Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease: A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group

Gene Y Im; Jessica L Mellinger; Adam Winters; Elizabeth S Aby; Zurabi Lominadze; John Rice; Michael R Lucey; Juan P Arab; Aparna Goel; Loretta L Jophlin; Courtney B Sherman; Richard Parker; Po-Hung Chen; Deepika Devuni; Sandeep Sidhu; Winston Dunn; Gyongyi Szabo; Ashwani K Singal; Vijay H Shah

doi:10.1016/j.cgh.2020.10.026

Provider Attitudes and Practices for Alcohol Screening, Treatment, and Education in Patients With Liver Disease: A Survey From the American Association for the Study of Liver Diseases Alcohol-Associated Liver Disease Special Interest Group

Clin Gastroenterol Hepatol. 2021 Nov;19(11):2407-2416.e8. doi: 10.1016/j.cgh.2020.10.026. Epub 2020 Oct 16.

Authors

Gene Y Im¹, Jessica L Mellinger², Adam Winters³, Elizabeth S Aby⁴, Zurabi Lominadze⁵, John Rice⁶, Michael R Lucey⁶, Juan P Arab⁷, Aparna Goel⁸, Loretta L Jophlin⁹, Courtney B Sherman¹⁰, Richard Parker¹¹, Po-Hung Chen¹², Deepika Devuni¹³, Sandeep Sidhu¹⁴, Winston Dunn¹⁵, Gyongyi Szabo¹⁶, Ashwani K Singal¹⁷, Vijay H Shah⁹

Affiliations

¹ Division of Liver Diseases, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York. Electronic address: [email protected].
² Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan.
³ Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, California.
⁴ Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, Minnesota.
⁵ Division of Gastroenterology, Department of Medicine, University of Maryland, Baltimore, Maryland.
⁶ Division of Gastroenterology and Hepatology, University of Wisconsin School of Medicine, Madison, Wisconsin.
⁷ Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
⁸ Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California.
⁹ Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
¹⁰ Division of Gastroenterology and Hepatology, University of California, San Francisco, San Francisco, California.
¹¹ Leeds Liver Unit, St James's University Hospital, Leeds, United Kingdom.
¹² Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
¹³ Division of Gastroenterology, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts.
¹⁴ Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
¹⁵ Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas.
¹⁶ Division of Gastroenterology and Hepatology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
¹⁷ Division of Gastroenterology and Hepatology, Department of Medicine, Avera McKennan University Hospital Transplant Institute, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

Abstract

Background & aims: While abstinence-promoting behavioral and pharmacotherapies are part of the therapeutic foundation for alcohol use disorder (AUD) and alcohol-associated liver disease (ALD), these therapies, along with alcohol screening and education, are often underutilized. Our aim was to examine provider attitudes and practices for alcohol screening, treatment and education in patients with liver disease.

Methods: We conducted a survey of primarily (89%) hepatology and gastroenterology providers within (80%) and outside the United States (20%). Surveys were sent to 921 providers with 408 complete responses (44%), of whom 343 (80%) work in a tertiary liver transplant center.

Results: While alcohol screening rates in liver disease patients was nearly universal, less than half of providers reported practicing with integrated addiction providers, using alcohol biomarkers and screening tools. Safe alcohol use by liver disease patients was felt to exist by 40% of providers. While 60% of providers reported referring AUD patients for behavioral therapy, 71% never prescribed AUD pharmacotherapy due to low comfort (84%). Most providers (77%) reported low addiction education and 90% desired more during GI/hepatology fellowship training. Amongst prescribers, baclofen was preferred, but with gaps in pharmacotherapy knowledge. Overall, there was low adherence to the 2019 AASLD practice guidance for ALD, although higher in hepatologists and experienced providers.

Conclusions: While our survey of hepatology and gastroenterology providers demonstrated higher rates of alcohol screening and referrals for behavioral therapy, we found low rates of prescribing AUD pharmacotherapy due to knowledge gaps from insufficient education. Further studies are needed to assess interventions to improve provider alignment with best practices for treating patients with AUD and ALD.

Keywords: Addiction Medicine; Alcohol Pharmacotherapy; Alcohol Survey; Alcohol Use Disorder; Alcohol-Associated Liver Disease.

MeSH terms

Alcoholism* / complications
Alcoholism* / diagnosis
Alcoholism* / therapy
Attitude
Humans
Liver Diseases*
Public Opinion
Surveys and Questionnaires
United States

Grants and funding

K23 AA028297/AA/NIAAA NIH HHS/United States