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

摘要 酒精性肝病（ALD）导致美国近一半的肝脏相关死亡，并且最近增加 在酒精使用障碍中，预计与ALD相关的死亡人数将增加。不幸的是，药物治疗 ALD中肝功能障碍的治疗效果有限。相比之下，停止饮酒是唯一被证明的因素 即使是在ALD的最晚期，也能降低长期死亡率。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 并不是肝病学研究的主要焦点，我们也不知道为什么这些重症患者 继续喝。动机性面试可能有好处，但对于这些复杂的问题， 患者通过发现和纠正患者如何看待风险的错误来创建针对患者的干预措施 酒精使用和肝脏疾病，并了解这些观点如何影响酒精治疗参与 (the“心理模型”方法）结合量身定制的酒精干预参与可能是一个更有效的 帮助病人戒酒的方法ALD患者经常寻求治疗肝病， 避免正式治疗以停止饮酒。因此，肝病学访视是一个独特的机会， 将现有的肝脏健康和酒精使用讨论转化为有效的行为干预措施，以帮助ALD 患者停止饮酒。该项目的目标是通过开发一种新的 多模式行为干预，将部署在肝病诊所，以帮助患者停止饮酒。我们 将通过以下方式实现这一点：1）引发患者对持续饮酒的肝脏相关风险的心理模型， 探索这些信念如何与参与酒精干预有关，2）制定行为 将量身定制的风险教育与动机增强和偏好敏感酒精相结合的干预措施 治疗参与，以及3）在ALD患者中对这种多模式行为干预进行试点测试。到 为了实现这些目标，Mellinger博士将接受指导和重点教学课程和培训， 酒精滥用/使用障碍治疗和研究，行为干预设计和实施，以及 先进的混合方法研究技术。梅林杰博士的长期目标是成为一个领先的 独立的临床研究者和肝病学和行为科学专家， 行为干预，以改善酒精性肝病（ALD）患者的预后， 别喝了NIAAA K23奖将为Mellinger博士提供受保护的时间和所需的培训， 实现她的职业目标，并通过帮助他们戒酒来改善ALD患者的预后。

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.