How can I effectively counsel patients with alcoholic liver disease about the risks of continued alcohol use and the benefits of abstinence?

Effective counselling for patients with alcoholic liver disease (ALD) should focus on clearly communicating the serious risks of continued alcohol consumption and the substantial benefits of abstinence.

• Explain the risks of continued alcohol use: Continued drinking in ALD can worsen liver damage, leading to progression to cirrhosis, decompensated liver disease (including jaundice, ascites, variceal bleeding, hepatic encephalopathy), and increased mortality risk. Patients should understand that harmful drinking patterns cause ongoing physical damage to the liver and other organs ¹,².

• Highlight the benefits of abstinence: Abstinence from alcohol is the cornerstone of managing ALD and can halt or even partially reverse liver damage, improve survival, and reduce complications. For patients with decompensated liver disease, sustained abstinence for at least 3 months is required before consideration for liver transplantation ¹.

• Discuss the importance of early intervention: Early reduction or cessation of alcohol intake can prevent extensive liver damage and improve outcomes. Patients are more likely to change behaviour if risks and benefits are discussed early and clearly ³.

• Address nutritional support and complications: Malnutrition is common in ALD and abstinence combined with nutritional support improves prognosis ¹.

• Offer referral and specialist support: Refer patients to hepatology or addiction specialists for comprehensive management, including assessment for liver biopsy, corticosteroid treatment in severe alcoholic hepatitis, and consideration of liver transplantation if appropriate ¹,².

• Use a patient-centred approach: Involve patients in discussions about their care, ensuring they understand the risks and benefits, and support informed decision-making ²,³.