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Principal Investigator: Lamia Haque
Organization: YALE UNIVERSITY
Fiscal Year: 2024
Award: $194,267
Funding agency: National Institute on Alcohol Abuse and Alcoholism
ABSTRACT
Deaths due to alcohol-associated liver disease (ALD), a serious consequence of alcohol use disorder (AUD),
have risen substantially over the past two decades. Although reduction and cessation of alcohol use is a vital
component of treating ALD, few patients with AUD and ALD receive treatment for AUD, including behavioral
treatment or medications (MAUD), due to clinician, patient, and system-level barriers ranging from lack of
familiarity to stigma. Treatment of AUD, including MAUD, is associated with liver-specific benefits in patients
with ALD, such as reductions in complications including cirrhosis, or scarring of the liver, and hepatic
decompensation, or severe deterioration of liver function. As such, guidelines on the treatment of ALD
recommend AUD treatment be provided to patients with AUD and ALD, however little is known regarding which
treatments may be of greatest benefit in this population and how to deliver them most effectively. There is a
lack of data regarding the comparative effectiveness of different forms of MAUD among patients with AUD and
ALD and limited consideration of the perspectives of patients with AUD and ALD with regard to receipt of AUD
treatment. Finally, while multidisciplinary teams of co-located hepatology and addiction specialists to facilitate
AUD treatment in patients with AUD and ALD have been described, these models of care are resource-
intensive and not commonly available. Therefore, alternative strategies are needed to inform delivery of AUD
treatment for patients with both AUD and ALD. Hepatology clinicians are well-positioned to provide integrated
AUD treatment, such as MAUD and brief counseling, for patients with AUD and ALD in the context of routine
hepatology care. Existing NIAAA resources, such as the Healthcare Professional’s Core Resource on Alcohol
(HPCR) and Alcohol Treatment Navigator (ATN), are readily available but have not been tailored for
implementation in hepatology clinics. Therefore, the Specific Aims of this work are to: 1) Determine the
comparative effectiveness of different forms of MAUD among patients with AUD by liver disease severity,
relative to no MAUD, 2) Elicit AUD treatment preferences among patients with AUD and ALD, particularly
regarding integrated MAUD and brief counseling in hepatology clinics, and 3) Determine the feasibility and
acceptability of a novel implementation intervention to promote MAUD and brief counseling in hepatology
clinics using the HPCR and ATN with clinical decision support. As a board-certified hepatologist and addiction
medicine specialist with training in health services research, I am well-suited to lead efforts to integrate AUD
treatment into hepatology clinics. Guided by mentors with expertise in pharmacoepidemiology, mixed-methods
research, clinical trials, and implementation science, this work will generate important foundational data and
provide me with the opportunity to build methodological expertise in these complementary areas. This will be
critical to achieve my goal of becoming an independent clinician-investigator dedicated to optimizing the care
of patients with AUD and ALD.
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