Alcohol use disorder is the disease driving alcohol-associated liver disease, and it is the one part of the problem that is reliably treatable. Yet in most hepatology clinics it is handled with a sentence of advice and, at best, a referral that nobody follows up. The liver gets a MELD score, a scan and an endoscopy; the addiction gets a line in the letter.

Make it a managed condition instead. Screen formally with AUDIT rather than asking how much someone drinks — the question that gets an underestimate. Assess for withdrawal risk before advising abrupt cessation in a heavy drinker, because unsupervised withdrawal in a patient with cirrhosis is dangerous. Offer pharmacotherapy where it is appropriate, which as of today includes naltrexone in compensated disease. Arrange psychosocial support as part of the same plan and record who is providing it. And review drinking at every appointment with the same routine attention as the liver function tests, because it predicts outcome better than they do.

The practical test of whether this has been done properly is simple: read your own last clinic letter for a patient with alcohol-related liver disease and see whether there is a named intervention with a named provider and a review date, or just the word 'abstinence'.

Screen with AUDIT at diagnosis and repeat it; do not rely on asking about weekly units.
Assess withdrawal risk before advising abrupt cessation in a dependent drinker.
Offer pharmacotherapy explicitly rather than leaving it to another team.
Name the psychosocial provider and a review date in the clinic letter, not just the goal.
Review drinking at every visit; it predicts outcome better than the liver function tests do.

The statistics, in plain English

The evidence that abstinence changes outcome in alcohol-associated liver disease is observational and always will be, since drinking cannot be randomised — but the effect is large and consistent enough across cohorts that it is not seriously disputed. What has been randomisable is whether specific treatments increase abstinence, and that is where trial evidence exists. The gap worth noticing is that the intervention with randomised support is the one most often left out of the plan.