When patients are diagnosed with alcoholic liver disease (ALD), doctors instruct them to abstain from drinking. Abstinence improves their survival by preventing additional liver damage.
It's the most proven therapeutic intervention, even in cases of cirrhosis, where extensive scarring in the liver occurs because of repeated heavy alcohol use.
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Still, patients struggle to follow doctor orders, according to a study by a team of Michigan Medicine specialists who examined patients' preferences, misconceptions, and barriers to getting help to stop drinking. Often, the researchers found, they try to kick the bottle on their own.
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About half the study participants (52 people) reported drinking within the past year despite their ALD diagnosis. Of these, 13 drank at least once a week, 12 drank at least three or more drinks per day, and six drank a half dozen or more drinks on a single occasion at least once a week.
"One drink is too many if you have ALD," says Jessica Mellinger, M.D., lead author of the study and a specialist in hepatology, gastroenterology and internal medicine at Michigan Medicine.
A nationwide problem
Quitting drinking is a nationwide issue. According to the 2015 National Survey on Drug Use and Health, 15.1 million U.S. adults — 9.8 million men and 5.3 million women — have alcohol use disorder (AUD), the medical diagnosis for alcoholism characterized by symptoms that include compulsive alcohol use despite consequences and side effects, loss of control over alcohol intake, tolerance, withdrawal and cravings.
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About 60 percent of the study participants had never received any kind of treatment for their alcohol use disorder, including attending Alcoholics Anonymous meetings.
"Their perception is they don't think that alcohol use disorder treatment works," says G. Scott Winder, M.D., an assistant professor in the Department of Psychiatry and one of study authors.
Some participants pegged it a "waste of time" and "a big joke," the study reveals.
A chronic disease
Others felt they kicked the habit and didn't think any help was necessary since they plan to avoid a relapse, suggesting the participants lacked the understanding that alcohol use disorder is often a chronic disease marred by relapsing, Winder says.
Research shows treatment improves their chances of relapsing. A third of people who are treated for alcohol problems have no further symptoms a year later, according to the National Institute on Alcohol Abuse and Alcoholism. Many others substantially reduce their drinking and report fewer alcohol-related problems.
Some of Mellinger and Winder's study participants appeared to have thrown in the towel, suggesting "it's too late" because the liver disease was already present. As a result, they felt like alcohol use disorder treatment is futile.
Other options
Participants also had misconceptions about the variety of treatments available, believing 12-step support, like Alcoholics Anonymous, was one of few options. Other options include one-on-one counseling, inpatient rehab, medical treatment for alcohol withdrawal, cognitive behavioral therapy and motivational therapy.
"It was interesting how people from small towns shy away from group therapy because they want to maintain some anonymity," Mellinger says.
Others think support groups are counterproductive and could simply mean meeting a new drinking buddy.
Mellinger and Winder hope it motivates other healthcare professionals to address alcohol use with ALD patients. They also would like to see their peers receive additional training on addiction and various treatment options and to explore new ways to motivate patients to receive help with alcohol use disorders and maintain the changes they make.
"A study like this helps us understand better how to help those with alcohol use disorder," Winder says.
To make an appointment with Michigan Medicine's liver clinic, call 844-233-0433.