Telehealth Stepped Alcohol Therapy in Chronic Liver Disease

Key Takeaways

• Among adults with chronic liver disease and unhealthy alcohol use, telehealth stepped alcohol treatment was reported to show no difference from usual care on the primary outcome of alcohol use below moderate level, while secondary alcohol-use measures moved in favor of the intervention.
• At month 6, 30-day abstinence was reported as 29% with telehealth stepped alcohol treatment versus 18% with usual care, and drinks per week were reported to decline more with the intervention, with estimates of −0.66 at month 3 and −0.67 at month 6.
• Telehealth stepped alcohol treatment consisted of three motivational interviewing sessions with step-up addiction medicine referral if drinking had not decreased by month 3, and higher baseline motivation to reduce alcohol use was reported to be positively associated with treatment response.

Results from a telehealth stepped alcohol treatment trial in chronic liver disease described a mixed efficacy profile: month 6 30-day abstinence was reported as 29% with the intervention versus 18% with usual care, while the primary outcome showed no difference between groups in percentage of alcohol use below moderate level. The randomized comparison included 157 adults with chronic liver disease and unhealthy alcohol use who received either the telehealth-delivered stepped intervention or usual care. Taken together, the findings pointed to favorable secondary alcohol-use signals without changing the null primary comparison.

The randomized comparison assigned 81 participants to stepped alcohol treatment and 76 to usual care. The intervention consisted of three motivational interviewing sessions followed by addiction medicine referral if no drinking reduction occurred by month 3, and enrolled adults met unhealthy alcohol use thresholds of >7 drinks/week or ≥4/day for women and >14/week or ≥5/day for men, or had heavy episodic drinking. That stepped-care structure was the main operational feature distinguishing the telehealth model from usual care.

Across secondary alcohol-use measures, stepped alcohol treatment was associated with greater reduction in drinks per week from baseline to month 3 and month 6, with estimates of −0.66 and −0.67, and the six-month effect remained significant after controlling for covariates. The report also described a positive association between higher baseline motivation to reduce alcohol use and treatment response. Integrated alcohol interventions were described as still uncommon in liver clinics. Several authors disclosed ties to the pharmaceutical and biopharmaceutical industries.

Clinician Questions

What did telehealth stepped alcohol treatment include for adults with chronic liver disease and unhealthy alcohol use?

Telehealth stepped alcohol treatment in adults with chronic liver disease and unhealthy alcohol use consisted of three motivational interviewing sessions, followed by addiction medicine referral if drinking had not decreased by month 3. In the randomized trial, that telehealth stepped model was the intervention compared with usual care.

Did telehealth stepped alcohol treatment improve alcohol outcomes versus usual care in chronic liver disease?

In 157 adults with chronic liver disease and unhealthy alcohol use, the randomized comparison found no difference in the primary outcome of percentage of alcohol use below moderate level, while greater reductions in drinks per week were reported at month 3 and month 6 with estimates of −0.66 and −0.67. Month 6 30-day abstinence in chronic liver disease was reported as 29% with telehealth stepped alcohol treatment versus 18% with usual care.

Which baseline factor was associated with better response to telehealth stepped alcohol treatment in chronic liver disease?

Higher baseline motivation to reduce alcohol use was reported to be positively associated with treatment response among adults with chronic liver disease and unhealthy alcohol use. That association was presented as a participant factor linked with better response.