Psychotherapy may reduce the incidence and progression of alcohol-associated liver disease in individuals with alcohol use disorder, according to study findings published in Clinical Gastroenterology and Hepatology.
Researchers at Harvard University conducted a retrospective cohort study, obtaining data from 9635 patients with alcohol use disorder enrolled in the Mass General Brigham Biobank between January 2010 and August 2021.
A diagnosis of alcohol use disorder was confirmed using ICD-9 and ICD-10 codes indicating alcohol dependence or alcohol abuse. The researchers also measured alcohol consumption using a questionnaire that the patients completed once. At the time of enrollment, all patients lacked evidence of alcohol-associated liver disease.
Over an average of 9.2 years, the researchers assessed whether patients developed alcohol-associated liver disease using ICD-9 and ICD-10 codes for alcoholic hepatitis, alcoholic liver failure, alcoholic or unspecified cirrhosis, and alcoholic fibrosis and sclerosis. Alcohol-associated liver disease eventually developed in 1135 (11.8%) patients.
Standard CPT-4 codes confirmed that 3544 (36.8%) of the patients received individual, family, or group psychotherapy. The researchers excluded patients who initiated psychotherapy after completing the questionnaire on alcohol consumption.
Younger women with viral hepatitis, comorbid psychiatric disorders, homelessness, nicotine dependence, and who also received medication-assisted treatment and used substances other than alcohol were more likely to receive psychotherapy treatment.
Psychotherapy was associated with reduced incidence of alcohol-associated liver disease (hazard ratio HR, 0.59; 95% CI, 0.50-0.71; P <.001), particularly those who received individual (HR, 0.70; 95% CI, 0.56-0.86; P <.001) or group (HR, 0.76; 95% CI, 0.61-0.94; P =.01) psychotherapy. Moreover, patients who developed cirrhosis demonstrated lower rates of hepatic decompensation if they underwent psychotherapy treatment (HR, 0.68; 95% CI, 0.44-0.95; P =.03).
Study limitations include the retrospective design, restricted generalizability due to lack of sample diversity, gaps in data regarding alcohol consumption over time, lack of mortality data, the higher likelihood of advanced disease stages in those with alcohol-related liver disease compared with other liver diseases, and lack of accounting for psychotherapy adherence.
“Preventing the development of ALD [alcohol-associated liver disease] is a critically important outcome as this is the most common complication of AUD [alcohol use disorder] and is associated with significant morbidity and mortality worldwide,” the study authors said. “In this large well-characterized cohort of patients with AUD [alcohol use disorder], our analysis suggests that treatment with psychotherapy may reduce the development of ALD [alcohol-associated liver disease] in patients with AUD [alcohol use disorder].”
Vannier AGL, Przybyszewski EM, Shay J, et al. Psychotherapy for alcohol use disorder is associated with reduced risk of incident alcohol-associated liver disease. Clin Gastroenterol Hepatol. Published online August 11, 2022. doi:10.1016/j.cgh.2022.08.001