Mack Mitchell, MD, is the vice president for medical affairs and the Nancy and Jeremy Halbreich Professor of Internal Medicine at UT Southwestern.

Mack Mitchell, MD

Reducing Alcohol Use in Patients with Liver Disease, with Mack Mitchell, MD

 remains a critical yet underutilized component of 

While significant advances have been made in addressing the complications of advanced liver disease, there is a growing recognition that early intervention is essential for preventing disease progression. However, the stigma surrounding AUD, both within the healthcare system and society at large, frequently creates barriers to effective treatment.

A 2024 study from Massachusetts General Hospital found that although practice recommendations from several medical societies advise against potentially stigmatizing language for AUD and ALD, many liver transplant centers continue to use outdated terms like “alcoholism” and “alcoholic,” potentially hindering patient care and their willingness to seek treatment.

Overcoming challenges like this will require a shift in perspective, recognizing AUD as a treatable medical condition and integrating evidence-based interventions into routine hepatology care.

, Mack Mitchell, MD, vice president for medical affairs and the Nancy and Jeremy Halbreich Professor of Internal Medicine at UT Southwestern, reviews pharmacologic treatment options for AUD in patients with ALD and looks ahead to other medications that may eventually be used in these patients.

Mitchell begins by highlighting the 3 medications that are currently approved by the FDA to reduce drinking: disulfiram, naltrexone, and acamprosate. However, he notes that disulfiram is not suitable for use in patients with liver disease due to its off-target side effects.

Of the remaining therapies, Mitchell says clinicians should consider acamprosate for their patients who have a longer drinking history and disulfiram for patients in earlier stages of AUD.

Looking ahead, Mitchell says he believes GLP-1 receptor agonists will eventually be used for patients with AUD and ALD, citing recent research demonstrating use of semaglutide led to reduced alcohol consumption. Similarly, he says he thinks resmetirom (Rezdiffra), which is currently approved by the FDA for the treatment of patients with noncirrhotic metabolic dysfunction-associated steatohepatitis (MASH), will be used for the treatment of AUD and ALD.

“I think the landscape out there is pretty exciting,” Mitchell concluded. “Hopefully, over the next 5 to 10 years, we will see a lot better outcomes in all of the patients with steatotic liver disease.”

Managing Alcohol Use Disorder in Alcohol-Associated Liver Disease, with Mack Mitchell, MD

Editors’ note: Mitchell has relevant disclosures with Durect, GlaxoSmithKline, and National Institute on Alcohol Abuse and Alcoholism.

Brooks A. The Power of Words: Liver Transplant Centers Continue to Use Stigmatizing Language. HCPLive. February 17, 2024. Accessed March 24, 2025. 

https://www.hcplive.com/view/the-power-words-liver-transplant-centers-continue-use-stigmatizing-language

Brooks A. Resmetirom (Rezdiffra) Receives Historic FDA Approval for Noncirrhotic NASH. HCPLive. March 14, 2024. Accessed March 24, 2025. 

https://www.hcplive.com/view/resmetirom-rezdiffra-receives-historic-fda-approval-for-noncirrhotic-nash

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Mitchell reviews FDA-approved drugs for reducing alcohol use, which ones can be used in patients with liver disease, and other therapies on the horizon.

 remains a critical yet underutilized component of hepatology care.

While significant advances have been made in addressing the complications of advanced liver disease, there is a growing recognition that early intervention is essential for preventing disease progression. However, the stigma surrounding AUD, both within the healthcare system and society at large, often creates barriers to effective treatment.

A 2024 study from Massachusetts General Hospital found that although practice recommendations from several medical societies advise against potentially stigmatizing language for AUD and ALD, many liver transplant centers continue to use outdated terms like “alcoholism” and “alcoholic,” potentially hindering patient care and their willingness to seek treatment as well as posing significant implications for disease detection and intervention strategies.

Overcoming such challenges will require a shift in perspective, recognizing AUD as a treatable medical condition and integrating evidence-based interventions into routine hepatology care.

, Mack Mitchell, MD, vice president for medical affairs and the Nancy and Jeremy Halbreich Professor of Internal Medicine at UT Southwestern, highlights the paradox facing hepatologists in the management of ALD. While the focus has historically been on treating complications of advanced disease, he emphasizes the need to shift attention toward early intervention—specifically, managing alcohol consumption before irreversible liver damage occurs.

“It really takes a conversation with patients to understand both why they're consuming alcohol and why they may be drinking more than they intend to, and also what strategies they can use to reduce that,” Mitchell explained.

He then draws parallels to the early days of 

 treatment, asserting that instead of only managing complications, hepatologists should prioritize preventing fibrosis progression and decompensation through proactive discussions with patients.

A crucial barrier to this approach, according to Mitchell, is the pervasive skepticism about the effectiveness of alcohol use treatment, something he attributes to underlying stigma that he says must be recognized and addressed, starting with the use of person-first language.

Mitchell also advocates for the use of brief interventions, beginning with obtaining patient consent to discuss alcohol use, acknowledging its impact on liver health, and engaging patients in a reflective conversation about their drinking patterns and health goals in an effort to facilitate meaningful behavior change.

He goes on to describe referral options for patients who require additional support, including 12-step programs, addiction counselors, psychologists, social workers, and even faith-based support systems.

Brooks A. The Power of Words: Liver Transplant Centers Continue to Use Stigmatizing Language. 

. February 17, 2024. Accessed March 20, 2025. 

Mitchell describes the “paradox” hepatologists face in the management of ALD and the importance of early intervention for improving outcomes.

Mack Mitchell, MD

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