Management of alcohol use disorder in alcohol-related liver disease

Alcohol-related liver disease (ArLD) is a leading cause of liver-related morbidity and mortality worldwide and is fundamentally connected to alcohol use disorder (AUD). ArLD develops in a subset of heavy drinkers, with progression from steatosis to cirrhosis. Despite the proven benefits of AUD treatment in halting ArLD progression, fewer than 20% of patients with AUD and ArLD receive treatment, and less than 2% are prescribed pharmacotherapy. Hepatology and gastroenterology practitioners are often not confident to manage coexistent AUD and ArLD. This article examines the relationship between AUD and ArLD, evaluates treatment options and highlights the role of integrated care in improving outcomes. Medical addiction therapy significantly reduces binge drinking, hospitalisations and the risk of hepatic decompensation. Several pharmacotherapies are viable in ArLD, but require specific consideration of hepatotoxicity, renal excretion and central nervous system effects. Psychotherapy is associated with lower rates of hepatic decompensation and improved liver-related outcomes. Integrated care models that embed AUD treatment within liver clinics improve engagement, abstinence rates and clinical outcomes compared with standard referrals. AUD treatment is fundamental in ArLD management. Increased use of pharmacological and psychological therapies, alongside integrated care models, may improve patient outcomes and reduce the burden of ArLD. Further research is needed to optimise treatment strategies in this high-risk population.