Download PDF
Semin Liver Dis 2009; 29(1): 066-073
DOI: 10.1055/s-0029-1192056
© Thieme Medical Publishers

Alcohol and Substance Abuse

Michael R. Lucey1 , R.M. Weinrieb2
  • 1Section of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
  • 2Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Further Information

Publication History

Publication Date:
23 February 2009 (online)

    Permissions and Reprints

ABSTRACT

Alcoholic liver disease is an important cause of cirrhosis, liver-associated death, and need for liver transplant. Up to 50% of recipients use some alcohol, and perhaps 10% drink addictively. Careful evaluation by an addiction medicine specialist is the best predictive instrument before transplant surgery, whereas the 6-month rule lacks sensitivity and specificity. Addictive drinking, but not minor slips, is associated with increased mortality. There is no standard therapy for alcoholism in alcoholics waiting for a transplant or for those who have undergone a transplant. Stably abstinent, methadone-maintained opiate-dependent patients should continue methadone; are generally good candidates for liver transplant; and show low relapse rates. Pre- and post-transplant smoking rates are high and cause significant morbidity and mortality. Transplant teams should encourage smoking cessation treatments. Marijuana use in liver transplant recipients is common, although risks associated with this practice are unknown.

KEYWORDS

Alcoholic liver disease - liver transplantation - transplant - alcohol - smoking

REFERENCES

  • 1 O'Brien C P, McLellan A T. Myths about the treatment of addiction.  Lancet. 1996;  347(8996) 237-240
    CrossrefPubMedGoogle Scholar
  • 2 Orrego H, Blake J E, Blendis L M, Kapur B M, Israel Y. Reliability of assessment of alcohol intake based on personal interviews in a liver clinic.  Lancet. 1979;  2(8156–8157) 1354-1356
    PubMedGoogle Scholar
  • 3 Weinrieb R M, Van Horn D H, McLellan A T, Lucey M R. Interpreting the significance of drinking by alcohol-dependent liver transplant patients: fostering candor is the key to recovery.  Liver Transpl. 2000;  6 769-776
    CrossrefPubMedGoogle Scholar
  • 4 Tome S, Lucey M R. Timing of liver transplantation in alcoholic cirrhosis.  J Hepatol. 2003;  39(3) 302-307
    CrossrefPubMedGoogle Scholar
  • 5 DiMartini A, Day N, Dew M A et al.. Alcohol consumption patterns and predictors of use following liver transplantation for alcoholic liver disease.  Liver Transpl. 2006;  12 813-820
    CrossrefPubMedGoogle Scholar
  • 6 Beresford T P. Overt and covert alcoholism. In: Lucey MR, Merion RM, Beresford TP Liver Transplantation and the Alcoholic Patient: Medical, Surgical and Psychosocial Issues. Cambridge, UK; Cambridge University Press 1994: 6-28
    Google Scholar
  • 7 Fuller R K. Definition and diagnosis of relapse to drinking.  Liver Transpl Surg. 1997;  3 258-262
    CrossrefPubMedGoogle Scholar
  • 8 Pfitzmann R, Schwenzer J, Rayes N, Seehofer D, Neuhaus R, Nüssler N C. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease.  Liver Transpl. 2007;  13 197-205
    CrossrefPubMedGoogle Scholar
  • 9 Vaillant G E. The Natural History of Alcoholism, Revisited. Cambridge, MA; Harvard University Press 1995
    Google Scholar
  • 10 Vaillant G E. A 60-year follow-up of alcoholic men.  Addiction. 2003;  98 1043-1051
    CrossrefPubMedGoogle Scholar
  • 11 Lucey M R, Connor J T, Boyer T D, Henderson J M, Rikkers L F. DIVERT Study Group . Alcohol consumption by cirrhotic subjects: patterns of use and effects on liver function.  Am J Gastroenterol. 2008;  103 1698-1706
    CrossrefPubMedGoogle Scholar
  • 12 Centers for Disease Control and Prevention (CDC) . Alcohol-attributable deaths and years of potential life lost–United States, 2001.  MMWR Morb Mortal Wkly Rep. 2004;  53(37) 866-870
    PubMedGoogle Scholar
  • 13 Mokdad A H, Marks J S, Stroup D F, Gerberding J L. Actual causes of death in the United States, 2000.  JAMA. 2004;  291 1238-1245 , See also: Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Correction: actual causes of death in the United States, 2000. JAMA 2005:293(3);293–294
    CrossrefPubMedGoogle Scholar
