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Haque LY, Leggio L. Integrated and collaborative care across the spectrum of alcohol-associated liver disease and alcohol use disorder. Hepatology 2024:01515467-990000000-00939. [PMID: 38935926 DOI: 10.1097/hep.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
The public health impact of alcohol-associated liver disease (ALD), a serious consequence of problematic alcohol use, and alcohol use disorder (AUD) is growing, with ALD becoming a major cause of alcohol-associated death overall and the leading indication for liver transplantation in the United States. Comprehensive care for ALD often requires treatment of AUD. Although there is a growing body of evidence showing that AUD treatment is associated with reductions in liver-related morbidity and mortality, only a minority of patients with ALD and AUD receive this care. Integrated and collaborative models that streamline both ALD and AUD care for patients with ALD and AUD are promising approaches to bridge this treatment gap and rely on multidisciplinary and interprofessional teams and partnerships. Here, we review the role of AUD care in ALD treatment, the effects of AUD treatment on liver-related outcomes, the impact of comorbid conditions such as other substance use disorders, obesity, and metabolic syndrome, and the current landscape of integrated and collaborative care for ALD and AUD in various treatment settings. We further review knowledge gaps and unmet needs that remain, including the role of precision medicine, the application of harm reduction approaches, the impact of health disparities, and the need for additional AUD treatment options, as well as further efforts to support implementation and dissemination.
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Affiliation(s)
- Lamia Y Haque
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Baltimore and Bethesda, Maryland, USA
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, Rhode Island, USA
- Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Neuroscience, Georgetown University Medical Center, Washington, District of Columbia, USA
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2
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Verma M, Desai AP. The role of patient-reported outcomes in a patient-centered care model for managing chronic liver diseases. Clin Liver Dis (Hoboken) 2024; 23:e0222. [PMID: 38881726 PMCID: PMC11177829 DOI: 10.1097/cld.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 04/15/2024] [Indexed: 06/18/2024] Open
Affiliation(s)
- Manisha Verma
- Department of Medicine, Jefferson Einstein Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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3
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Manfready RA, Rzepczynski A, Janardhan SV. Which patient should be prioritized for liver transplant: NAFLD? Clin Liver Dis (Hoboken) 2024; 23:e0163. [PMID: 38860126 PMCID: PMC11164004 DOI: 10.1097/cld.0000000000000163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/27/2024] [Indexed: 06/12/2024] Open
Affiliation(s)
- Richard A. Manfready
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Allison Rzepczynski
- Department of Internal Medicine, Division of Digestive Diseases and Nutrition, Rush University Medical Center, Chicago, Illinois, USA
| | - Sujit V. Janardhan
- Department of Internal Medicine, Section of Hepatology, Rush University Medical Center, Chicago, Illinois, USA
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4
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Fatakhova K, Patel P, Inayat F, Dhillon R, Ali H, Taj S, Nawaz G, Afzal A, Rehman AU, Afzal MS, Khan R, Ishtiaq R, Jones L, Rajapakse R. Trends in hospital admissions and mortality among inflammatory bowel disease patients with substance use disorder: a 10-year United States nationwide analysis. Proc AMIA Symp 2023; 36:427-433. [PMID: 37334096 PMCID: PMC10269429 DOI: 10.1080/08998280.2023.2204535] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/30/2023] [Accepted: 04/04/2023] [Indexed: 06/20/2023] Open
Abstract
Background Patients with inflammatory bowel disease (IBD) and substance use disorder (SUD) may have worse clinical outcomes. However, data specific to the hospital admission and mortality rates among IBD patients with SUD are scarce. Our objective was to assess trends in admission, healthcare expenses, and mortality for IBD patients with SUD. Methods We conducted a retrospective study using the National Inpatient Sample database to analyze SUD (alcohol, opioids, cocaine, and cannabis) among IBD hospitalizations from 2009 to 2019. Results A total of 132,894 hospitalizations for IBD had a secondary diagnosis of SUD. Of these patients, 75,172 (57%) were men and 57,696 (43%) were women. The IBD-SUD cohort had a longer length of stay than the non-SUD cohort (P < 0.001). The mean inpatient charges for IBD hospitalizations with SUD increased from $48,699 ± $1374 in 2009 to $62,672 ± $1528 in 2019 (P < 0.001). We found a 159.5% increase in IBD hospitalizations with SUD. The hospitalization rate increased from 3492 per 100,000 IBD hospitalizations in 2009 to 9063 per 100,000 in 2019 (P < 0.001). In-hospital mortality for IBD hospitalizations with SUD increased by 129.6% (from 250 deaths per 100,000 IBD hospitalizations in 2009 to 574 deaths per 100,000 IBD hospitalizations in 2019) (P < 0.001). Conclusions Over the last decade, there has been a rise in IBD hospitalizations with SUD. This has resulted in a longer length of stay, higher inpatient charges, and higher mortality rates. Identifying IBD patients potentially at risk for SUD by screening for anxiety, depression, pain, or other factors has become crucial.
