Robert Weinrieb, MD: Psychiatry-Hepatology Approach for Alcohol-Related Liver Disease

Last month in an HCPLive special report, Hersh Shroff, MD, MPA, moderated a conversation between hepatology specialist Jay Luther, MD, and addiction specialist Chris Kahler, PhD, to discuss the stigmatization of alcohol use disorder (AUD) and how hepatologists and addiction specialists can work together to enhance patients’ care.

A similar conversation continued the other week at the annual American Psychiatric Association (APA) conference in New York on May 7, presented by Robert Weinrieb, MD, FACLP, professor of psychiatry at the Hospital of the University of Pennsylvania. The session centered around integrating psychiatry into alcohol-associated liver disease clinics and patient outcomes with the cross-disciplinary approach.

Cases of alcohol-associated liver disease have risen 400% since COVID-19. Now patients aged 20 – 40 years are being diagnosed with alcohol-related liver disease, as opposed to patients aged 50 – 60 years as it had been before the pandemic. The mortality rate of the disease is high; if the patient does not receive a transplant, the survival is < 30% within 6 months.

A psychiatry-hepatology approach for treating alcohol-associated liver disease can prevent patients from turning back to drinking. Several clinics with a psychiatry-hepatology approach exist in centers worldwide, including at the University of Michigan, the University of Pennsylvania which has an AALD-Psychiatry clinic model, and in Italy.

“The motivation behind these clinics and working together is partly for the convenience of the patient,” Weinrieb told HCPLive. “A big part of it is that it's difficult for these very sick patients to have to go to so many appointments in so many different places.”

Patients may be reluctant to seek mental health care for their alcohol-associated liver disease. Most patients with alcohol-associated liver disease quit drinking because they get too sick.

For some people with alcohol-associated liver disease, they believe if they quit drinking, they will be cured so they do not want to receive treatment.

“They don't really want to hear that there is a chance that they'll go back to drinking, and it's a pretty high chance,” Weinrieb said. “Because when they hear that they sometimes feel insulted… and it's a complicated conversation.”

At the University of Pennsylvania, Weinrieb and his team created a 12-week program with individual and group counseling to integrate psychiatry treatment in the clinic.

“What makes this unique, and maybe the only 1 in the country, is that it's only for the patients with alcohol-related liver disease,” Weinrieb said. “So they feel so much more comfortable being together with one another and supporting one another.”

The program included motivational enhancement, cognitive behavioral, and trauma-focused therapy. The patients liked the program so much they created their own alumni group.

“Because once the 12 weeks was over, it wasn't enough for them,” he said. “They wanted to be together, they wanted more support. I have never seen this in my entire career.”

References

1. ^{Derman, C. Addressing Stigma to Improve Outcomes in Alcohol-Related Liver Disease. HCPLive. April 30, 2024. https://www.hcplive.com/view/addressing-stigma-to-improve-outcomes-in-alcohol-related-liver-disease. Accessed May 13, 2024.}
2. ^{Weinrieb, R. Integrating Psychiatry into Alcohol-Associated Liver Disease (AALD) Clinics: Enhancing Patient Adherence and Outcomes. Session presented at: American Psychiatric Association (APA) 2024 Annual Meeting. New York, NY. May 7, 2024.}