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Current Hepatology Reports
Erschienen in: Current Hepatology Reports 1/2019

31.01.2019 | Management of Cirrhotic Patient (A Cardenas and P Tandon, Section Editors)

Overcoming Alcohol Addiction in Patients with Alcohol-Related Liver Disease

verfasst von: Gene Y. Im

Erschienen in: Current Hepatology Reports | Ausgabe 1/2019

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Abstract

Purpose of Review

This review provides a brief overview of key concepts in addiction medicine and provides tips and tricks as it pertains to treating patients with alcohol addiction in the setting of advanced alcohol-related liver disease (ALD).

Recent Findings

Understanding the brain disease model of addiction by both providers and patients is a vital springboard for establishing a therapeutic relationship. Despite a paucity of high-quality evidence, psychosocial treatments have withstood the test of time and still form the foundation of alcohol use disorder (AUD) treatment in advanced ALD. Despite the inescapable link between AUD) and advanced ALD, there are no FDA-approved medications for use in this special population. In this urgent subgroup, only baclofen, used off-label, has been shown to be effective for AUD in randomized controlled trials.

Summary

An integrated, multidisciplinary and longitudinal approach remains the best option for the management of AUD in advanced ALD.
Literatur
1.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author; 2013.
2.
• Addolorato G, Mirijello A, Barrio P, Gual A. Treatment of alcohol use disorders in patients with alcoholic liver disease. J Hepatol. 2016;65:618–30 Important review describing state of the art dilemmas and nuances in treating this population. CrossRefPubMed
3.
•• Vaillant GE. A 60-year follow-up of alcoholic men. Addiction. 2003;98(8):1043–51 Seminal longitudinal study of AUD, describing its natural history in men. CrossRefPubMed
4.
Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291(10):1238–45.CrossRefPubMed
5.
6.
• Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on alcohol and related conditions III. JAMA Psychiatry. 2015;72:757–66 Important recent U.S. epidemiological survey of increasing AUD prevalence. CrossRefPubMedPubMedCentral
7.
Mellinger JL, Shedden K, Winder GS, Tapper E, Adams M, Fontana RJ, et al. The high burden of alcoholic cirrhosis in privately insured persons in the United States. Hepatology. 2018;68(3):872–82.CrossRefPubMed
8.
9.
GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2018;392(10152):1015–35.CrossRefPubMedCentral
10.
11.
• Volkow ND, Koob GF, McLellan AT. Neurobiologic advances from the brain disease model of addiction. N Engl J Med. 2016;374(4):363–71 Important review of the brain disease model of addiction suited for the clinician. CrossRefPubMedPubMedCentral
12.
Soyka M, Kranzler HR, Berglund M, Gorelick D, Hesselbrock V, Johnson BA, et al. World Federation of Societies of biological psychiatry (WFSBP) guidelines for biological treatment of substance use and related disorders, part 1: alcoholism. World J Biol Psychiatry. 2008;9(1):6–23.CrossRefPubMed
13.
Palmer RH, McGeary JE, Heath AC, Keller MC, Brick LA, Knopik VS. Shared additive genetic influences on DSM-IV criteria for alcohol dependence in subjects of European ancestry. Addiction. 2015;110(12):1922–31.CrossRefPubMedPubMedCentral
14.
Crabb DW, Matsumoto M, Chang D, You M. Overview of the role of alcohol dehydrogenase and aldehyde dehydrogenase and their variants in the genesis of alcohol-related pathology. Proc Nutr Soc. 2004;63:49–63.CrossRefPubMed
