- Design
- Retrospective single-system cohort
- Population
- 608 adults with steatotic liver disease, Veterans Affairs hepatology clinics
- Primary outcome
- Receipt of alcohol treatment among drinkers
- Effect
- 13.4% received any treatment over median 27 months
A single-system Veterans Affairs cohort in the American Journal of Medicine (September 2026) followed 608 adults with steatotic liver disease on elastography seen in hepatology clinics from 2020 to 2025. Most (92%) had an AUDIT-C alcohol screen within six months: 46% reported no alcohol, 39% mild to moderate use and 15% hazardous use.
Among those who drank, only 13.4% received alcohol pharmacotherapy or any treatment service over a median 27 months. Those who did receive treatment had falling AUDIT-C scores over follow-up.
The population was 94% male veterans, and the link between treatment and lower scores is observational. But the gap is the finding: screening was done, and almost nobody acted on it.
Fatty liver is now often labelled metabolic, which can close the alcohol question too early. In patients with steatosis and any alcohol use, alcohol is a modifiable cause of progression.
- Take an alcohol history using AUDIT-C in every patient with steatotic liver disease
- Do not let a metabolic label end the alcohol conversation — many patients have both
- Offer brief intervention and consider naltrexone or acamprosate for hazardous drinking
- Record a referral pathway to alcohol services, not just the screening score
Why it matters
It shows the gap is not in screening but in what follows it.
Don't overread it
The fall in drinking among treated patients is an association, and the population was almost entirely male veterans.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for internal medicine, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free