Reducing alcohol-associated liver disease burden in the general population

Abstract

The prevalence of alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) is rising. The National Institute on Alcohol Abuse and Alcoholism organised a multistakeholder workshop focused on reducing the burden of ALD. Decreasing ALD morbidity and mortality requires a multipronged approach, including increased population-based screening for AUD, early recognition of ALD, and multidisciplinary treatment. Recommended screening tools for alcohol use include the alcohol use disorders identification test for consumption (AUDIT-C). In patients with elevated AUDIT-C scores (AUDIT-C score of ≥3 points in women, ≥4 points in men), screening for fibrosis is recommended using non-invasive blood-based tests, such as the Fibrosis-4 index. Sequential testing using blood-based and imaging-based non-invasive liver disease assessment is preferred to blood-based tests alone to increase the positive predictive value of referral pathways. Screening, brief intervention, and referral to treatment are effective for reducing unhealthy alcohol use among adults who are not alcohol dependent. Integrated care models that incorporate mental health treatment into general medical settings are crucial for AUD and ALD. Emerging care models, such as multidisciplinary ALD clinics and substance use navigators, can improve patient engagement and outcomes. Markers of success include a reduction in per capita alcohol consumption, declines in morbidity and mortality related to AUD and ALD, and a decrease in health-care costs.