Managing Alcohol Use Disorder in Alcohol-Associated Liver Disease, with Mack Mitchell, MD
Mitchell describes the “paradox” hepatologists face in the management of ALD and the importance of early intervention for improving outcomes.
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The management of alcohol use disorder (AUD) in patients with alcohol-associated liver disease (ALD) remains a critical yet underutilized component of hepatology care.
While significant advances have been made in addressing the complications of advanced liver disease, there is a growing recognition that early intervention is essential for preventing disease progression. However, the stigma surrounding AUD, both within the healthcare system and society at large, often creates barriers to effective treatment.
A 2024 study from Massachusetts General Hospital found that although practice recommendations from several medical societies advise against potentially stigmatizing language for AUD and ALD, many liver transplant centers continue to use outdated terms like “alcoholism” and “alcoholic,” potentially hindering patient care and their willingness to seek treatment as well as posing significant implications for disease detection and intervention strategies.
Overcoming such challenges will require a shift in perspective, recognizing AUD as a treatable medical condition and integrating evidence-based interventions into routine hepatology care.
In an interview with HCPLive, Mack Mitchell, MD, vice president for medical affairs and the Nancy and Jeremy Halbreich Professor of Internal Medicine at UT Southwestern, highlights the paradox facing hepatologists in the management of ALD. While the focus has historically been on treating complications of advanced disease, he emphasizes the need to shift attention toward early intervention—specifically, managing alcohol consumption before irreversible liver damage occurs.
“It really takes a conversation with patients to understand both why they're consuming alcohol and why they may be drinking more than they intend to, and also what strategies they can use to reduce that,” Mitchell explained.
He then draws parallels to the early days of hepatitis C treatment, asserting that instead of only managing complications, hepatologists should prioritize preventing fibrosis progression and decompensation through proactive discussions with patients.
A crucial barrier to this approach, according to Mitchell, is the pervasive skepticism about the effectiveness of alcohol use treatment, something he attributes to underlying stigma that he says must be recognized and addressed, starting with the use of person-first language.
Mitchell also advocates for the use of brief interventions, beginning with obtaining patient consent to discuss alcohol use, acknowledging its impact on liver health, and engaging patients in a reflective conversation about their drinking patterns and health goals in an effort to facilitate meaningful behavior change.
He goes on to describe referral options for patients who require additional support, including 12-step programs, addiction counselors, psychologists, social workers, and even faith-based support systems.
Editors’ note: Mitchell has relevant disclosures with Durect, GlaxoSmithKline, and National Institute on Alcohol Abuse and Alcoholism.
