Original article
Systematic reviews and meta-analyses
Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic Review

https://doi.org/10.1016/j.cgh.2015.07.047Get rights and content

Background & Aims

We conducted a systematic review of efficacy of psychosocial interventions in inducing or maintaining alcohol abstinence in patients with chronic liver disease (CLD) and alcohol use disorder (AUD).

Methods

We performed structured keyword searches in PubMed, PsychINFO, and MEDLINE for original research articles that were published from January 1983 through November 2014 that evaluated the use of psychosocial interventions to induce or maintain alcohol abstinence in patients with CLD and AUD.

Results

We identified 13 eligible studies that comprised 1945 patients; 5 were randomized controlled trials (RCTs). Delivered therapies included motivational enhancement therapy, cognitive behavioral therapy (CBT), motivational interviewing, supportive therapy, and psychoeducation either alone or in combination in the intervention group and general health education or treatment as usual in the control group. All studies of induction of abstinence (4 RCTs and 6 observational studies) reported an increase in abstinence among participants in the intervention and control groups. Only an integrated therapy that combined CBT and motivational enhancement therapy with comprehensive medical care, delivered during a period of 2 years, produced a significant increase in abstinence (74% increase in intervention group vs 48% increase in control group, P = .02), which was reported in 1 RCT. All studies of maintenance of abstinence (1 RCT and 2 observational studies) observed recidivism in the intervention and control groups. Only an integrated therapy that combined medical care with CBT produced a significantly smaller rate of recidivism (32.7% in integrated CBT group vs 75% in control group, P = .03), which was reported from 1 observational study. However, data were not collected for more than 2 years on outcomes of patients with CLD and AUD.

Conclusions

In a systematic analysis of studies of interventions to induce or maintain alcohol abstinence in patients with CLD and AUD, integrated combination psychotherapy with CBT, motivational enhancement therapy, and comprehensive medical care increased alcohol abstinence. No psychosocial intervention was successful in maintaining abstinence, but an integrated therapy with CBT and medical care appears to reduce recidivism.

Section snippets

Methods

We conducted our systematic review in accordance with the PRISMA guidelines18 including use of an a priori designed study protocol that guided our literature search, study selection, and data synthesis.

Study Selection

We screened 3055 potentially eligible studies and then examined in detail 32 full-text articles. Of these, we excluded 19 studies. The most common reasons for ineligibility of reviewed studies were inability to report alcohol abstinence as an outcome (N = 8) or lack of inclusion of patients with CLD (N = 6) (Figure 1).

Study Characteristics

We included 5 RCTs21, 22, 23, 24, 25 and 8 non-randomized or observational studies (N = 2 non-randomized cohort studies with historical control groups26, 27 and N = 6 uncontrolled

Discussion

Substantial evidence exists to support the use of non-integrated, stand-alone psychosocial interventions in treating AUD in non-CLD population.16, 34, 35 Our systematic review suggests that integrated combination psychotherapy with CBT, MET, and comprehensive medical care may increase alcohol abstinence in patients with CLD and AUD. Most other interventions did not impact induction of abstinence in patients with CLD. We also found that therapies that used integrated care resulted in better

References (36)

  • J. Rehm et al.

    Alcohol as a risk factor for liver cirrhosis: a systematic review and meta-analysis

    Drug Alcohol Rev

    (2010)
  • G. Corrao et al.

    Independent and combined action of hepatitis C virus infection and alcohol consumption on the risk of symptomatic liver cirrhosis

    Hepatology

    (1998)
  • T. Minato et al.

    Binge alcohol consumption aggravates oxidative stress and promotes pathogenesis of NASH from obesity-induced simple steatosis

    Mol Med

    (2014)
  • F. Pessione et al.

    Five-year survival predictive factors in patients with excessive alcohol intake and cirrhosis: effect of alcoholic hepatitis, smoking and abstinence

    Liver Int

    (2003)
  • Z.M. Younossi

    Mortality risk greater among patients with HCV who drank alcohol moderately, heavily

    Aliment Pharmacol Ther

    (2013)
  • M.M. Jaurigue et al.

    Therapy for alcoholic liver disease

    World J Gastroenterol

    (2014)
  • D. Kershenobich et al.

    Management of alcoholic liver disease: an update

    Alcohol Clin Exp Res

    (2011)
  • C.L. Vuittonet et al.

    Pharmacotherapy for alcoholic patients with alcoholic liver disease

    Am J Health-Syst Pharm

    (2014)
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    This article has an accompanying continuing medical education activity on page e20. Learning Objective–Upon completion of this activity, successful learners should be able to determine that psychosocial interventions that are integrated with medical care are most efficacious in inducing and maintaining alcohol abstinence in patients with chronic liver disease and alcohol use disorder.

    Conflicts of interest The authors disclose no conflicts.

    Funding This research was supported in part by the Houston Veterans Affairs Health Services Research Center of Innovations (CIN13-413), Texas Medical Center Digestive Disease Center (DK56338), and the Dan L. Duncan Cancer Center. Dr White receives research support from the NIH (DK095082). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the National Institutes of Health.

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