The role of brief intervention in achieving and maintaining abstinence in patients with alcoholic liver disease

Objective of the study. prove the effectiveness of brief psychological intervention (BPI) conducted by an internist in achieving and maintaining abstinence in patients with alcoholic liver disease (ALD).

Materials and methods. A total of 65 patients were included in the study: 29 patients in the BPI group and 36 in the historical control group. A comparative analysis of the frequency of achievement and maintenance of abstinence and analysis of factors associated with these parameters were conducted.

Results of the study. The frequency of achieving abstinence was significantly higher in the BPI group compared with the control group after 6, 9, 12 and 24 months from the date of inclusion in the study (p <0.001, p = 0.002, p = 0.001, p = 0.017, respectively; criterion χ2). The frequency of failures to achieve abstinence in the CPC group was significantly lower than in the control group after 6 months and in general for the entire observation period (p = 0.004, p = 0.005, respectively; criterion χ2). Provision of BPIs for 12 months after alcohol-induced decompensation serves as a factor that is reliably associated with achieving total abstinence within 24 months (p = 0.001, criterion χ2). Decompensated cirrhosis of the liver serves as factors independently associated with failures to achieve abstinence within 24 months after alcohol-induced illness (OS: 10.72 [95% CI 2.17–52.81]; p = 0.004) and the absence of BPI after discharge from the hospital (OSH BPI: 0.80 [95% CI 0.14–0.479]; p = 0.006)

Conclusion. BPIs provided by an internist to the patients with ABD for 12 months after alcohol-induced decompensation leads to a higher rate of achieving total abstinence and decrease in the frequency of failures to achieve abstinence within 24 months after discharge from the hospital.

1. Ивашкин В.Т., Маевская М.В., Павлов Ч.С., Сиволап Ю.П., Луньков В.Д., Жаркова М.С., Масленников Р.В. Клинические рекомендации Российского общества по изучению печени по ведению взрослых пациентов с алкогольной болезнью печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2017;27(6):20–40. Режим доступа: https://www.

2. gastro-j.ru/jour/article/view/190/164. Ivashkin V.T., Mayevskaya M.V., Pavlov C.S., Sivolap Y.P., Lunkov V.D., Zharkova M.S., Maslennikov R.V. Management of adult patients with alcoholic liver disease: clinical guidelines of the Russian Scientific Liver Society. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian Journal of Gastroenterology, Hepatology, Сoloproctology. 2017;27(6):20–40. (In Russ.) Available at: https://www.gastro-j.ru/jour/article/view/190/164.

3. Louvet A., Labreuche J., Artru F., Bouthors A., Rolland B., Saffers P., et al. Main drivers of outcome differ between short term and long term in severe alcoholic hepatitis: A prospective study. Hepatology. 2017;66(5):1464–1473. doi: 10.1002/hep.29240.

4. Fitzgerald N., Molloy H., MacDonald F., McCambridge J. Alcohol brief interventions practice following training for multidisciplinary health and social care teams: a qualitative interview study. Drug Alcohol Rev. 2015;34(2):185–193. doi: 10.1111/dar.12193.

5. Crabb D., Bataller R., Chalasani N.P, Kamath P.S., Lucey M., Mathurin P., et al. Standard Definitions and Common Data Elements for Clinical Trials in Patients With Alcoholic Hepatitis: Recommendation From the NIAAA Alcoholic Hepatitis Consortia. Gastroenterology. 2016;150(4):785–790. doi: 10.1053/j.gastro.2016.02.042.

6. Khan A., Tansel A., White D.L., Kayani W.T., Bano S., Lindsay J., et al. Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients with Chronic Liver Disease: A Systematic Review. Clinical gastroenterology and hepatology. 2016;14(2):191–202.e4. doi: 10.1016/j.cgh.2015.07.047.

7. Маевская М.В., Бакулин И.Г., Чирков А.А., Люсина Е.О, Луньков В.Д. Злоупотребление алкоголем среди пациентов гастроэнтероло- гического профиля. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016;26(4):24–35. Режим доступа: https://www.gastro-j.ru/jour/article/view/69. Mayevskaya M.V., Bakulin I.G., Chirkov A.A., Lyusina Y.O, Lun’kov V.D. Alcohol abuse in gastroenterological patients. Rossiyskiy zhurnal gastroehnterologii, gepatologii, koloproktologii = Russian journal of Gastroenterology, Hepatology, Сoloproctology. 2016;26(4):24–35 (In Russ.) Available at: https://www.gastro-j.ru/jour/article/view/69.

8. Kaner E.F.S., Beyer F.R., Muirhead C., Campbell F., Pienaar E.D., Bertholet N., et al. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews. 2018. doi: 10.1002/14651858.CD004148.pub4.

9. Sassi F. (ed.) Tackling Harmful Alcohol Use: Economics and Public Health Policy. OECD report. 2015. 236 p. DOI: 10.1787/9789264181069-en.

10. Shield K.D., Rylett M., Rehm J. Public health successes and missed opportunities Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990–2014. Available at: http://www.euro.who.int/__data/assets/pdf_file/0018/319122/Public-healthsuccesses-and-missed-opportunities-alcoholmortality-19902014.pdf.

11. Dew M.A., Dimartini A.F., Steel J., De Vito Dabbs A., Myaskovsky L., Unruh M., Greenhouse J. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl. 2008;14(2):159–172. doi: 10.1002/lt.21278.

12. Weinrieb R.M., Van Horn D.H., Lynch K.G., Lucey M.R. A randomized, controlled study of treatment for alcohol dependence in patients awaiting liver transplantation. Liver Transpl. 2011;17(5):539–547. doi: 10.1002/lt.22259.

13. Addolorato G., Mirijello A., Barrio P., Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J. Hepatol. 2016;65(3):618–630. doi: 10.1016/j.jhep.2016.04.029.

14. Addolorato G., Mirijello A., Leggio L., Ferrulli A., D’Angelo C., Vassallo G., et al. Liver transplantation in alcoholic patients: impact of an alcohol addiction unit within a liver transplant center. Alcohol Clin Exp Res. 2013;37(9):1601–1608. doi: 10.1111/acer.12117.