Diagnosis and Management of Alcohol Use Disorder in Patients with Liver Disease: Lights and Shadows

  • Giovanni AddoloratoEmail author
  • Gabriele A. Vassallo
  • Antonio Mirijello
  • Antonio Gasbarrini


Alcohol use disorder is the most common cause of advanced liver disease in the Western world. Diagnosis of alcohol use disorder can be difficult because patients with liver disease tend to deny alcohol intake for the fear of being excluded from treatment and because available biomarkers of alcohol intake have poor specificity in these patients. Alcohol abstinence is the cornerstone of the therapy in these patients. However, pharmacological treatments for alcohol use disorders have not been formally tested in patients with advanced liver disease, except for baclofen. Psychosocial intervention became crucial in these patients considering the limited pharmacological choice. However, psychosocial approach and an appropriate team to manage these patients are not still well defined. In this review, we critically discuss the diagnosis and the management of alcohol use disorder in patients with liver disease.

Key Words

Alcohol use disorder alcoholic liver disease alcoholic cirrhosis anti-craving drugs psychosocial approach liver transplantation 



Alcohol use disorder


Alcohol-related liver disease


Alcohol withdrawal syndrome


Liver disease


Randomized controlled trials



The authors are grateful to Ms. Caterina Mirijello for her expert revision of the English language.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Author Contributions

G. Addolorato, G.A. Vassallo, and A. Mirijello interpreted the literature data. G. Addolorato, G.A. Vassallo, A. Mirijello, and A. Gasbarrini thought the scientific rationale and wrote and revised the paper. G. Addolorato and A. Gasbarrini revised the final version of the paper. Each one of the authors has contributed to the writing and reviewing of the paper and approved the final version.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interests.

Guarantor of the article: Giovanni Addolorato.

Supplementary material

13311_2019_802_MOESM1_ESM.pdf (2 mb)
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Copyright information

© The American Society for Experimental NeuroTherapeutics, Inc. 2019

Authors and Affiliations

  • Giovanni Addolorato
    • 1
    • 2
    Email author
  • Gabriele A. Vassallo
    • 1
    • 3
  • Antonio Mirijello
    • 1
    • 4
  • Antonio Gasbarrini
    • 2
    • 5
  1. 1.“Internal Medicine and Alcohol Related Disease” Unit, Department of Internal Medicine and GastroenterologyCatholic University of RomeRomeItaly
  2. 2.Fondazione Policlinico Universitario A Gemelli IRCCS Research HospitalRomeItaly
  3. 3.Department of Internal MedicineBarone Lombardo HospitalCanicattìItaly
  4. 4.Department of Medical SciencesIRCCS Casa Sollievo della Sofferenza HospitalSan Giovanni RotondoItaly
  5. 5.Department of Internal Medicine and GastroenterologyCatholic University of RomeRomeItaly

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