Diagnosis and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and Shadows
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REVIEW
Diagnosis and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and Shadows Giovanni Addolorato 1,2 & Gabriele A. Vassallo 1,3 & Antonio Mirijello 1,4 & Antonio Gasbarrini 2,5
# The American Society for Experimental NeuroTherapeutics, Inc. 2019
Abstract Alcohol use disorder is the most common cause of advanced liver disease in the Western world. Diagnosis of alcohol use disorder can be difficult because patients with liver disease tend to deny alcohol intake for the fear of being excluded from treatment and because available biomarkers of alcohol intake have poor specificity in these patients. Alcohol abstinence is the cornerstone of the therapy in these patients. However, pharmacological treatments for alcohol use disorders have not been formally tested in patients with advanced liver disease, except for baclofen. Psychosocial intervention became crucial in these patients considering the limited pharmacological choice. However, psychosocial approach and an appropriate team to manage these patients are not still well defined. In this review, we critically discuss the diagnosis and the management of alcohol use disorder in patients with liver disease. Key Words Alcohol use disorder . alcoholic liver disease . alcoholic cirrhosis . anti-craving drugs . psychosocial approach . liver transplantation
Abbreviations AUD Alcohol use disorder ALD Alcohol-related liver disease AWS Alcohol withdrawal syndrome
LD RCTs
Key Points • Alcohol use disorder is the most common cause of liver disease in the Western world. • AUDIT and CAGE are useful tools to screen alcohol use disorder, although diagnosis is made when DSM-V criteria are fulfilled. • Biological markers can help physicians to detect and monitor alcohol intake. Among them, direct biomarkers are better to detect alcohol intake in patients with liver disease; indirect biological markers have a low specificity in this population of patients. • Among pharmacological treatment for alcohol use disorder approved by National Medical Agency, only baclofen has been tested in randomized clinical trials in patients with liver disease, showing efficacy and safety in this population. • Psychosocial-integrated approach is useful for this population of patients, although questions about the type of psychosocial support and appropriate team to manage it are still opened.
Introduction
Invited review for Special Issue on “Neurobiological Targets in Translational Addiction Research” * Giovanni Addolorato [email protected] Extended author information available on the last page of the article
Liver disease Randomized controlled trials
Alcohol use disorder (AUD) is a chronic and relapsing condition characterized by harmful alcohol intake leading to multiorgan damage, injuries [1] and behavioral–cognitive alterations. Effects of alcohol consumption are estimated to be accountable to 3.8% of all global deaths and 4.6% of global disability–adjusted life-years attributable to alcohol [1]. The costs associated with alcohol amount to more than 1%
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