State of the Evidence for Psychosocial Interventions Among People With Alcohol Use Disorder and Liver Disease

Researchers summarized the current evidence for the efficacy of psychosocial interventions to reduce alcohol use among people with alcohol use disorder (AUD) and alcohol-related liver disease. The authors conducted a systematic review of randomized trials of interventions with the primary outcome of reduced alcohol consumption or abstinence at the longest available follow-up.

• Ten trials were included, with a total of 1519 participants. The studies were conducted between 1990 and 2020; eight were in the US, one in Australia, and one in China. Follow-up varied between eight and 24 months. Reduction in alcohol consumption was the primary outcome in four trials; abstinence was the primary outcome in six.
• The interventions studied were cognitive behavioral therapy (CBT), motivational enhancement therapy (MET), motivational interviewing (MI), brief intervention/brief advice (BI/BA), and peer support. Four studies combined more than one intervention (BI and MI, MI and MET, or CBT and MET). The number of sessions varied from one to 36.
• Five studies reported on reductions in alcohol consumption. The interventions were: MET, MET/MI, and MI/BI. A significant effect was observed in one study (one of the two studies that assessed MET efficacy).
• Abstinence was reported in six studies. A significant effect was shown in three studies (MET, peer support [Alcoholics Anonymous], and MET/CBT).
• The overall level of certainty of evidence was assessed as moderate, with some studies presenting a high risk of bias and methodological limitations.

Comments: The current evidence for effective interventions for alcohol reduction or cessation among people with AUD and liver disease is limited. These results indicate that MET and integrated interventions have potential. Future research is needed to refine which treatment modalities are most appropriate to address alcohol consumption in people with AUD and liver disease, especially since these patients are often excluded from clinical trials of interventions due to comorbidities and/or their pharmacological profiles.

Nicolas Bertholet, MD, MSc

Reference: Hemrage S, Brobbin E, Deluca P, Drummond C. Efficacy of psychosocial interventions to reduce alcohol use in comorbid alcohol use disorder and alcohol-related liver disease: a systematic review of randomized controlled trials. Alcohol Alcohol. 2023;58(5):478–484.