I. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in alcoholic liver disease: effects on drinking behavior by nurse/physician teams.
BACKGROUND
This multicenter prospective, randomized, double-blind placebo-controlled trial was designed to evaluate the effectiveness of polyenylphosphatidylcholine against the progression of liver fibrosis toward cirrhosis in alcoholics. Seven hundred eighty-nine alcoholics with an average intake of 16 drinks per day were enrolled. To control excessive drinking, patients were referred to a standard 12-step-based alcoholism treatment program, but most patients refused to attend. Accordingly, study follow-up procedures incorporated the essential features of the brief-intervention approach. An overall substantial and sustained reduction in drinking was observed. Hepatic histological and other findings are described in a companion article.


METHODS
Patients were randomized to receive daily three tablets of either polyenylphosphatidylcholine or placebo. Monthly follow-up visits included an extensive session with a medical nurse along with brief visits with a study physician (hepatologist or gastroenterologist). A detailed physical examination occurred every 6 months. In addition, telephone consultations with the nurse were readily available. All patients had a liver biopsy before entry; a repeat biopsy was scheduled at 24 and 48 months.


RESULTS
There was a striking decrease in average daily alcohol intake to approximately 2.5 drinks per day. This was sustained over the course of the trial, lasting from 2 to 6 years. The effect was similar both in early dropouts and long-term patients, i.e., those with a 24-month biopsy or beyond.


CONCLUSIONS
In a treatment trial of alcoholic liver fibrosis, a striking reduction in alcohol consumption from 16 to 2.5 daily drinks was achieved with a brief-intervention approach, which consisted of a relative economy of therapeutic efforts that relied mainly on treatment sessions with a medical nurse accompanied by shorter reinforcing visits with a physician. This approach deserves generalization to address the heavy drinking problems commonly encountered in primary care and medical specialty practices.
Lieber
Charles S
CS
Bronx Veterans Affairs Medical Center and the Mount Sinai School of Medicine, New York 10468, USA. liebercs@aol.com
Weiss
David G
DG
Groszmann
Roberto
R
Paronetto
Fiorenzo
F
Schenker
Steven
S
D000428:Alcohol Drinking / Q000188:drug therapy / Q000378:metabolism / Q000523:psychology; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008108:Liver Diseases, Alcoholic / Q000188:drug therapy* / Q000378:metabolism / Q000523:psychology; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role / Q000523:psychology; D010713:Phosphatidylcholines / Q000627:therapeutic use*; D010819:Physician's Role / Q000523:psychology; D011446:Prospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs
D010713:Phosphatidylcholines; C005152:lipostabil