From the Guidelines
Alcohol cessation is strongly recommended for patients with cirrhosis, alcoholic hepatitis, or hepatocellular carcinoma (HCC) to limit the risk of excess mortality. This recommendation is based on the most recent and highest quality study available, which suggests that complete and permanent cessation of alcohol consumption is likely to improve outcomes in these patients 1.
Key Considerations for Alcohol Cessation
- For patients with cirrhosis, persistent consumption of more than two standard drinks/day is independently associated with increased mortality 1.
- In cases of severe alcoholic hepatitis, even low levels of alcohol consumption are correlated with a significantly increased risk of mortality 1.
- Prolonged alcohol abstinence in patients with HCC is associated with a better overall prognosis than continued drinking, although the effects of very low levels of alcohol consumption are not well understood 1.
Approach to Alcohol Cessation
- A comprehensive approach that includes medical supervision is crucial, especially for heavy drinkers.
- Medications such as benzodiazepines (e.g., diazepam or lorazepam) may be used for medical detoxification to manage withdrawal symptoms.
- Maintenance therapy with medications like naltrexone, acamprosate, or disulfiram, along with thiamine supplementation, can support abstinence and prevent complications.
- Behavioral support through counseling, support groups, and addressing underlying mental health issues is essential for successful cessation.
Importance of Cessation
- The harmful role of continued alcohol consumption in patients with cirrhosis, alcoholic hepatitis, or HCC is well-established, although the level of scientific evidence regarding the exact thresholds of harmful consumption remains low 1.
- Given the potential for significant morbidity and mortality associated with continued alcohol use in these patients, complete cessation is the recommended course of action.
From the Research
Alcohol Cessation Methods
- There are several methods for alcohol cessation, including pharmacotherapy and cognitive behavioral therapy (CBT) 2, 3, 4, 5, 6.
- Studies have shown that combined pharmacotherapy with naltrexone and acamprosate, along with CBT, can be effective in achieving alcohol abstinence 2.
- Acamprosate and naltrexone have been shown to be superior to placebo in supporting continuous abstinence, with acamprosate increasing the total number of abstinence days by 14% 3.
Pharmacotherapy Options
- Disulfiram, naltrexone, and acamprosate are three medications approved for the treatment of alcohol use disorder by the US Food and Drug Administration (FDA) 5.
- Supervised disulfiram has been shown to be effective in reducing heavy drinking days and increasing abstinent days, especially during the continuous medication period 4.
- Naltrexone and acamprosate have been shown to be effective in reducing drinking outcomes, with naltrexone being as effective as combined medication with CBT in some studies 2, 4.
Combination Therapy
- Combination therapy with naltrexone and acamprosate has been shown to be effective in achieving alcohol abstinence, with a trend favoring combination medication 2.
- However, other studies have found that combination therapy may not be significantly better than single-agent therapy, and that the benefit of combination therapy may depend on specific symptoms or subpopulations 6.
- More research is needed to determine the effectiveness of combination therapy for alcohol cessation 6.