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Addressing Problematic Drinking in Liver Disease by ‘Opening the Conversation’
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Treating alcohol-related liver disease doesn’t start or stop with the liver. When I talk to my patients with alcohol use disorder, I tell them that dependence and addiction are true medical disorders. I can’t ask them to go home and stop drinking any better than I can tell someone to heal diabetes with concentration. These patients need help identifying their problematic drinking or alcohol use disorder, without stigma, as much as they need to know about their risks for liver disease. This opening conversation is vital.
Part of this conversation should also concern the possibility of underlying depression and anxiety. You are not going to fully address problematic drinking if you don’t also address why they’re using it.
Because not all of this can necessarily be handled by one physician alone, as a hepatologist I’m really best equipped to help someone with identified liver disease or risks for it related to alcohol use. Equally important is co-management with an addiction specialist or psychiatrist. Insurance can sometimes be a hurdle, so it is important to keep in mind that it may be more appropriate to address their professional counseling as depression, when relevant, rather than simply addiction.
For patients who are unable to seek professional help due to insurance or distance from a specialist center, support systems can provide the help they need, whether it be from a church or community center, family and friends, or programs such as Alcoholics Anonymous. Addressing this is like a team sport and it’s going to have to be addressed with realistic goals. With knowledge of medications and the options for counseling, the other key to fighting this problem is to ensure the patient knows not to get frustrated by relapse.
In cases which patients have reached the point that transplantation is necessary, we have another conversation regarding expectations before and after surgery. These patients are going to be incredibly motivated to agree to things because they are sick, so it is incredibly important to put expectations up front and make it clear that this is going to be a life path. Are they going to be responsible for the gift of an organ? Do they understand what life will be like posttransplant?
Finally, as a reminder for the physician: people who live in glass houses cannot throw stones. Every one of us at one point in our life has made a decision that we probably wish we had not made; it might be as simple as not studying hard enough for a test, but you can’t look at the person in front of you and think you’re so different from that individual. Patients can feel that; they can feel if you’re condescending or judging them, and a lot of times they don’t want to disappoint you, or they are afraid to be honest. So, finding a set of tools that allows you to be relatable to that patient and help them invest in their health is paramount in treating this population.
– Nancy S. Reau, MD, FAASLD, AGAF
Section Chief of Hepatology and Associate Director of Organ Transplantation at Rush University Medical Center
Disclosure: Reau reports no relevant financial disclosures.