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Affiliation(s)
- Karina Fatakhova
- Department of Gastroenterology, Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, New York
| | - Pratik Patel
- Department of Gastroenterology, Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, New York
| | - Faisal Inayat
- Department of Medicine, Allama Iqbal Medical College, Lahore, Punjab, Pakistan
| | - Rubaid Dhillon
- Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Hassam Ali
- Department of Internal Medicine, East Carolina University Brody School of Medicine, Greenville, North Carolina
| | - Sobaan Taj
- Department of Internal Medicine, Hackensack Meridian Jersey Shore University Medical Center, Neptune, New Jersey
| | - Gul Nawaz
- Department of Internal Medicine, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Arslan Afzal
- Department of Internal Medicine, Woodhull Medical Center, Brooklyn, New York
| | - Attiq Ur Rehman
- Department of Hepatology, Mercy Medical Center, Baltimore, Maryland
| | | | - Rafeh Khan
- Department of Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, Punjab, Pakistan
| | - Rizwan Ishtiaq
- Department of Internal Medicine, Saint Francis Hospital and Medical Center, Hartford, Connecticut
| | - Lindsey Jones
- Department of Internal Medicine, Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, New York
| | - Ramona Rajapakse
- Department of Gastroenterology, Mather Hospital and Hofstra University Zucker School of Medicine, Port Jefferson, New York
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5
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Murthy P, Shadakshari D, Mahadevan J, Chand PK. Management of Alcohol Use Disorder in Patients With Alcoholic Liver Disease. J Clin Exp Hepatol 2022; 12:1514-1526. [PMID: 36340303 PMCID: PMC9630026 DOI: 10.1016/j.jceh.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/10/2022] [Indexed: 12/12/2022] Open
Abstract
Alcohol use disorder (AUD) is a common condition that develops on the background of heavy alcohol use and is characterised by the loss of control over alcohol use and a compulsion to use alcohol, often despite negative consequences. AUD is a leading cause for the resumption of alcohol use in patients with alcoholic liver disease (ALD) after treatment. Hence it is essential to screen all patients with ALD for the presence of AUD. Screening tools such as alcohol use disorders identification test (AUDIT) and AUDIT-C are used, following which the diagnosis and severity of AUD are determined using DSM-5 criteria. The management of AUD in patients with ALD is best carried out using an integrated approach involving psychiatrists and gastroenterologists/hepatologists. The treatment most often involves a combination of pharmacotherapy and psychosocial interventions which try to achieve and maintain abstinence. Although, there is limited evidence, Baclofen is the first line pharmacological agent for long-term management of AUD in patients with ALD. Intensive psychological interventions such as motivation enhancement therapy and cognitive behavioural therapy are also seen to be beneficial. Treatment retention and follow-up are vital and can positively influence outcomes.
