Improving Outcomes in Alcoholic Liver Disease: Integrating Behavioral Interventions into the Hepatology Clinic

摘要 在美国，酒精性肝病(ALD)导致了近一半与肝脏相关的死亡，而且最近还在增加 在酒精使用障碍中，与ALD相关的死亡预计将上升。不幸的是，药物治疗要逮捕 ALD患者的肝功能障碍疗效有限。相比之下，停止饮酒是唯一被证实的因素。 以控制长期死亡率，即使是在ALD的最晚期。然而，许多ALD患者从未 停止饮酒。在成瘾文献中被广泛研究，戒酒的行为干预 一直不是肝病研究的主要焦点，我们对为什么如此严重的患者知之甚少 继续喝下去。激励性面试可能有好处，但仅有动机面试可能不足以满足这些复杂的需求 病人。通过查找和纠正患者看待风险的错误来创建针对患者的干预措施 了解饮酒与肝病的关系，了解这些观点如何影响饮酒治疗的参与度 (“心理模型”方法)结合量身定制的酒精干预活动可能更有效。 帮助病人戒酒的方法。ALD患者经常为他们的肝脏疾病寻求治疗，而 避免接受正式治疗以停止饮酒。因此，肝病访问是一个独特的机会 将现有的肝脏健康和饮酒讨论转化为有效的行为干预，以帮助ALD 病人会停止饮酒。该项目的目标是通过开发一种新型的ALD专利来改善结果 多模式行为干预，将部署在肝病诊所，帮助患者戒酒。我们 将通过以下方式实现这一点：1)建立持续饮酒的肝脏相关风险的患者心理模型，并 探索这些信念与饮酒干预的关系，2)发展一种行为 将量身定制的风险教育与激励增强和偏好敏感酒精相结合的干预措施 治疗参与度，以及3)在ALD患者中试验这种多模式行为干预。至 为了实现这些目标，梅林格博士将得到指导，并专注于教学课程和培训 酒精滥用/使用障碍的治疗和研究、行为干预设计和实施，以及 先进的混合方法研究技术。梅林格博士的长期目标是成为一位领先的 独立的临床调查员和肝病和行为科学方面的专家，以设计 通过帮助酒精性肝病患者改善预后的行为干预 别再喝酒了。NIAAA K23奖将为梅林格博士提供受保护的时间和所需的培训 通过帮助ALD患者戒酒来实现她的职业目标并改善他们的预后。

ABSTRACT Alcoholic liver disease (ALD) causes nearly half of the liver-related deaths in the US, and with recent increases in alcohol use disorders, ALD-related deaths are expected to rise. Unfortunately, medical treatments to arrest liver dysfunction in ALD are of limited efficacy. Cessation of alcohol use, by contrast, is the only factor proven to curb long-term mortality, even in the most advanced stages of ALD. Yet many patients with ALD never cease alcohol use. Widely studied in the addiction literature, behavioral interventions for alcohol cessation have not been a major focus of research in hepatology, and we know little about why such severely ill patients continue to drink. Motivational interviewing may have benefit, but alone, may not be enough for these complex patients. Creating patient-specific interventions by finding and correcting errors in how patients view the risks of alcohol use and liver disease and understanding how these views impact alcohol treatment engagement (the “mental models” method) combined with tailored alcohol intervention engagement may be a more effective way of helping patients stop drinking. ALD patients often seek medical treatment for their liver disease while avoiding formal treatment to stop alcohol use. The hepatology visit is therefore a unique opportunity to transform existing liver health and alcohol use discussions into effective behavioral interventions to help ALD patients stop drinking. The goal of this project is to improve outcomes in ALD patents by developing a novel multimodal behavioral intervention, to be deployed in the hepatology clinic, to help patients stop drinking. We will accomplish this by 1) eliciting patient mental models of the liver-related risk of ongoing alcohol use and exploring how those beliefs are related to engagement in alcohol interventions, 2) developing a behavioral intervention combining tailored risk education with motivational enhancement and preference-sensitive alcohol treatment engagement, and 3) pilot testing this multimodal behavioral intervention in ALD patients. To accomplish these aims, Dr. Mellinger will receive mentorship and focused didactic coursework and training in alcohol misuse/use disorder treatment and research, behavioral intervention design and implementation, and advanced mixed-methods research techniques. Dr. Mellinger's long-term goal is to become a leading independent clinical investigator and expert in both hepatology and behavioral science in order to design behavioral interventions to improve outcomes for patients with alcoholic liver disease (ALD) by helping them stop drinking. An NIAAA K23 award will provide Dr. Mellinger with the protected time and needed training to achieve her career goals and improve outcomes for patients with ALD by helping them stop drinking.