Jessica L Mellinger1, G Scott Winder2, Melissa DeJonckheere2, Robert J Fontana2, Michael L Volk2, Anna S F Lok2, Frederic C Blow2. 1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Psychiatry, Ann Arbor, MI, United States; VA Center for Clinical Management Research, Ann Arbor, MI, United States; Transplantation Institute, Loma Linda University Health, Loma Linda, CA, United States. Electronic address: jmelling@med.umich.edu. 2. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, United States; Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States; Department of Psychiatry, Ann Arbor, MI, United States; VA Center for Clinical Management Research, Ann Arbor, MI, United States; Transplantation Institute, Loma Linda University Health, Loma Linda, CA, United States.
Abstract
BACKGROUND: While alcohol cessation improves mortality in alcoholic liver disease (ALD), many patients struggle to achieve abstinence. Our aim was to characterize ALD patients' preferences, misconceptions, and barriers to alcohol use treatment options. METHODS: This mixed-methods study included outpatients with a history of alcohol-related cirrhosis or alcoholic hepatitis recruited from a hepatology clinic for a survey or an in-depth semi-structured interview. We purposefully sampled men and women, compensated and decompensated patients to ensure adequate representation of gender and severity of liver disease for the qualitative interviews. RESULTS: 123 patients completed surveys among which 50% reported having at least one drink within the past year while only 20 patients were in any form of current alcohol treatment. Of the 23 patients reporting drinking within 3 months, only 3 were in AUD treatment currently. 17% had at least one misconception about alcohol use or treatment. An additional 22 ALD patients (10 women, 12 men) completed phone interviews of which two-third self-reported alcohol abstinence. All 22 interview participants had awareness of some form of alcohol treatment, but 13 felt that they did not need treatment with several characterizing it as ineffective or a "waste of time." Misconceptions included inaccurate perceptions of relapse medication side effects, beliefs that the presence of advanced liver disease symptoms means it is too late to treat alcohol use, and a lack of understanding about the chronicity of alcohol use disorders. The most common barriers to treatment included unwillingness to be in treatment, financial/insurance and transportation barriers. CONCLUSIONS: Alcohol use treatment was underutilized in many ALD patients, despite active drinking in many. Tailored education and preference sensitive treatment engagement may overcome barriers to alcohol use treatment and promote abstinence.
BACKGROUND: While alcohol cessation improves mortality in alcoholic liver disease (ALD), many patients struggle to achieve abstinence. Our aim was to characterize ALDpatients' preferences, misconceptions, and barriers to alcohol use treatment options. METHODS: This mixed-methods study included outpatients with a history of alcohol-related cirrhosis or alcoholic hepatitis recruited from a hepatology clinic for a survey or an in-depth semi-structured interview. We purposefully sampled men and women, compensated and decompensated patients to ensure adequate representation of gender and severity of liver disease for the qualitative interviews. RESULTS: 123 patients completed surveys among which 50% reported having at least one drink within the past year while only 20 patients were in any form of current alcohol treatment. Of the 23 patients reporting drinking within 3 months, only 3 were in AUD treatment currently. 17% had at least one misconception about alcohol use or treatment. An additional 22 ALDpatients (10 women, 12 men) completed phone interviews of which two-third self-reported alcohol abstinence. All 22 interview participants had awareness of some form of alcohol treatment, but 13 felt that they did not need treatment with several characterizing it as ineffective or a "waste of time." Misconceptions included inaccurate perceptions of relapse medication side effects, beliefs that the presence of advanced liver disease symptoms means it is too late to treat alcohol use, and a lack of understanding about the chronicity of alcohol use disorders. The most common barriers to treatment included unwillingness to be in treatment, financial/insurance and transportation barriers. CONCLUSIONS:Alcohol use treatment was underutilized in many ALDpatients, despite active drinking in many. Tailored education and preference sensitive treatment engagement may overcome barriers to alcohol use treatment and promote abstinence.
Authors: Gene Y Im; Jessica L Mellinger; Adam Winters; Elizabeth S Aby; Zurabi Lominadze; John Rice; Michael R Lucey; Juan P Arab; Aparna Goel; Loretta L Jophlin; Courtney B Sherman; Richard Parker; Po-Hung Chen; Deepika Devuni; Sandeep Sidhu; Winston Dunn; Gyongyi Szabo; Ashwani K Singal; Vijay H Shah Journal: Clin Gastroenterol Hepatol Date: 2020-10-16 Impact factor: 11.382
Authors: Jessica L Mellinger; Anne Fernandez; Kerby Shedden; G Scott Winder; Robert J Fontana; Michael L Volk; Frederic C Blow; Anna S F Lok Journal: Alcohol Clin Exp Res Date: 2019-01-22 Impact factor: 3.455
Authors: Tae-Joon Moon; Charles W Mathias; Jillian Mullen; Tara E Karns-Wright; Nathalie Hill-Kapturczak; John D Roache; Donald M Dougherty Journal: Health Commun Date: 2020-02-24