Psychotherapy Shows Promise In Preventing Alcohol-Related Liver Disease

Alcohol-associated liver disease (ALD) is a devastating consequence of alcohol use disorder (AUD) that poses significant challenges for effective treatment. However, a recent retrospective cohort study published in the journal Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association conducted by researchers at the Mass General Brigham Biobank offers hope by suggesting that psychotherapy may play a crucial role in preventing the development of ALD in individuals with AUD.

The study conducted by Augustin G.L. Vannier and team which analyzed data from 9,635 patients with AUD, utilized International Classification of Diseases codes to identify cases of ALD. The patients were followed up for an average period of 9.2 years. Cox regression models were used to assess the impact of psychotherapy on the incidence of ALD, while accounting for various contributing factors, including the use of medication-assisted treatment.

● The results revealed that 36.8% of patients received psychotherapy, with individual and group therapy both showing promise in reducing the rate of ALD.

● In the multivariable analysis, psychotherapy was associated with a significantly reduced risk of developing ALD, with a hazard ratio (HR) of 0.59 (95% confidence interval [CI], 0.50–0.71; P < .001).

● The positive association held true for both individual therapy (HR, 0.70; 95% CI, 0.56–0.86; P < .001) and group therapy (HR, 0.76; 95% CI, 0.61–0.94; P = .01).

● Psychotherapy also demonstrated potential benefits in patients with cirrhosis, as it was associated with a lower rate of hepatic decompensation (HR, 0.68; 95% CI, 0.48–0.95; P = .03).

These findings have significant implications for clinical practice, suggesting that incorporating psychotherapy into the treatment of individuals with AUD may help prevent the development and progression of ALD. The safety and potential benefits of psychotherapy make it an attractive option for clinicians looking to address the underlying causes of increased alcohol consumption and mitigate the risk of ALD.

While the study's retrospective design limits its ability to establish causality, it provides compelling evidence for the potential of psychotherapy as a preventive measure against ALD in patients with AUD. Further research, including prospective studies, is warranted to confirm these findings and explore the underlying mechanisms by which psychotherapy influences the development and progression of ALD.

In conclusion, psychotherapy shows promise as a preventive intervention in individuals with AUD to reduce the incidence and progression of alcohol-related liver disease. With its potential benefits and favourable safety profile, clinicians should consider incorporating psychotherapy into their treatment strategies to protect patients from the devastating consequences of ALD.

Reference:

Vannier, A. G. L., Przybyszewski, E. M., Shay, J., Patel, S. J., Schaefer, E., Goodman, R. P., & Luther, J. (2023). Psychotherapy for alcohol use disorder is associated with reduced risk of incident alcohol-associated liver disease. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association, 21(6), 1571-1580.e7. https://doi.org/10.1016/j.cgh.2022.08.001.