  • 14 Bellentani S, Saccoccio G, Costa G et al.. Drinking habits as cofactors of risk for alcohol induced liver damage.  Gut. 1997;  41 845-850
    CrossrefPubMedGoogle Scholar
  • 15 Becker U, Deis A, Sorensen T IA et al.. Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study.  Hepatology. 1996;  23 1025-1029
    CrossrefPubMedGoogle Scholar
  • 16 Wilfred de Alwis N M, Day C P. Genetics of alcoholic liver disease and nonalcoholic fatty liver disease.  Semin Liver Dis. 2007;  27 44-54
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Nishiguchi S, Kuroki T, Yabusako T et al.. Detection of hepatitis C virus antibodies and hepatitis C virus RNA in patients with alcoholic liver disease.  Hepatology. 1991;  14 985-989
    CrossrefPubMedGoogle Scholar
  • 18 Teli M R, Day C P, Burt A D, Bennett M K, James O F. Determinants of progression to cirrhosis or fibrosis in pure alcoholic fatty liver.  Lancet. 1995;  346(8981) 987-990
    CrossrefPubMedGoogle Scholar
  • 19 National Institutes of Health Consensus Development Conference statement: liver transplantation—June 20–23, 1983.  Hepatology. 1984;  4(1 Suppl) 107S-110S
    CrossrefPubMedGoogle Scholar
  • 20 Starzl T E, Van Thiel D, Tzakis A G et al.. Orthotopic liver transplantation for alcoholic cirrhosis.  JAMA. 1988;  260 2542-2544
    CrossrefPubMedGoogle Scholar
  • 21 Lucey M R, Merion R M, Henley K S et al.. Selection for and outcome of liver transplantation in alcoholic liver disease.  Gastroenterology. 1992;  102 1736-1741
    PubMedGoogle Scholar
  • 22 Beresford T P. Psychiatric assessment of alcoholic candidates for liver transplantation. In: Lucey MR, Merion RM, Beresford TP Liver Transplantation and the Alcoholic Patient: Medical, Surgical and Psychosocial Issues. Cambridge, UK; Cambridge University Press 1994: 29-49
    Google Scholar
  • 23 Strauss R, Bacon S D. Alcoholism and social stability; a study of occupational integration in 2,023 mail clinic patients.  Q J Stud Alcohol. 1951;  12 231-260
    PubMedGoogle Scholar
  • 24 Cuadrado A, Fabrega E, Casafont F, Pons-Romero F. Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease.  Liver Transpl. 2005;  11 420-426
    Google Scholar
  • 25 Conjeevaram H S, Hart J, Lissoos T W et al.. Rapidly progressive liver injury and fatal alcoholic hepatitis occurring after liver transplantation in alcoholic patients.  Transplantation. 1999;  67 1562-1568
    CrossrefPubMedGoogle Scholar
  • 26 Pageaux G P, Bismuth M, Perney P et al.. Alcohol relapse after liver transplantation for alcoholic liver disease: does it matter?.  J Hepatol. 2003;  38 629-634
    CrossrefPubMedGoogle Scholar
  • 27 Pageaux G P, Michel J, Coste V et al.. Alcoholic cirrhosis is a good indication for liver transplantation, even for cases of recidivism.  Gut. 1999;  45(3) 421-426
    PubMedGoogle Scholar
  • 28 Addolorato G, Leggio L, Ferrulli A et al.. Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study.  Lancet. 2007;  370 1915-1922
    CrossrefPubMedGoogle Scholar
  • 29 Anton R F. Naltrexone for the management of alcohol dependence.  N Engl J Med. 2008;  359 715-721
    CrossrefPubMedGoogle Scholar
  • 30 Lucey M R, Silverman B L, Illeperuma A, O'Brien C P. Hepatic safety of once-monthly injectable extended-release naltrexone administered to actively drinking alcoholics.  Alcohol Clin Exp Res. 2008;  32 498-504
    CrossrefPubMedGoogle Scholar
  • 31 Wagner C C, Haller D L, Olbrisch M E. Relapse prevention treatment for liver transplant patients.  J Clin Psychol Med Settings. 1996;  3(4) 387-398
    CrossrefPubMedGoogle Scholar
  • 32 Weinrieb R M, Van Horn D H, McLellan A T, Volpicelli J R, Calarco J S, Lucey M R. Drinking behavior and motivation for treatment among alcohol-dependent liver transplant candidates.  J Addict Dis. 2001;  20(2) 105-119
    PubMedGoogle Scholar
  • 33 Weinrieb R M, Van Horn D H, Mclellan A T et al.. Alcoholism treatment after liver transplantation: lessons learned from a clinical trial that failed.  Psychosomatics. 2001;  42(2) 111-115
    PubMedGoogle Scholar
