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Journal of substance abuse treatment v.91, 2018년, pp.20 - 27  

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

Mellinger, Jessica L. (Corresponding author at: 1500 E. Medical Center Dr., 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109, United States. ) ; Scott Winder, G. ; DeJonckheere, Melissa ; Fontana, Robert J. ; Volk, Michael L. ; Lok, Anna S.F. ; Blow, Frederic C. ;
  • 초록  

    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. Highlights 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.


  • 주제어

    Alcoholic liver disease .   Alcohol abuse .   Qualitative research .   Patient preferences.  

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