dependence scale, readiness to change questionnaire, and a structured questionnaire developed for clinical use. Results A majority of patients reported recent alcohol use. Most were long-term (n=2932, 78% >5 y) and frequently drinking alcohol (n=2905, 77.3%) drinking alcohol three or more times per week), and 57.4% (n=2158) had attempted quitting previously. Individuals with ongoing alcohol consumption had higher dependence severity compared to abstinent patients. Despite this, many current drinkers reported awareness of alcohol-related harms and the need for treatment. Motivation to reduce or stop alcohol use was reported in both groups. Interpretation and conclusions Continued alcohol use among patients with alcohol-related liver disease appears strongly associated with dependence severity rather than lack of awareness or motivation. These findings highlight the need for integrated hepatology- addiction care approaches addressing both behavioural and biological aspects of alcohol dependence.