Fewer than one in seven adults with steatotic liver disease and alcohol use received treatment

Design

Single-centre retrospective cohort, US Veterans Affairs hepatology clinics, 2020 to 2025

Population

608 adults with steatotic liver disease (controlled attenuation parameter above 263 dB/m)

Primary outcome

Receipt of alcohol treatment among those with mild-to-moderate or hazardous alcohol use

Effect

13.4% received treatment over a median 27.1 months; 14.5% had hazardous use

This single-centre cohort looked at 608 adults with steatotic liver disease (defined by a controlled attenuation parameter above 263 dB/m) seen in hepatology clinics at a US Veterans Affairs system between 2020 and 2025. Most were men, with a mean age of 63.9 years.

Alcohol screening with AUDIT-C within six months of elastography was done in 91.6%. Of these, 46.3% reported no alcohol, 39.1% mild-to-moderate use and 14.5% hazardous use. Among those with any alcohol use, only 13.4% received pharmacotherapy or other alcohol treatment services over a median follow-up of 27.1 months. Receiving treatment was associated with a fall in AUDIT-C scores.

This is a single-centre, mostly male, observational study, and the link between treatment and lower scores could reflect who accepted treatment. The practical message is a process one: screening was done, but the step after a positive screen was often missing.

• Screen for alcohol with a validated tool such as AUDIT-C in every patient with steatotic liver disease.
• After a positive screen, offer brief intervention and linkage to treatment, and discuss medicines for alcohol use disorder where appropriate.
• Document the follow-up plan so the screen leads to an action.
• Reassess AUDIT-C at later visits to see whether drinking has changed.

Why it matters

The gap was not in detecting drinking but in doing something about it.

Don't overread it

This is a single-centre observational study in a mostly male veteran population, so the proportions may not apply to other settings.

The statistics, in plain English

The 13.4% is a proportion of the people with any alcohol use who got any treatment. The association with falling scores is not evidence that treatment caused the fall, because patients who engage may differ from those who do not.

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