Utilizing Alcohol Use Disorder Pharmacotherapy in Hepatology, With Hersh Shroff, MD, MPA – HCPLive

Report on Pharmacotherapy for Alcohol Use Disorder in Liver Transplant Recipients and Alignment with Sustainable Development Goals

Introduction

This report analyzes new research concerning prescription rates for Alcohol Use Disorder (AUD) medications among liver transplant recipients with a history of Alcohol-associated Liver Disease (ALD). The findings highlight a significant treatment gap that directly impacts the achievement of the United Nations Sustainable Development Goals (SDGs), particularly SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

Alignment with SDG 3: Good Health and Well-being

The research findings present a critical challenge to the fulfillment of SDG Target 3.5: “Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.” The underutilization of proven, effective pharmacotherapy for AUD in a high-risk patient population demonstrates a systemic failure in providing comprehensive care. Addressing the intricate link between liver disease, addiction, and mental health is essential for a holistic approach to health, as envisioned by SDG 3.

Key Research Findings

Data presented at the American Association for the Study of Liver Diseases (AASLD) The Liver Meeting 2025 provides a quantitative analysis of this treatment gap. The retrospective study utilized deidentified patient data from Epic Cosmos.

• Study Cohort: 17,975 adult patients in the US who received a liver transplant between January 2015 and December 2023 and had a diagnosis of ALD.
• Patient Demographics: The average age at transplant was 54 years, 31% of patients were female, and 72% had a concomitant diagnosis of an alcohol-related disorder.
• Post-Transplant Alcohol Use: Of the 34% of patients with available ethanol biomarker tests, 15% tested positive for an ethanol metabolite, indicating a return to alcohol use.

Analysis of Prescription Rates

The core finding reveals a significant shortfall in the application of evidence-based treatment, hindering progress toward SDG 3.

1. Overall Prescription Rate: Only 3.4% of patients were prescribed a medication for AUD within one year following their liver transplant.
2. Medication Breakdown: Prescriptions included baclofen (1.9%), naltrexone (0.84%), and acamprosate (0.85%).
3. Positive Trend: A significant increase in prescriptions was observed over the study period, rising from 2.0% of transplant recipients in 2015 to 6.2% in 2023. However, the overall rate remains critically low.

Barriers to Achieving Health Equity (SDG 10) and Well-being (SDG 3)

Several barriers contribute to the low prescription rates, creating health inequalities and preventing the attainment of well-being for this vulnerable group.

• Clinician Discomfort: Many gastroenterologists and hepatologists report a lack of training in addiction and mental health, leading to discomfort and hesitation in prescribing AUD pharmacotherapy.
• Misconceptions about Safety: A persistent perception that AUD medications may be unsafe in this patient population, despite evidence of their safety and efficacy.
• Social Stigma: A prevailing stigma surrounding the use of medications to treat addiction, which impacts both patient acceptance and clinician prescribing habits. This represents a significant barrier to achieving health equity as outlined in SDG 10.

Recommendations and Future Directions for Achieving SDG Targets

To align clinical practice with the objectives of SDG 3 and SDG 10, the following actions are recommended:

1. Enhance Clinician Education: Integrate comprehensive training on addiction and mental health into hepatology and gastroenterology curricula to build clinician confidence and competence in managing AUD.
2. Disseminate Evidence: Broadly share research findings on the safety and efficacy of AUD pharmacotherapy to dispel myths and inform clinical practice.
3. Promote Integrated Care Models: Foster partnerships between hepatology, addiction medicine, and mental health services to provide holistic, patient-centered care, directly supporting SDG 17 (Partnerships for the Goals).
4. Combat Stigma: Increase patient involvement and public awareness to challenge the stigma associated with addiction and its treatment, ensuring equitable access to care for all.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article primarily addresses issues related to SDG 3: Good Health and Well-being. The entire discussion revolves around a specific health crisis: the under-treatment of alcohol use disorder (AUD) in patients who have received liver transplants for alcohol-associated liver disease (ALD). This connects directly to the goal of ensuring healthy lives and promoting well-being for all at all ages.

• SDG 3: Good Health and Well-being: The article focuses on the medical treatment of a substance use disorder and a non-communicable disease (liver disease). It discusses prescription rates, the need for better healthcare provider training, the integration of mental health services, and the importance of research to improve patient outcomes. It highlights a significant gap in healthcare delivery for a vulnerable patient population, which is a core concern of SDG 3.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, two specific targets under SDG 3 are clearly identifiable:

1. Target 3.5: Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol.
   • The article’s central theme is the low rate of pharmacotherapy prescriptions for AUD, which is a direct measure of the “treatment of substance abuse” and “harmful use of alcohol.” The research presented aims to contextualize and understand the use of medications designed to treat AUD in a high-risk group, directly aligning with the goal of strengthening treatment.
2. Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
   • Alcohol-associated liver disease (ALD) is a non-communicable disease. The patients discussed are at a stage so severe they require a liver transplant, indicating a high risk of premature mortality. Treating the underlying AUD is a critical component of post-transplant “treatment” to prevent relapse and subsequent graft failure or death.
   • The article explicitly mentions the intricate link between “the liver disease and the addiction, and sometimes a third condition of mental health,” directly addressing the target’s call to “promote mental health and well-being” as an integral part of managing non-communicable diseases.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article provides several specific quantitative and qualitative indicators that can be used to measure progress towards the identified targets.

• For Target 3.5 (Treatment of substance abuse):
  • Indicator: The percentage of liver transplant recipients with ALD who are prescribed medication for AUD. The article states this was only 3.4% within one year after transplant in the study cohort.
  • Indicator: The trend in prescription rates over time. The article notes a significant increase from 2.0% of transplant recipients in 2015 to 6.2% in 2023, which can be tracked to measure progress.
  • Indicator: The percentage of patients with a positive ethanol biomarker test post-transplant. The study found that 15% of patients tested were positive, indicating ongoing harmful alcohol use and a continued need for treatment.
• For Target 3.4 (Treatment of non-communicable diseases and promotion of mental health):
  • Indicator: The prevalence of a diagnosed alcohol-related disorder among liver transplant recipients. The article states that 72% of the cohort had a documented concomitant diagnosis, highlighting the scale of the underlying condition that contributes to the non-communicable disease.
  • Indicator: The gap in integrated care. The article implies this through the observation that “many hepatologists are not trained to deal with addiction or mental health, creating a sense of discomfort among clinicians.” Closing this training and comfort gap is a measure of progress in promoting holistic well-being.

4. Table of SDGs, Targets, and Indicators

Source: hcplive.com