Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis
Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis
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DOI：
10.1016/j.jsat.2018.05.003
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发表时间：
2018-08-01
影响因子：
3.9
通讯作者：
Blow, Frederic C.
中科院分区：
文献类型：
--
作者：
Mellinger, Jessica L.;Winder, G. Scott;Blow, Frederic C.
背景：虽然戒酒可改善酒精性肝病（ALD）患者的死亡率，但许多患者难以实现戒酒。我们的目的是描述ALD患者对酒精使用治疗方案的偏好、误解和障碍。
方法：这项混合方法研究纳入了从肝病诊所招募的有酒精相关性肝硬化或酒精性肝炎病史的门诊患者，进行调查或深入的半结构化访谈。我们有目的地对男性和女性、代偿期和失代偿期患者进行抽样，以确保在定性访谈中性别和肝病严重程度有足够的代表性。
结果：123名患者完成了调查，其中50%报告在过去一年中至少喝过一次酒，而只有20名患者正在接受任何形式的当前酒精治疗。在报告3个月内饮酒的23名患者中，目前只有3名正在接受酒精使用障碍（AUD）治疗。17%的患者对酒精使用或治疗至少存在一种误解。另外22名ALD患者（10名女性，12名男性）完成了电话访谈，其中三分之二自我报告戒酒。所有22名访谈参与者都知道某种形式的酒精治疗，但13名认为他们不需要治疗，其中一些人认为治疗无效或“浪费时间”。误解包括对复发药物副作用的不准确认知，认为出现晚期肝病症状意味着治疗酒精使用为时已晚，以及对酒精使用障碍的慢性缺乏了解。治疗的最常见障碍包括不愿接受治疗、经济/保险和交通障碍。
结论：尽管许多ALD患者仍在饮酒，但酒精使用治疗在许多ALD患者中未得到充分利用。有针对性的教育和注重偏好的治疗参与可能克服酒精使用治疗的障碍并促进戒酒。
Background: While alcohol cessation improves mortality in alcoholic liver disease (ALD), many patients struggle to achieve abstinence. Our aim was to characterize ALD patients' preferences, misconceptions, and barriers to alcohol use treatment options.Methods: This mixed-methods study included outpatients with a history of alcohol-related cirrhosis or alcoholic hepatitis recruited from a hepatology clinic for a survey or an in-depth semi-structured interview. We purposefully sampled men and women, compensated and decompensated patients to ensure adequate representation of gender and severity of liver disease for the qualitative interviews.Results: 123 patients completed surveys among which 50% reported having at least one drink within the past year while only 20 patients were in any form of current alcohol treatment. Of the 23 patients reporting drinking within 3 months, only 3 were in AUD treatment currently. 17% had at least one misconception about alcohol use or treatment. An additional 22 ALD patients (10 women, 12 men) completed phone interviews of which two third self-reported alcohol abstinence. All 22 interview participants had awareness of some form of alcohol treatment, but 13 felt that they did not need treatment with several characterizing it as ineffective or a "waste of time." Misconceptions included inaccurate perceptions of relapse medication side effects, beliefs that the presence of advanced liver disease symptoms means it is too late to treat alcohol use, and a lack of understanding about the chronicity of alcohol use disorders. The most common barriers to treatment included unwillingness to be in treatment, financial/insurance and transportation barriers.Conclusions: Alcohol use treatment was underutilized in many ALD patients, despite active drinking in many. Tailored education and preference sensitive treatment engagement may overcome barriers to alcohol use treatment and promote abstinence.