Background & Aims

Alcohol-associated liver disease (ALD) is a devastating complication of alcohol use disorder (AUD). Once it develops, ALD is exceedingly difficult to treat; it therefore is critical to identify ways to prevent ALD. By treating the causes of increased alcohol consumption, psychotherapy may offer prophylactic benefit against the development of ALD for patients with AUD.

Methods

In this retrospective cohort study, we used International Classification of Diseases, 9th and 10th revision, codes to identify 9635 patients with AUD in the Mass General Brigham Biobank. The mean follow-up period from AUD diagnosis was 9.2 years. We used Cox regression models to generate hazard ratios (HR) for the development of ALD given the receipt or nonreceipt of psychotherapy, adjusting for a range of other contributors including the receipt of medication-assisted treatment.

Results

In our cohort, 60.4% of patients were men, 83.5% of patients were white, the median age was 57.0 years, and 3544 patients (36.8%) received psychotherapy. ALD developed in 1135 patients (11.8%). In multivariable analysis, psychotherapy was associated with a reduced rate of ALD (HR, 0.59; 95% CI, 0.50–0.71; P < .001). This association held for both individual psychotherapy (HR, 0.70; 95% CI, 0.56–0.86; P < .001) and group psychotherapy (HR, 0.76; 95% CI, 0.61–0.94; P = .01). Among patients with cirrhosis, psychotherapy was associated with a lower rate of hepatic decompensation (HR, 0.68; 95% CI, 0.48–0.95; P = .03).

Conclusions

The receipt of psychotherapy in the setting of AUD is associated with reduced incidence and progression of ALD. Given the safety and potential benefit of psychotherapy, clinicians should consider using it to prevent the development of ALD.

中文翻译：

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酒精使用障碍的心理治疗可降低发生酒精相关肝病的风险

 背景与目标

酒精相关性肝病 (ALD) 是酒精使用障碍 (AUD) 的一种破坏性并发症。 ALD 一旦发展就极难治疗。因此，找到预防 ALD 的方法至关重要。通过治疗饮酒量增加的原因，心理治疗可以为 AUD 患者提供预防 ALD 发展的益处。

 方法

在这项回顾性队列研究中，我们使用国际疾病分类第 9 版和第 10 版代码来识别麻省总医院布里格姆生物库中的 9635 名 AUD 患者。 AUD 诊断后的平均随访时间为 9.2 年。我们使用 Cox 回归模型来生成在接受或不接受心理治疗的情况下发生 ALD 的风险比 (HR)，并调整一系列其他因素，包括接受药物辅助治疗。

 结果

在我们的队列中，60.4%的患者是男性，83.5%的患者是白人，中位年龄为57.0岁，3544名患者（36.8%）接受了心理治疗。 1135 名患者 (11.8%) 出现 ALD。在多变量分析中，心理治疗与 ALD 发生率降低相关（HR，0.59；95% CI，0.50–0.71； P < .001）。这种关联适用于个体心理治疗（HR，0.70；95% CI，0.56-0.86； P < .001）和团体心理治疗（HR，0.76；95% CI，0.61-0.94； P = .01）。在肝硬化患者中，心理治疗与较低的肝功能失代偿发生率相关（HR，0.68；95% CI，0.48-0.95； P = .03）。

 结论

AUD 接受心理治疗与 ALD 的发病率和进展降低相关。鉴于心理治疗的安全性和潜在益处，临床医生应考虑使用它来预防 ALD 的发展。