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Key Words
- AA, Alcoholics Anonymous
- ALD, Alcoholic Liver Disease
- AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid
- AUD, Alcohol Use Disorder
- AUDIT – C, Alcohol Use Disorder Identification Test – Consumption
- AUDIT, Alcohol Use Disorder Identification Test
- CBT, Cognitive Behavioural Therapy
- CDT, Carbohydrate Deficient Transferrin
- CIWA – Ar, Clinical Institute Withdrawal Assessment for Alcohol Revised
- DALY, Disability Adjusted Life Years
- EtG, Ethyl glucuronide
- EtS, Ethyl Sulphate
- FAEE, Fatty acid ethyl ester
- FDA, Food and Drug Administration
- GABA, Gamma-Aminobutyric acid
- GGT, Gamma glutamyl transferase
- HCV, Hepatitis C Virus
- HE, Hepatic Encephalopathy
- LT, Liver Transplantation
- MCV, Mean corpuscular volume
- MET, Motivation Enhancement Therapy
- MI, Motivational Interviewing
- NMDA, N-Methyl-d-aspartate
- PEth, Phosphatidylethanol
- RCT, Randomised control trial
- SMS, Short Message Service
- alcohol use disorder
- alcoholic liver disease
- diagnosis
- pharmacotherapy
- psychotherapy
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Affiliation(s)
- Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Darshan Shadakshari
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jayant Mahadevan
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Prabhat Kumar Chand
- Centre for Addiction Medicine, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Whitsett MP, Goswami Banerjee A, Serper M. Assessment of mental health in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2022; 20:52-56. [PMID: 36033429 PMCID: PMC9405502 DOI: 10.1002/cld.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
| | | | - Marina Serper
- Gastroenterology and HepatologyUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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7
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Verma M, Winder GS. Treatment of substance use disorders in patients with chronic liver disease. Clin Liver Dis (Hoboken) 2022; 20:66-71. [PMID: 36033425 PMCID: PMC9405498 DOI: 10.1002/cld.1248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 06/11/2022] [Accepted: 06/19/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Manisha Verma
- Department of MedicineEinstein Healthcare NetworkPhiladelphiaPennsylvaniaUSA
| | - Gerald Scott Winder
- Departments of Psychiatry, Surgery, and NeurologyUniversity of MichiganAnn ArborMichiganUSA
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Shenoy A, Salajegheh A, Shen NT. Multimodal multidisciplinary management of alcohol use disorder in liver transplant candidates and recipients. Transl Gastroenterol Hepatol 2022; 7:28. [PMID: 35892051 PMCID: PMC9257538 DOI: 10.21037/tgh.2020.02.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/06/2019] [Indexed: 08/01/2023] Open
Abstract
Alcohol-related liver disease (ALD) is the most common indication for liver transplantation (LT) in the United States. The judicious allocation of organs and improvement in outcomes requires identification and monitoring of patients with ALD at high-risk for relapse post-transplantation. The controversial movement toward early LT for severe alcohol-related hepatitis (SAH) has also raised concern for alcohol relapse. While LT cures ALD, treatment of alcohol use disorder (AUD) must be included in the care plan to prevent a return to drinking and subsequent graft ALD. Patients with underlying AUD must be recognized, offered brief interventions and referred for multimodal multidisciplinary treatment that includes medications and psychotherapies along with sober support groups, family engagement, and a new dedication to healthy living in order to help sustain remission. Such comprehensive care will increase LT candidacy in patients with ALD while optimizing clinical outcomes of patients transplanted with AUD.
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Affiliation(s)
- Akhil Shenoy
- Director of Transplant Psychiatry, Assistant Professor, Columbia University Medical Center, Psychiatric Liaison to the Center for Liver Disease and Transplantation, New York-Presbyterian Hospital-Columbia, New York, NY, USA
| | - Anna Salajegheh
- Assistant Professor, Weill Cornell Psychiatry, Psychiatric Liaison to the Center for Liver Disease and Transplantation, New York-Presbyterian Hospital-Cornell, New York, NY, USA
| | - Nicole T. Shen
- Weill Cornell Medicine, Division of Clinical Epidemiology and Evaluative Sciences Research, Fellow, Transplant Hepatology, New York-Presbyterian Hospitals-Columbia and Cornell, New York, NY, USA
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Ufere NN, Hinson J, Finnigan S, Powell EE, Donlan J, Martin C, Clark P, Valery PC. The Impact of Social Workers in Cirrhosis Care: a Systematic Review. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:160-176. [PMID: 35676928 PMCID: PMC9167183 DOI: 10.1007/s11938-022-00381-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/23/2023]
Abstract
Purpose of review To report social workers' involvement in supporting patients with cirrhosis. Recent findings Six intervention studies (three published in the past 3 years) highlighed the potential role of social worker-led interventions to improve the outcomes of patients with cirrhosis. In studies of patients with alcohol-related liver disease (n = 4), social workers conducted psychosocial assessments, screened for substance use disorder and psychological distress, coordinated referrals to addiction services, and provided relapse prevention therapy. In studies including transplant recipients or candidates (n = 2), social workers focused on psychosocial interventions. In two studies (n = 1 patient with alcohol-related liver disease; n = 1 transplant recipients), social workers provided practical support (e.g., housing, transportation). Most articles provided limited information about the intervention and the role of the social worker, making comparisons of the studies difficult. Summary More high-quality evidence is needed to formally assess the impact of social workers in improving the outcomes of patients with cirrhosis. Supplementary Information The online version contains supplementary material available at 10.1007/s11938-022-00381-2.