15.
•• Buch S, Stickel F, Trépo E, Way M, Herrmann A, Nischalke HD, et al. A genome-wide association study confirms PNPLA3 and identifies TM6SF2 and MBOAT7 as risk loci for alcohol-related cirrhosis. Nat Genet. 2015;47(12):1443–8 Large seminal study confirming old and identifying new genetic risk factors for developing alcohol-related cirrhosis compared to heavy drinkers without cirrhosis. CrossRefPubMed
16.
Abul-Husn NS, Cheng X, Li AH, Xin Y, Schurmann C, Stevis P, et al. A protein-truncating HSD17B13 variant and protection from chronic liver disease. N Engl J Med. 2018;378(12):1096–106.CrossRefPubMedPubMedCentral
17.
Lucey MR. Liver transplantation in patients with alcoholic liver disease. Liver Transpl. 2011 Jul;17(7):751–9.CrossRefPubMed
18.
• Babor TF. The classification of alcoholics: typology theories from the 19th century to the present. Alcohol Health Res World. 1996;20(1):6–14 Good expert review of AUD typologies and their utility.
19.
Longabaugh R, Wirtz PW, Zweben A, Stout RL. Network support for drinking, alcoholics anonymous and long-term matching effects. Addiction. 1998 Sep;93(9):1313–33.CrossRefPubMed
20.
Miller WR, Rollnick S. Motivational Interviewing, Third Edition. Guilford Press; 2012.
21.
Seitz HK, Bataller R, Cortez-Pinto H, Gao B, Gual A, Lackner C, et al. Alcoholic liver disease. Nat Rev Dis Primers. 2018;4(1):16.CrossRefPubMed
22.
Chedid A, Mendenhall CL, Gartside P, French SW, Chen T, Rabin L, et al. Prognostic factors in alcoholic liver disease. Am J Gastroenterol. 1991;86(2):210–6.PubMed
23.
Parés A, Caballería J, Bruguera M, Torres M, Rodés J. Histological course of alcoholic hepatitis. Influence of abstinence, sex and extent of hepatic damage. J Hepatol. 1986;2(1):33–42.CrossRefPubMed
24.
Vaillant GE, Hiller-Sturmhöfel S. The natural history of alcoholism. Alcohol Health Res World. 1996;20(3):152–61.
25.
• Weinrieb RM, Van Horn DH, McLellan AT, Volpicelli JR, Calarco JS, Lucey MR. Drinking behavior and motivation for treatment among alcohol-dependent liver transplant candidates. J Addict Dis. 2001;20(2):105–19 Important study of AUD patients with ALD requiring LT, highlighting their differences (and therapeutic challenges) from other AUD patients. CrossRefPubMed
26.
Weinrieb RM, Van Horn DH, McLellan AT, Volpicelli JR, Calarco JS, Lucey MR. Drinking behavior and motivation for treatment among alcohol-dependent liver transplant candidates. J Addict Dis. 2001;20(2):105–19.
27.
Miller WR, Benefield RG, Tonigan JS. Enhancing motivation for change in problem drinking: a controlled comparison of two therapist styles. J Consult Clin Psychol. 1993;61(3):455–61.CrossRefPubMed
28.
Leggio L, Lee MR. Treatment of alcohol use disorder in patients with alcoholic liver disease. Am J Med. 2017;130(2):124–34.CrossRefPubMed
29.
Gustafson DH, McTavish FM, Chih MY, Atwood AK, Johnson RA, Boyle MG, et al. A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry. 2014;71(5):566–72.CrossRefPubMedPubMedCentral
30.
Carroll KM, Connors GJ, Cooney NL, DiClemente CC, Donovan DM, Kadden RR, et al. Internal validity of project MATCH treatments: discriminability and integrity. J Consult Clin Psychol. 1998;66(2):290–303.CrossRefPubMed
31.
Copello A, Orfor J, Hodgson R, Tober G, Barrett C, UKATT Research Team. United Kingdom Alcohol Treatment Trial. Social behaviour and network therapy basic principles and early experiences. Addict Behav. 2002;27(3):345–66.CrossRefPubMed
32.