  • 34 Georgiou G, Webb K, Griggs K, Copello A, Neuberger J, Day E. First report of a psychosocial intervention for patients with alcohol-related liver disease undergoing liver transplantation.  Liver Transpl. 2003;  9(7) 772-775
    CrossrefPubMedGoogle Scholar
  • 35 Ball J, Ross A. The Effectiveness of Methadone Maintenance Treatment. New York; Springer-Verlag 1991
    Google Scholar
  • 36 Kanchana T P, Kaul V, Manzarbeitia C et al.. Liver transplantation for patients on methadone maintenance.  Liver Transpl. 2002;  8(9) 778-782
    CrossrefPubMedGoogle Scholar
  • 37 Liu L U, Schiano T D, Lau N et al.. Survival and risk of recidivism methadone-dependent patients undergoing liver transplantation.  Am J Transplant. 2003;  3 1273-1277
    CrossrefPubMedGoogle Scholar
  • 38 Weinrieb R M, Barnett R, Lynch K G, DePiano M, Atanda A, Olthoff K M. A matched comparison study of medical and psychiatric complications and anesthesia and analgesia requirements in methadone-maintained liver transplant recipients.  Liver Transpl. 2004;  10 97-106
    CrossrefPubMedGoogle Scholar
  • 39 Trescot A M, Boswell M V, Atluri S L et al.. Opioid guidelines in the management of chronic non-cancer pain.  Pain Physician. 2006;  9(1) 1-39
    PubMedGoogle Scholar
  • 40 DiMartini A, Javed L, Russell S et al.. Tobacco use following liver transplantation for alcoholic liver disease: an underestimated problem.  Liver Transpl. 2005;  11 679-683
    CrossrefPubMedGoogle Scholar
  • 41 Pungpapong S, Manzarbeitia C, Ortiz J et al.. Cigarette smoking is associated with an increased incidence of vascular complications after liver transplantation.  Liver Transpl. 2002;  8(7) 582-587
    CrossrefPubMedGoogle Scholar
  • 42 Johnston S D, Morris J K, Cramb R, Gunson B K, Neuberger J. Cardiovascular morbidity and mortality after orthotopic liver transplantation.  Transplantation. 2002;  73(6) 901-906
    CrossrefPubMedGoogle Scholar
  • 43 Muñoz S J. Tobacco use by liver transplant recipients: grappling with a smoking gun.  Liver Transpl. 2005;  11(6) 606-609
    CrossrefPubMedGoogle Scholar
  • 44 Leeman R F, Huffman C J, O'Malley S S. Alcohol history and smoking cessation in nicotine replacement therapy, bupropion sustained release and varencicline trials: a review.  Alcohol Alcohol. 2007;  42(3) 196-206
    PubMedGoogle Scholar
  • 45 Hall S M, Humfleet G L, Reus V I, Munoz R F, Cullen J. Extended nortriptyline and psychological treatment for cigarette smoking.  Am J Psychiatry. 2004;  161(11) 2100-2107
    CrossrefPubMedGoogle Scholar
  • 46 Pirmoradi P, Roshan S, Nadeem S S. Neuropsychiatric disturbance after initiation of varenicline in a patient with a history of alcohol abuse and major depression.  Am J Health Syst Pharm. 2008;  65(17) 1624-1626
    CrossrefPubMedGoogle Scholar
  • 47 Block R I, Farnham S, Braverman K, Noyes Jr R, Ghoneim M M. Long-term marijuana use and subsequent effects on learning and cognitive functions related to school achievement: preliminary study. In: Spencer JW, Boren JJ Residual Effects of Abused Drugs on Behavior. National Institute on Drug Abuse Research Monograph No. 101. Rockville, MD; U.S. Department of Health and Human Services 1990: 96-111
    Google Scholar
  • 48 Hamadeh R, Ardehali A, Locksley R M, York M K. Fatal aspergillosis associated with smoking contaminated marijuana, in a marrow transplant recipient.  Chest. 1988;  94 432-433
    CrossrefPubMedGoogle Scholar
  • 49 Marks W H, Florence L, Lieberman J et al.. Successfully treated invasive pulmonary aspergillosis associated with smoking marijuana in a renal transplant recipient.  Transplantation. 1996;  27(61) 1771-1774
    PubMedGoogle Scholar
  • 50 Hézode C, Roudot-Thoraval F, Nguyen S et al.. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C.  Hepatology. 2005;  42(1) 63-71
    CrossrefPubMedGoogle Scholar
  • 51 Dackis C A, Kampman K M, Lynch K G, Pettinati H M, O'Brien C P. A double-blind, placebo-controlled trial of modafinil for cocaine dependence.  Neuropsychopharmacology. 2005;  30(1) 205-211
    CrossrefPubMedGoogle Scholar

Michael R LuceyM.D. 

Section of Gastroenterology and Hepatology, University of Wisconsin School of Medicine and Public Health

Madison, WI 53792-5124

Email: mrl@medicine.wisc.edu

      >