Management of Alcohol Use Disorder: The Role of the Multidisciplinary Clinic

Alcohol use disorder (AUD) is chronic relapsing unhealthy use of alcohol. The constellation of features include withdrawal, compulsive search for alcohol, tolerance, craving, negative emotional state and failure to meet major obligations. AUD is a major public health issue and requires early recognition for focused counseling.

Risk drinking is >1 drink/day for females and >2 drinks/day for males, while heavy drinking is >4 drinks/day for females and >5 drinks/day for males. Binge drinking is continuous drinking over 2 to 3 hours.

Alcoholic liver disease (ALD) accounts for 40% to 50% of total mortality due to liver disease. The risk factors for decompensation are increased dose (×6), obesity, diabetes and drinking pattern.

The validated surveys for AUD include AUDIT (Alcohol Use Disorder Identifi cation Test), AUDIT-C, CAGE (Cut, Annoyed, Guilty, Eye) and CIWA-AR (Clinical Institute Withdrawal Assessment of Alcohol Scale). Hepatologists lack training in addiction medicine.

Management of AUD requires integrating alcohol use detection, assessing severity of ALD, direction to treatment and referral to higher levels of care. Integrated care improves alcohol impact on liver disease.

Behavioral therapy is effective in motivating patients to change behavior. Around 20% to 30% achieve abstinence with Screening, Brief Intervention and Referral to Treatment (SBIRT) approach. Cognitive behavioral therapy addresses drinking triggers, enhances coping skills, utilizes nondrinking activities and modifi es dysfunctional thoughts, emotions and behaviors.

Pharmacotherapy is a useful adjunct to behavioral therapy