A randomized controlled trial of stepped treatment to reduce unhealthy alcohol use in patients with chronic liver disease.

BACKGROUND 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 3 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 followback), were enrolled at a safety-net and 2 Veterans Affairs hepatology clinics from March 1, 2022, to February 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) and were 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 with UC, SAT had no difference in percentage of alcohol use below moderate level (primary outcome) but had a greater reduction in drinks/week from baseline to month 3 (estimate -0.66, p =0.03) and month 6 (estimate -0.67, p =0.03) (secondary outcome). The 6-month effect of SAT (vs. UC) on alcohol use reduction remained significant ( p =0.02), controlling for covariates. At month 6, 30-day abstinence rates were 29% for SAT and 18% for UC ( p =0.14). Baseline motivation to reduce alcohol use was positively associated with treatment response.

CONCLUSIONS

SAT was not superior on the primary outcome, yet reduced alcohol use more than UC at 6 months in this difficult-to-engage population and may be valuable in hepatology.