Psychosocial therapy improves outcomes for alcohol use disorder in people with chronic liver disease: A systematic review and meta-analysis.

BACKGROUND

Psychosocial interventions are effective for alcohol use disorder (AUD), but their impact on patients with chronic liver disease and AUD remains unclear. This systematic review and meta-analysis evaluated the effectiveness of psychosocial therapies in preventing return-to-drinking and promoting abstinence among this population.

METHODS AND

RESULTS

The protocol (CRD42024527757) was registered in Prospero. We included studies involving adults (≥18 y) with chronic liver disease and AUD or harmful alcohol use receiving psychosocial interventions. Databases searched were PubMed, Embase, Cochrane CENTRAL, and APA PsycInfo. Outcomes assessed were return-to-drinking and abstinence. Risk of bias was evaluated using RoB2 for randomized controlled trials (RCTs) and ROBINS-I for non-RCTs. Meta-analysis was performed using random effects (Knap-Hartung adjustment) and fixed effects (inverse variance) models. Funding was provided by the intramural research program at the National Institute of Diabetes and Digestive and Kidney Diseases. Of 2240 studies reviewed, 20 met the inclusion criteria. Meta-analysis of 7 non-RCTs (n=767) demonstrated a 48% reduction in return-to-drinking risk (relative risk [RR]=0.52, 95% CI: 0.28-0.99, p=0.048) with significant heterogeneity (I2=74%; p=0.006). Subgroup analyses showed greater return-to-drinking reduction in multidisciplinary care (RR=0.40, 95% CI: 0.31-0.52) and recipients of liver transplant (RR=0.40, 95% CI: 0.27-0.58). Four RCTs found no significant return-to-drinking reduction (RR=0.99, 95% CI: 0.45-2.16, p=0.96). Abstinence was not significantly improved in either RCTs or non-RCTs, with moderate- to low-quality evidence.

CONCLUSIONS

Psychosocial therapy reduces return-to-drinking risk in chronic liver disease with AUD, particularly within multidisciplinary teams or transplant populations, but findings are tempered by scarce RCT evidence. Future RCTs should evaluate multidisciplinary interventions in transplant populations.