Behavioral Interventions to Reduce Alcohol Consumption Among Patients with Liver Disease Caused By Hepatitis C Virus: A Systematic Review

Background and Purpose: Alcohol consumption accelerates hepatitis C virus (HCV) cellular replication, the natural history of HCV infection, and has a synergistic effect on the progression of liver disease. The American Association for the Study of Liver Diseases recommends complete abstinence from any level of alcohol consumption for HCV-infected patients. Despite this warning, continued alcohol use among HCV-infected patients is prevalent in clinical settings. Nearly 60% of patients presenting at liver clinics continue to consume alcohol despite the harmful effects of continued use. The purpose of this systematic review was to identify and describe studies that designed and implemented behavioral interventions to reduce alcohol use among HCV-infected patients.

Methods:  This systematic review was conducted using the PRISMA Statement guidelines. PubMed, Psych Info, Web of Science, and Cochrane library databases were used to perform an exhaustive search of peer-reviewed articles published by March 15, 2015. The search strategy used Boolean operators in combination with the following keywords: hepatitis C, HCV, intervention, treatment, and alcohol. The first round of searches across the databases produced 4,384 citations. The second round of searches excluded citations published before 2010 and citations that were not published in English and without peer-review. Thereafter, the two investigators independently reviewed to citation titles and abstracts for inclusion. Abstracts that provided behavioral interventions to HCV-infected patients were advanced for the fourth level of review. Full-text articles were reviewed; and there were no study design restrictions. Studies without adjunctive psychopharmacologic therapy and studies that reported outcomes of alcohol use were selected for inclusion. The two investigators converged to resolve any disagreement by consensus. Three studies met inclusion criteria.      

Results:  More than 50% of patients who received Cognitive Behavioral Therapy in combination with Motivational Enhancement Therapy achieved abstinence or significant reductions in alcohol use over time (Dieperink et al. 2010). Motivational Enhancement Therapy significantly increased the percentage of days abstinent from baseline to 6 months compared to the control condition (35% to 73%) (Dieperink et al. 2014). Twenty-seven percent of patients reduced alcohol use and 44% achieved abstinence with Motivational Interviewing in combination with Cognitive Behavioral Therapy (Preseschold-Bell et al. 2012). The following health and mental health topics were thematic in the three behavioral studies: psychoeducation on the synergistic effects of alcohol and HCV on liver injury, the adverse impact of alcohol on HCV antiviral therapy, management of cravings and urges to use, relapse prevention, and stress and anxiety management.

Conclusions and Implications: Translation of harm reduction and cognitive based interventions—with integrated health and mental health curricula—for use in HCV clinics has the potential to positively change alcohol using behaviors among HCV-infected patients. Likewise, it is probable alcohol reduction or cessation will enhance adherence to antiviral therapy, improve social functioning and quality of life, and reduce engagement in other risky behaviors. HCV health scientists and interventionists are strongly encouraged to consider further research and future implementation of harm reduction and cognitive based interventions to modify alcohol using behaviors among HCV-infected patients.