Study Highlights Traits of Patients with Alcohol-Associated Cirrhosis Seeking Treatment

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Individuals with alcohol-associated cirrhosis who have anxiety/depression and are younger are more likely to implement alcohol use disorder (AUD) treatment, new findings suggest.¹

These data also suggest that implementing targeted outreach and the integration of alcohol-associated liver disease (ALD) and AUD may be necessary. Jeremy W. Luk, from the office of the clinical director at the National Institute on Alcohol Abuse and Alcoholism in Maryland, led the analysis that resulted in these findings.

Luk and colleagues noted the importance of identifying and treating AUD among those who have ALD, highlighting recent research into ALD suggesting that prior history of treatment, younger age, and co-occurring depression or AUD may be linked with AUD treatment utilization.^2,3 However, such findings are not helpful for understanding the role of quality of life in the process of AUD recovery.

“Addressing this gap, we aim to examine patient demographic and clinical factors, as well as liver disease quality of life, in relation to patient-reported utilization of lifetime and past 12-month pharmacological and behavioral AUD treatment among socioeconomically disadvantaged patients with alcohol-associated cirrhosis,” Luk and colleagues wrote.¹

Trial Design Details

The research team enrolled individuals who had cirrhosis receiving care at hepatology specialty clinics of 3 academic medical centers. These included 2 Veterans Affairs (VA) facilities as well as a public safety-net hospital between February 2022 - February 2023.

Criteria for inclusion in their research were being aged 18 years or older, having a clinical diagnosis of cirrhosis, being mainly English- or Spanish-speaking for survey administration, and at least a single hepatology clinic visit within the prior half-year period.

During participants' enrollment period, none were noted as having presented with acute alcohol-induced hepatitis. The study subjects filled out a 1-time interviewer-administered questionnaire, including inquiries about liver disease quality of life (LDQoL), the Alcohol Use Disorders Identification Test (AUDIT), demographic data, self-reported mental health symptoms, and history of AUD treatment utilization.

Subjects' clinical measures, some of which included liver disease severity, were captured from their medical records. The research team standardized their procedures across the 3 medical sites through the use of standard operating procedures.

Notable Findings

There were a total of 196 subjects, with 88% being male and a mean age of 62 years. The investigative team noted that 67% had reported ever implementing AUD treatment and also noted that 32% had reported using AUD treatment within the prior 12 months.

Compared with those who did not utilize AUD treatment, participants who utilized lifetime or past 12-month AUD treatment were younger, had lower LDQoL scores, and had higher scores on current symptoms of anxiety, depression, and problematic drinking.

Following the team's multivariable analyses, it was reported that there were lower odds of ever using pharmacological treatment alone or both behavioral and pharmacological practices (compared to none) with higher LDQoL or older age.

Odds were found to be higher among individuals with a history of anxiety/depressive disorder. In terms of prior 12-month treatment use, the researchers highlighted that odds were lower with those of older age, and higher among subjects currently reporting clinically significant anxiety/depression or reporting drinking habits labeled as problematic.

“These findings underscore the importance of using validated assessment tools like GAD-7, PHQ-8, and AUDIT to screen for symptoms of anxiety and depression, as well as problematic drinking,” they wrote. “Integrating these assessments into hepatology practices can facilitate tailored interventions and referrals to behavioral health and AUD treatment services.”¹

References

1. ^{Luk, J.W., Ha, N.B., Shui, A.M., Snyder, H.R., Batki, S.L., Ostacher, M.J. et al. (2024) Demographic and clinical characteristics associated with utilization of alcohol use disorder treatment in a multicenter study of patients with alcohol-associated cirrhosis. Alcohol: Clinical and Experimental Research, 00, 1–12. Available from: https://doi.org/10.1111/acer.15500.}
2. ^{Thompson, M.F., Schwandt, M.L., Ramchandani, V.A., Diazgranados, N., Goldman, D. & Luk, J.W. (2024) Stress and alcohol-related coping mechanisms linking lifetime suicide ideation and attempt to multidimensional quality of life. Journal of Affective Disorders, 351, 729–737. Available from: https://doi.org/10.1016/j.jad.2024.01.209.}
3. ^{Luk, J.W., Ramchandani, V.A., Diazgranados, N., Schwandt, M.L., Gunawan, T., George, D.T. et al. (2022) Multidimensional quality of life across the Spectrum of alcohol use behavior. Psychiatric Research and Clinical Practice, 4(4), 92–101. Available from: https://doi.org/10.1176/appi.prcp.20220023.}