Efficacy of psychosocial interventions to reduce alcohol use in patients with alcohol-related liver disease: a systematic review of randomised controlled trials.

Background: Effective interventions to reduce harm in patients with alcohol-related liver disease (ARLD) remain a clinical unmet need. This systematic review fills a gap in the literature by assessing the efficacy of psychosocial interventions in this clinical population.

Methods: A systematic search for randomised controlled trials (RCTs) was conducted in February 2021 on: CENTRAL, CINAHL, EMBASE, MEDLINE, PubMed, PsycINFO, Scopus and Web of Science. Study screening and data extraction were conducted independently by two reviewers. The data was presented through narrative synthesis and informed by risk of bias (Risk of Bias 2) and GRADE analyses. Primary outcomes were drinking reduction and abstinence at the longest follow-up.

Results: Ten RCTs were included, evaluating interventions such as cognitive-behavioural therapy (CBT), motivational enhancement therapy (MET), motivational interviewing (MI) or peer support. The total population included 1,519 participants. Four studies included more than one psychosocial intervention, and two trialled an integrated approach including medical and psychosocial management of ARLD.

A significant alcohol reduction trend was only observed with peer support (p < 0.05), MET (p = 0.03) and MI (p = 0.035), while improved abstinence outcomes were limited to peer support (p < 0.05), MET (p = 0.024) and CBT/MET as part of integrated treatment (p = 0.02). The overall certainty of the evidence was high for reduction and moderate for abstinence outcomes. Six studies presented low risk of bias, one flagged some concerns and three presented a high risk of bias.

Conclusion: While there is some data suggesting the efficacy of psychosocial interventions, the available literature, and its respective quality, demonstrates a lack of robust evidence of the efficacy of psychosocial interventions in ARLD. This may affect the translation of the evidence into real-world settings. The findings of this review highlight a need for new interventions, tailored to this clinical population, to be trialled and evaluated.