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Semin Liver Dis
DOI: 10.1055/a-2717-3496
Review Article

Integrated Alcohol Use Disorder and Liver Disease Management

Authors

  • Hanna Blaney    *

    1   Medstar Transplant Hepatology Institute, MedStar Georgetown University Hospital, Washington, District of Columbia

  • Adelina Horhat    *

    2   Department of Hepatology, Paris-Est Créteil University, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Paris, France

  • Abdulmalik Saleem

    3   Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan

  • Gerald S. Winder

    4   Department of Psychiatry and Behavioral Medicine, Henry Ford Health, Detroit, Michigan

  • Jessica Mellinger 

    5   Division of Gastroenterology and Hepatology, Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan

  • Juan P. Arab 

    6   Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
    7   Departamento de Gastroenterologia, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Graphical Abstract

Abstract

Alcohol-associated liver disease (ALD) is a leading cause of liver disease worldwide, caused by hazardous alcohol use. Many patients with ALD also have alcohol use disorder (AUD), a chronic mental health condition characterized by a cluster of behavioral, cognitive, and physiological symptoms that indicate continued alcohol use despite significant alcohol-related problems. Comprehensive care of ALD often requires treatment of AUD, and evidence has demonstrated that treating the latter improves patient outcomes. However, only a minority of patients with AUD/ALD receive treatment. Integrative care models where hepatologists work alongside AUD specialists have been developed. These partnerships have been associated with improved outcomes, including decreased rates of return to alcohol use, decreased healthcare utilization, and even improved mortality. We review the epidemiology, diagnosis, and treatment of AUD and ALD, examples of successful integrated care models, and outcomes. We also discuss knowledge gaps and areas where future research is needed, including the role of integrated care in the peri-transplantation period for ALD, harm reduction approaches, and the need for efforts to support collaboration for integrative care. In conclusion, the dual pathologies of AUD and ALD necessitate multidisciplinary care, and integrated care models have been shown to be both feasible and effective.

Keywords

alcohol-associated liver disease - alcohol use disorder - integrated care

* Co-first author.




Publication History

Received: 22 June 2025

Accepted: 06 October 2025

Article published online:
28 October 2025

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