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Affiliation(s)
- Nneka N Ufere
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Jan Hinson
- Faculty of Health Sciences, School of Allied Health, Social Work Discipline, Australian Catholic University, Brisbane Campus (McAuley), 1100 Nudgee Road, Banyo, QLD 4014 Australia
| | - Simon Finnigan
- Centre for Functioning and Health Research, Metro South Health, Level 3, Buranda Village, Buranda, QLD 4102 Australia.,Department of Social Work, Princess Alexandra Hospital, 199 Ipswish Road, Woolloongabba, QLD 4102 Australia.,UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4029 Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswish Road, Woolloongabba, QLD 4102 Australia
| | - John Donlan
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Cathy Martin
- Queensland Liver Transplant Service, Princess Alexandra Hospital, 199 Ipswish Road, Woolloongabba, QLD 4102 Australia
| | - Phil Clark
- Faculty of Health Sciences, School of Allied Health, Social Work Discipline, Australian Catholic University, Brisbane Campus (McAuley), 1100 Nudgee Road, Banyo, QLD 4014 Australia
| | - Patricia C Valery
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006 Australia
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10
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Holmes R, Patel A, Desai AP. Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease. Clin Liver Dis (Hoboken) 2022; 20:32-37. [PMID: 36033426 PMCID: PMC9405520 DOI: 10.1002/cld.1204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Content available: Audio Recording.
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Affiliation(s)
- Rachel Holmes
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIN
| | - Anahli Patel
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIN
| | - Archita P. Desai
- Division of Gastroenterology and HepatologyIndiana University School of MedicineIndianapolisIN
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Desai AP, Greene M, Nephew LD, Orman ES, Ghabril M, Chalasani N, Menachemi N. Contemporary Trends in Hospitalizations for Comorbid Chronic Liver Disease and Substance Use Disorders. Clin Transl Gastroenterol 2021; 12:e00372. [PMID: 34142663 PMCID: PMC8216677 DOI: 10.14309/ctg.0000000000000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/28/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Chronic liver diseases (CLDs) and substance use disorders (SUDs) are increasingly prevalent and often coexist. Contemporary studies describing the characteristics and hospitalization trends of those with comorbid CLD-SUD are lacking. We aimed to characterize a population-based cohort with comorbid CLD-SUD and describe trends in these hospitalizations over time by individual-level characteristics. METHODS We performed a cross-sectional analysis of the National Inpatient Sample from 2005 through 2017. Diagnosis codes were used to identify adult hospitalizations with CLD, SUD, or both. Bivariate and multivariate analyses were used to make comparisons between diagnosis categories. Unadjusted and age-adjusted trends in these hospitalizations were described over time. RESULTS Of 401,867,749 adult hospital discharges, 3.2% had CLD-only and 1.7% had comorbid CLD-SUD. Compared with CLD-only, comorbid CLD-SUD hospitalizations resulted in higher inpatient mortality (3.1% vs 2.4%, P < 0.001) and were associated with younger age, male sex, Native American race, and urban and Western US location. Over time, comorbid hospitalizations grew 34%, and the demographics shifted with larger increases in hospitalization rates seen in younger individuals, women, Native Americans, and those publicly insured. In comorbid hospitalizations, alcoholic SUD and CLD decreased, but drug SUDs and nonalcoholic fatty liver diseases are fast-growing contributors. DISCUSSION In this comprehensive analysis of US hospitalizations, comorbid CLD-SUD hospitalizations are increasing over time and lead to higher inpatient mortality than CLD alone. We further characterize the changing demographics of these hospitalizations, providing a contemporary yet inclusive look at comorbid CLD-SUD hospitalizations. These data can guide interventions needed to improve the poor outcomes suffered by this growing population.
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Affiliation(s)
- Archita P. Desai
- Department of Gastroenterology and Hepatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Marion Greene
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Lauren D. Nephew
- Department of Gastroenterology and Hepatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Eric S. Orman
- Department of Gastroenterology and Hepatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Marwan Ghabril
- Department of Gastroenterology and Hepatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Naga Chalasani
- Department of Gastroenterology and Hepatology, School of Medicine, Indiana University, Indianapolis, Indiana, USA
| | - Nir Menachemi
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
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12
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Verma M, Younossi Z. Integrating Patient-Reported Outcomes Within Routine Hepatology Care: A Prompt to Action. Hepatology 2021; 73:1570-1580. [PMID: 32918286 DOI: 10.1002/hep.31550] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Manisha Verma
- Department of Digestive Diseases and Transplantation, Einstein Healthcare Network, Philadelphia, PA
| | - Zobair Younossi
- Department of Medicine, Inova Fairfax Medical Campus, Falls Church, VA
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