title: Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic Review.
abstract: OBJECTIVE
  We conducted a systematic review of efficacy of psychosocial interventions in inducing or maintaining alcohol abstinence in patients with chronic liver disease (CLD) and alcohol use disorder (AUD).
  
  
  METHODS
  We performed structured keyword searches in PubMed, PsychINFO, and MEDLINE for original research articles that were published from January 1983 through November 2014 that evaluated the use of psychosocial interventions to induce or maintain alcohol abstinence in patients with CLD and AUD.
  
  
  RESULTS
  We identified 13 eligible studies that comprised 1945 patients; 5 were randomized controlled trials (RCTs). Delivered therapies included motivational enhancement therapy, cognitive behavioral therapy (CBT), motivational interviewing, supportive therapy, and psychoeducation either alone or in combination in the intervention group and general health education or treatment as usual in the control group. All studies of induction of abstinence (4 RCTs and 6 observational studies) reported an increase in abstinence among participants in the intervention and control groups. Only an integrated therapy that combined CBT and motivational enhancement therapy with comprehensive medical care, delivered during a period of 2 years, produced a significant increase in abstinence (74% increase in intervention group vs 48% increase in control group, P = .02), which was reported in 1 RCT. All studies of maintenance of abstinence (1 RCT and 2 observational studies) observed recidivism in the intervention and control groups. Only an integrated therapy that combined medical care with CBT produced a significantly smaller rate of recidivism (32.7% in integrated CBT group vs 75% in control group, P = .03), which was reported from 1 observational study. However, data were not collected for more than 2 years on outcomes of patients with CLD and AUD.
  
  
  CONCLUSIONS
  In a systematic analysis of studies of interventions to induce or maintain alcohol abstinence in patients with CLD and AUD, integrated combination psychotherapy with CBT, motivational enhancement therapy, and comprehensive medical care increased alcohol abstinence. No psychosocial intervention was successful in maintaining abstinence, but an integrated therapy with CBT and medical care appears to reduce recidivism.
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Anam
authors.initials: A
authors.lastname: Khan
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Aylin
authors.initials: A
authors.lastname: Tansel
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, and Texas Medical Center Digestive Disease Center, Houston, Texas; Dan L. Duncan Cancer Center, Houston, Texas; Center for Translational Research in Inflammatory Diseases (CTRID) at the Michael E. DeBakey VA, Houston, Texas.
authors.forename: Donna L
authors.initials: DL
authors.lastname: White
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, Texas.
authors.forename: Waleed Tallat
authors.initials: WT
authors.lastname: Kayani
authors.affiliation: Department of Medicine, Aga Khan University, Karachi, Pakistan.
authors.forename: Shah
authors.initials: S
authors.lastname: Bano
authors.affiliation: Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, and Texas Medical Center Digestive Disease Center, Houston, Texas; Department of Psychiatry, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
authors.forename: Jan
authors.initials: J
authors.lastname: Lindsay
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, and Texas Medical Center Digestive Disease Center, Houston, Texas; Dan L. Duncan Cancer Center, Houston, Texas.
authors.forename: Hashem B
authors.initials: HB
authors.lastname: El-Serag
authors.affiliation: Section of Gastroenterology and Hepatology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas; Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, and Texas Medical Center Digestive Disease Center, Houston, Texas; Dan L. Duncan Cancer Center, Houston, Texas. Electronic address: fasiha.kanwal@va.gov.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
mesh_terms: D064829:Alcohol Abstinence / Q000523:psychology*; D000437:Alcoholism / Q000150:complications*; D001521:Behavior Therapy / Q000379:methods*; D006801:Humans; D008107:Liver Diseases / Q000628:therapy*; D000067250:Psychiatric Rehabilitation / Q000379:methods*; D016896:Treatment Outcome
keywords: Alcohol Abuse; Alcoholism; Cirrhosis; MET; Relapse Prevention