Misconceptions, preferences and barriers to alcohol use disorder treatment in alcohol-related cirrhosis

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. This mixed-methods study included outpatients with a h...

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Bibliographic Details
Published in:Journal of substance abuse treatment 2018-08, Vol.91, p.20-27
Main Authors: Mellinger, Jessica L., Scott Winder, G., DeJonckheere, Melissa, Fontana, Robert J., Volk, Michael L., Lok, Anna S.F., Blow, Frederic C.
Format: Article
Language:English
Subjects:
Abstinence
Alcohol abuse
Alcohol related disorders
Alcohol related mortality
Alcohol use
Alcoholic liver disease
Alcoholism
Barriers
Drugs
Health services utilization
Hepatitis
Liver cirrhosis
Liver diseases
Misconceptions
Outpatients
Patient preferences
Polls & surveys
Preferences
Qualitative research
Relapse
Severity
Side effects
Substance abuse treatment
Substance use disorder
Treatment needs
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Summary: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. 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. 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. 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. •Fifty percent of alcohol-related cirrhosis patients drank within the past year.•Few alcohol-related cirrhosis patients utilized alcohol use treatment.•More women than men had misconceptions about alcohol use.•Medical symptoms and family concerns were prime motivators for alcohol cessation.•Despite ongoing drinking, many did not feel a need for or see benefit to alcohol treatment.
ISSN:0740-5472
1873-6483
DOI:10.1016/j.jsat.2018.05.003