title: Reluctance to Accept Alcohol Treatment by Alcoholic Liver Disease Transplant Patients: A Qualitative Study.
abstract: BACKGROUND
  Liver transplantation (LT) is the optimum treatment for patients with end-stage alcoholic liver disease (ALD). However, despite a recognized risk of relapse to harmful drinking, ALD transplant patients are reluctant to use speciality alcohol treatment to support their abstinence, even when offered within the LT context. This study aimed to understand and identify factors contributing to alcohol treatment reluctance by ALD patients undergoing transplantation.
  
  
  METHODS
  We conducted an in-depth qualitative study of ALD transplant patients. Minimally structured face-to-face interviews explored participants' alcohol-related experiences and their reasons for not using alcohol treatment during the course of their transplantation. Thematic analysis was used to analyze and interpret interview data to understand treatment reluctance based on participants' experiences.
  
  
  RESULTS
  Five major themes were identified among 3 subgroups of patients (pretransplant and posttransplant abstainers and posttransplant relapsers): (i) the "contract" of mandatory abstinence, (ii) the "gap in the program" involving the lack of candour between patient and staff about alcohol-related matters and the lack of addiction services, (iii) a preference by participants to self-manage their alcohol use disorder, (iv) social support as a facilitator of abstinence and the risk of relapse when social support is diminished, and (v) the fear of stigmatization. Each of these factors were dynamically interrelated and differed slightly for each subgroup.
  
  
  CONCLUSIONS
  The LT services may benefit from the inclusion of integrated specialist addiction services in their model of care. Such an approach may enhance the acceptability of alcohol treatment and reduce the risk of relapse among ALD transplant participants, especially for those whose social supports have diminished.
authors: Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; NHMRC Centre for Research Excellence in Mental Health and Substance Use, Australia.
authors: Cathy M
authors: CM
authors: Heyes
authors: Discipline of Behavioural and Social Sciences in Health, The University of Sydney, NSW, Australia.
authors: Toni
authors: T
authors: Schofield
authors: Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; Consultation Liaison Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors: Robert
authors: R
authors: Gribble
authors: Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW, Australia.
authors: Carolyn A
authors: CA
authors: Day
authors: Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; NHMRC Centre for Research Excellence in Mental Health and Substance Use, Australia.; Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW, Australia.
authors: Paul S
authors: PS
authors: Haber