Linkage and alcohol use outcomes of a screening, brief intervention, and referral to treatment (SBIRT) program for alcohol-related liver disease: A retrospective cohort study from India
Abhishek Ghosh, Nipun Verma, Harsh A. Thappa, Surabhi Gupta, Renjith R. Pillai, Shalini Naik, Arka De, Madhumita Premkumar, BN Subodh, Sunil Taneja, Debasish Basu, Ajay DusejaABSTRACT
Background:
Alcohol-related liver disease (ArLD) and alcohol use disorder remain undertreated. Collaborative care embedding addiction services within medical settings have shown promise.
Aim:
We evaluated the linkage and alcohol use outcomes of an SBIRT-based collaborative care clinic at a public sector hospital in India, examining rates of linkage to addiction treatment, alcohol use outcomes at follow-up, and factors associated with successful linkage.
Methods:
A retrospective cohort study of 500 consecutively enrolled patients was conducted over January 2023–July 2024. Patients with ArLD were systematically screened using the Alcohol Use Disorders Identification Test (AUDIT) and risk-stratified into brief advice, brief counselling, or referral for specialized addiction treatment.
Results:
All patients were male, predominantly rural (53.3%), and travelled a median of 80 km. The mean AUDIT score was 18.0 ± 9.4. The clinic enrolled a mean of 26.3 patients per month; stable throughout. Of 288 patients referred for addiction treatment, 156 (54.4%; 95% CI 48.4–59.8%) were successfully linked, with a median time to first addiction contact of 3 days. At the 3-month follow-up, retention was 26.1%; among those with a recorded alcohol use status, 35.9% were abstinent. On multivariable logistic regression, no patient-level variable was associated with linkage. The sole significant factor was therapist identity (likelihood ratio χ
2
= 22.75, df = 5,
Conclusions:
Collaborative care model is operationally viable within a public sector hepatology department in India. Marked intertherapist variability in linkage rates underscores the need for competency-based training.