Returning to drinking after alcohol-associated hepatitis (AH) is closely related to recurrent liver disease and death. Of those hospitalized for AH, 30% die within 90 days. Among the survivors, alcohol use is key to outcomes. The risk of relapse after AH is modifiable and lower in patients who engage with treatment for alcohol use disorder (AUD). Although behavioral therapy and medications can reduce drinking among people with AUD, it’s not clear which AH patients are most at risk for drinking or at what stages interventions are most helpful. For the study inAlcohol: Clinical & Experimental Research, US investigators assessed alcohol use among 518 adults with recent AH who were enrolled in clinical studies following discharge from the hospital.
Some participants were in a treatment trial for people with severe AH, while others, who had either moderate or severe AH, were studied observationally. They were all counseled on drinking cessation, and some engaged with addiction services or used AUD medications. All were assessed at intervals for up to 200 days after hospitalization.
Among the participants, 22% used alcohol within 3 months following hospitalization. After 6 months, 31% had used alcohol, with 12% drinking moderately (1–6 drinks a week) and 12% heavily (7+ drinks a week). Drinking was more likely among those with moderate AH, of whom 6 months after hospitalization, nearly half had used alcohol. Those with severe AH were less likely to return to drinking, perhaps reflecting stronger motivation to remain abstinent; their outcomes were similar between the treatment and observational study groups. Returning to drinking was linked to family histories of AUD and more frequent and intense alcohol use preceding hospitalization: those who had drunk on more than 20 days in the month before AH treatment had more than 3 times higher odds of drinking afterward. Taking medications for AUD was also linked to a greater risk, perhaps because those participants had more severe AUD or were treated in response to a relapse. Participants with a college education had half the odds of drinking than those without a college education.
The findings emphasize the need for early AUD interventions in all patients with AH. They point to the importance of identifying those at high risk of early relapse, potentially tailoring interventions, and determining optimal care.
