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

摘要

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.