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Multiple therapies, medical care increase alcohol abstinence in CLD

In a systematic review, researchers found that integrated combination psychotherapy with cognitive behavioral therapy, motivational enhancement therapy and comprehensive medical care, increased alcohol abstinence in patients with chronic liver disease and alcohol use disorder.

Researchers, including Fasiha Kanwal, MD, MSHS, of Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, looked at 13 studies with 1,945 patients found via PubMed, PsychINFO and MEDLINE databases published between January 1983 and November 2014, that evaluated the use of psychosocial interventions to induce or maintain alcohol abstinence in patients with chronic liver disease (CLD) and alcohol use disorder (AUD).

Fasiha Kanwal

Of the studies, five were randomized controlled trials and all used therapies including motivational enhancement therapy, cognitive behavioral therapy (CBT), motivational interviewing, supportive therapy and psychoeducation either alone or in combination in an intervention group, and used general health education or treatment in a control group.

Overall, only therapy that combined CBT and motivational enhancement therapy with comprehensive medical care over a period of 2 years increased alcohol abstinence (74% increase in intervention group vs. 48% increase in control group, P = .02). This was found in only one of the randomized clinical trials. In addition, only integrated therapy combined with medical care and CBT resulted in a smaller rate of recidivism (32.7% in integrated CBT group vs. 75% in control group, P = .03). This was found in only one of the observational studies. However, data were not collected for more than 2 years on outcomes of patients with CLD and AUD, according to the research.

“Substantial evidence exists to support the use of nonintegrated, stand-alone psychosocial interventions in treating AUD in non-CLD populations,” the researchers wrote. “Our systematic review suggests that integrated combination psychotherapy with CBT, [motivational enhancement therapy] and comprehensive medical care may increase alcohol abstinence in patients with CLD and AUD.”

They concluded: “Although no psychosocial intervention was successful in maintaining abstinence, an integrated CBT intervention holds promise as a strategy to reduce recidivism.” – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.