Referral to hepatology is lower in patients with excessive alcohol use who have mental health disorders

People with alcohol use disorder (AUD) who are at risk of advanced liver disease are less likely to be referred for liver evaluation and care if they present primarily with alcohol-related mental health issues or a mental health diagnosis, according to a study of referral practices in Virginia’s largest health system.

The findings point to the possibility of widespread missed opportunities for treating three conditions that commonly co-occur: AUD, mental health disorders, and liver disease. Recent years have seen notable increases in the U.S. in alcohol-related deaths, mental health disorders, and hospital admissions relating to alcohol use and concurrent mental health conditions.

AUD is a significant cause of liver disease, and both addiction and co-occurring mental illness can be barriers to successful liver treatment. Integrating AUD treatment, mental health care, and hepatology (liver care) is necessary to improve outcomes, but data suggests this approach is not the norm.

For the study published in Alcohol: Clinical & Experimental Research, investigators evaluated which patients with excessive alcohol use and potentially advanced liver disease were referred to hepatology for evaluation and treatment.

Researchers worked with data representing 316 patients experiencing excessive alcohol use who were treated between 2013 and 2023. All the patients in the study had results from FIB-4—a blood test included in routine lab work—correlating to a high risk of advanced liver fibrosis.

The researchers collected information on the participants’ demographics, alcohol-related hospital admissions, predicted mortality, referral patterns, and mental health diagnoses and hospitalizations. They used statistical analysis to explore factors associated with referral to hepatology.

Most patients were men, and the average age was 60. Six in 10 were Caucasian, and nearly 4 in 10 African American. Only 37% of patients with excessive alcohol use and a high risk of advanced liver disease were referred for liver care.

Referrals to hepatology were associated with higher FIB-4 scores, more co-occurring health conditions, and hospitalization due to AUD-related liver issues or gastrointestinal concerns. Patients less likely to be referred for liver care included those admitted to the hospital for physical injury or alcohol-related mental health concerns, who presented with mental health disorders, or who were older.

Of these, patients with depression or suicidal ideation were more frequently referred to hepatology than patients with other mental health diagnoses.

The study identified an opportunity to increase integration of care across specialties serving patients with alcohol-related liver disease and mental health conditions. People presenting with primarily mental health or addiction issues were especially unlikely to be referred for appropriate liver care.

The findings highlight the need for health care providers to be educated about the importance of multispecialty care, including hepatology and GI referrals. Managing liver disease is necessary for reducing the risk of cirrhosis, cancer, and other conditions and for liver transplant evaluation. Similarly, early identification of AUD in patients with liver disease is essential for improving outcomes.