A randomized controlled trial of stepped treatment to reduce unhealthy alcohol use in patients with chronic liver disease
Derek D. Satre, Leila Taj, Robert J. Wong, Hannah R. Snyder, Ramsey Cheung, William Hua, Alexander Monto, Steven L. Batki, Michael J. Ostacher, Priti Parekh, Amy M. Shui, Taylor Fakadej, Jennifer Y. Chen, Michele Tana, Meimei Liao, Christina G. Haight, Mandana KhaliliBackground and Aims:
Unhealthy alcohol use is prevalent in chronic liver disease (CLD). This randomized controlled trial evaluated the efficacy of telehealth stepped alcohol treatment (SAT) in three healthcare systems.
Approach and Results:
Participants (N=157) with CLD and unhealthy alcohol use (>7 drinks/week or ≥4/day for women; >14/week or ≥5/day for men; or heavy episodic drinking, using timeline follow back), were enrolled at a safety-net and 2 Veterans Affairs hepatology clinics from 3/1/2022-2/28/2024. Participants were randomized to SAT (N=81; Step 1: three motivational interviewing sessions, Step 2: addiction medicine referral if no drinking reduction at month 3) or usual care (UC; N=76); evaluated at months 3 and 6. Alcohol use reduction was analyzed using bivariate tests and multivariable modeling. Baseline characteristics were: median age 61, 86% male, 48% with cirrhosis (37% decompensation), and 78% with alcohol use disorder. Compared to UC, SAT had no difference in percentage of alcohol use below moderate level (primary outcome) but had greater reduction in drinks/week from baseline to month 3 (estimate -0.66,
Conclusions:
SAT was not superior on the primary outcome, yet reduced alcohol use more than UC at six months in this difficult-to-engage population and may be valuable in hepatology.