Klimas J, Tobin H, Field C-A, et al. Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users. Cochrane Drugs and Alcohol Group, ed. Cochrane Database Syst Rev. 2014;95:CD009269.
33.
•• Addolorato G, Leggio L, Ferrulli A, Cardone S, Vonghia L, Mirijello A, et al. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study. Lancet. 2007;370(9603):1915–22 Seminal study of the only RCT trial of AUD pharmacotherapy in patients with ALD cirrhosis. CrossRefPubMed
34.
Mason BJ, Quello S, Goodell V, Shadan F, Kyle M, Begovic A. Gabapentin treatment for alcohol dependence: a randomized clinical trial. JAMA Intern Med. 2014;174(1):70–7.CrossRefPubMedPubMedCentral
35.
Falk DE, Ryan ML, Fertig JB, Devine EG, Cruz R, Brown ES, National Institute on Alcohol Abuse and Alcoholism Clinical Investigations Group (NCIG) Study Group et al. Gabapentin enacarbil extended-release for alcohol use disorder: a randomized, double-blind, placebo-controlled, multisite trial assessing efficacy and safety. Alcohol Clin Exp Res. 2019;43(1):158–69.
36.
Litten RZ, Ryan ML, Fertig JB, Falk DE, Johnson B, Dunn KE, et al. A double-blind, placebo-controlled trial assessing the efficacy of varenicline tartrate for alcohol dependence. J Addict Med. 2013;7(4):277–86.CrossRefPubMedPubMedCentral
37.
• Lyon J. More Treatments on deck for alcohol use disorder. JAMA. 2017;317(22):2267–9 A nice short review highlighting the pipeline of pharmacotherapies for AUD. CrossRefPubMed
38.
Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, et al. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014;311(18):1889–900.CrossRefPubMed
39.
40.
Ragia G, Manolopoulos VG. Personalized medicine of alcohol addiction: pharmacogenomics and beyond. Curr Pharm Biotechnol. 2017;18(3):221–30.CrossRefPubMed
41.
Ooteman W, Naassila M, Koeter MW, Verheul R, Schippers GM, Houchi H, et al. Predicting the effect of naltrexone and acamprosate in alcohol-dependent patients using genetic indicators. Addict Biol. 2009;14(3):328–37.CrossRefPubMed
42.
•• Khan A, Tansel A, White DL, Kayani WT, Bano S, Lindsay J, et al. Efficacy of psychosocial interventions in inducing and maintaining alcohol abstinence in patients with chronic liver disease: a systematic review. Clin Gastroenterol Hepatol. 2016;14(2):191–202 Important systematic review of psychosocial therapies for AUD specifically in patients with established liver disease. CrossRefPubMed
43.
Peters TJ, Kotowicz J, Nyka W, Kozubski W, Kuznetsov V, Vanderbist F, et al. Treatment of alcoholic polyneuropathy with vitamin B complex: a randomised controlled trial. Alcohol Alcohol. 2006;41(6):636–42.CrossRefPubMed
44.
Jarvis M, Williams J, Hurford M, Lindsay D, Lincoln P, Giles L, et al. Appropriate use of drug testing in clinical addiction medicine. J Addict Med. 2017;11(3):163–73.CrossRefPubMed
45.
• Staufer K, Yegles M. Biomarkers for detection of alcohol consumption in liver transplantation. World J Gastroenterol. 2016;22(14):3725–34 Good review of clinically relevant alcohol biomarkers from a expert in the field. CrossRefPubMedPubMedCentral
46.
Cabezas J, Lucey MR, Bataller R. Biomarkers for monitoring alcohol use. Clin Liver Dis. 2016;8(3):59–63.CrossRef
Metadaten
Titel
Overcoming Alcohol Addiction in Patients with Alcohol-Related Liver Disease
verfasst von
Gene Y. Im
Publikationsdatum
31.01.2019
Verlag
Springer US
Erschienen in
Current Hepatology Reports / Ausgabe 1/2019
Elektronische ISSN: 2195-9595
DOI
https://doi.org/10.1007/s11901-019-00451-7

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