Concomitant treatment of alcohol associated liver disease and alcohol use disorder in the nontransplant setting: A scoping review

Abstract

Alcohol-associated liver disease (ALD) is a leading cause of liver-related deaths in the United States and worldwide, occurring in persons with alcohol use disorder (AUD). Effective treatment of AUD is essential to curtail the progression of ALD and/or reverse the disease course, yet there is a paucity of information on care models for the concomitant treatment of AUD in persons with ALD, particularly when liver transplant is not imminent or warranted. Here, we reviewed existing literature on care models for the concomitant treatment of ALD and AUD among individuals not undergoing liver transplant evaluation or consideration. A comprehensive search of electronic databases including Cochrane Library, CINAHL, Ovid MEDLINE, Ovid Embase, Scopus, Google Scholar, PubMed, and Web of Science Core Collection from inception to July 2024 was conducted to identify original studies reporting care for both ALD and AUD in persons not undergoing liver transplant evaluation or consideration. From the 1146 publications identified, 43 studies were selected for further review, of which three articles were selected for data charting and inclusion in the review. Concomitant treatment of ALD and AUD were implemented both within inpatient and outpatient settings, with multidisciplinary care teams typically involving hepatology and addiction medicine and/or addiction psychiatry. One study showed that attention and care for AUD led to improvement in liver disease and a decrease in emergency department visits and frequency of hospitalization. The studies reviewed suggest that concomitant care for ALD and AUD in the nontransplant setting may improve outcomes for some patients. The limited number of studies highlights the need for more prospective and longitudinal studies evaluating concomitant treatment, especially in persons for whom liver transplant may not be an option or a consideration.