Explainers

Non-Pharmacological Treatments for Alcohol-Related Liver Disease


Excessive alcohol intake is widely known to have various negative health outcomes for people of all ages.

Some of these negative outcomes can include:

  • Physical and mental illness
  • Injuries
  • Death
  • Harm to relationships

(Kaner et al. 2017)

Alcohol-Related Liver Disease

One of the most adverse health outcomes of excessive alcohol intake is alcohol-related liver disease (Buzzetti et al. 2017).

Alcoholic liver diseases can include:

  • Alcoholic hepatitis
  • Fatty liver
  • Alcoholic cirrhosis

Alcoholic liver diseases can cause a variety of health problems, from tiredness and confusion, to complete liver failure, vomiting blood, and death (Buzzetti et al. 2017)

Conversation-Based Interventions

With prevention being the best defence, Kaner et al. (2017) state that one effective evidence-based approach to preventing excessive intake of alcohol is for primary health settings to deliver brief ‘conversation-based interventions’.

Nowadays, technological advancements also allow clients to access interventions via mobile phones and computers (Kaner et al. 2017).

Kaner et al.’s (2017) study suggested that even conversation-based interventions conducted digitally (via mobile phones or computer, Skype, etc.) may decrease alcohol intake by up to three (UK) standard drinks each week (compared to the control group). However, it is important to note that the evidence, in this case, was of low to moderate quality (Kaner et al. 2017).

Klimas et al. (2014) highlight that people who use illicit drugs are likely to experience issues with alcohol use.

Drinking excessive amounts of alcohol in combination with drug use can lead to severe adverse health outcomes (Klimas et al, 2014).

Klimas et al (2014) aimed to investigate the effect of talking therapies on alcohol use for adults who, in particular, also use illicit drugs.

The review consisted of studies of low-quality evidence however, making it difficult for the researchers to ‘assess the effects of psychosocial interventions for problem alcohol use in illicit drug users’.

In Treating Alcohol-Related Liver Disease

Buzzetti et al.’s (2017) study to review pharmacological interventions for alcoholic liver disease did not provide any clear best treatment method.

With low-quality evidence and uncertain conclusions indicating further research is necessary regarding best practice for treating alcohol-related liver diseases (Buzzetti et al, 2017), could conversation-based intervention be considered as treatment?

A study by Foxcraft et al. (2016) found there to be only low or moderate quality of evidence related to motivational interviewing (MI) for preventing alcohol misuse in younger adults.

From their review, they were unable to find weighty benefits of MI for preventing alcohol misuse in young adults.

In Preventing Postoperative Complications

Another aspect of alcohol use/misuse to consider for healthcare workers is that there are higher rates of postoperative complications for excessive drinkers.

Some complications include:

  • Post-surgical infections;
  • Cardiopulmonary issues; and
  • Bleeding.

(Oppedal et al. 2012)

Oppedal et al. (2012) aimed to study the effect of various interventions to stop drinking alcohol preoperatively for excessive drinkers.

The conclusion of Oppedal et al. (2012) was that conversation-based cessation interventions, combined with a pharmacological element, could significantly lessen postoperative complications.

Interestingly, Oppedal et al. (2012) convey that there was no effect on the length of hospital stay or mortality rates from the intervention. However, the researchers state that the review included only a small amount of studies (and these may have been small sizes).

It is important to recognise that more research is needed to fully understand the effect of interventions for pre-surgery alcohol cessation in the prevention of postoperative complications (Oppedal et al. 2012).

Other Non-Pharmacological Treatment and Prevention Options

Siegfried et al. (2014) explain that there is widespread mainstream advertising for the consumption of alcohol, despite the various well-known health issues, such as alcohol-related liver disease, as well as safety concerns like violence and car accidents, that are connected to alcohol misuse.

There have, therefore, been suggestions to ban or restrict the advertisement of alcohol for the purpose of prevention (Siegfried et al. 2014).

Siegfried et al. (2014) completed a review on the notion of banning the advertising of alcohol but were unable to conclude whether it was effective.

The review further recommended that governments who wish to ban alcohol advertisements should do so as part of a research plan to evaluate the outcomes of the ban, over time, thus contributing to the body of evidence related to this topic (Siegfried et al. 2014).

 

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References

  • Buzzetti, E, Kalafateli, M, Thorburn, D, Davidson, BR, Thiele, M, Gluud, LL, Del Giovane, C, Askgaard, G, Krag, A, Tsochatzis, E, Gurusamy, KS 2017, ‘Pharmacological interventions for alcoholic liver disease (alcohol-related liver disease): an attempted network meta-analysis.’, Cochrane Database of Systematic Reviews 2017, no. 3, viewed 25 March 2018, https://www.ncbi.nlm.nih.gov/pubmed/28368093
  • Foxcroft, DR, Coombes, L, Wood, S, Allen, D, Almeida Santimano, NML & Moreira, MT 2016, ‘Motivational interviewing (MI) for preventing alcohol misuse in young adults is not effective enough’, Cochrane Database of Systematic Reviews 2016, no 7, viewed 25 March 2018, http://www.cochrane.org/CD007025/ADDICTN_motivational-interviewing-mi-preventing-alcohol-misuse-young-adults-not-effective-enough
  • Kaner, EFS, Beyer, FR, Garnett, C, Crane, D, Brown, J, Muirhead, C, Redmore, J, O’Donnell, A, Newham, JJ, de Vocht, F, Hickman, M, Brown, H, Maniatopoulos, G & Michie, S 2017, ‘Personalised digital interventions for reducing hazardous and harmful alcohol consumption in community-dwelling populations’, Cochrane Database of Systematic Reviews 2017, no. 9, viewed 25 March 2018, https://www.ncbi.nlm.nih.gov/pubmed/28944453
  • Klimas, J, Tobin, H, Field, CA, O’Gorman, CSM, Glynn, LG, Keenan, E, Saunders, J, Bury, G, Dunne, C & Cullen, W 2013, ‘Psychosocial interventions to reduce alcohol consumption in concurrent problem alcohol and illicit drug users’, Systematic Reviews, vol. 2, p. 3, viewed 25 March 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3564788/
  • Oppedal, K, Møller, AM, Pedersen, B, Tønnesen, H 2012, ‘Preoperative alcohol cessation prior to elective surgery’, Cochrane Database of Systematic Reviews 2012, no. 7, viewed 25 March 2018, https://www.ncbi.nlm.nih.gov/pubmed/22786514
  • Siegfried, N, Pienaar, DC, Ataguba, JE, Volmink, J, Kredo, T, Jere, M & Parry, CDH 2014, ‘Restricting or banning alcohol advertising to reduce alcohol consumption in adults and adolescents’, Cochrane Database of Systematic Reviews 2014, no. 11, viewed 25 March 2018,

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