Addressing Stigma to Improve Outcomes in Alcohol-Related Liver Disease

Shame derived from structural or self-stigma may inhibit patients from obtaining treatment for their alcohol-related liver disease. This could be because patients might downplay their drinking problems. By internalizing cultural norms surrounding alcohol use disorder (AUD), those with alcohol-related liver disease might fear being labeled as an “alcoholic.” ¹

The healthcare system was designed to separate addiction and hepatology care. Patients would see their alcohol or addiction specialist for alcohol-related issues and would see their hepatology specialist for liver problems. This contributes to patients feeling like they are the ones to be blamed—that their alcohol use was the sole reason they had developed liver disease.

However, this is not true. Although alcohol can lead to liver problems, other causes such as genetics or obesity can lead to liver issues, too.

Research suggests work needs to be done on de-stigmatizing alcohol-related liver disease. A recent study revealed limited usage of non-stigmatization language for AUD and alcohol-related liver disease, underscoring the need for more patient-centered language in transplant centers.^2,3

In this HCPLive special report, Hersh Shroff, MD, MPA, moderated a conversation between hepatology specialist Jay Luther, MD, and addiction specialist Chris Kahler, PhD, to discuss the stigmatization of AUD and how hepatologists and addiction specialists can work to collaborate to give patients improved care.

The first part of the report focused on the different types of stigma and how the stigma around AUD may contribute to delays in seeking care for liver disease. The second half of the discussion pivoted to how the collaboration between hepatology and addiction specialists may reduce the stigma surrounding alcohol-associated liver disease.

“To expect that the individual necessarily will have full control over their capacity to say, ‘I can stop drinking tomorrow’ is not realistic for many people,” Kahler said. “It involves not just the involvement of psychiatrists, but social workers, or psychologists, other people who can think about the social determinants of health because those are often driving factors both in alcohol use, but also in delays in seeking care.”

He added the importance of peer support or recovery coaches to share experiences with to reduce the stigma. He also said screening for unhealthy alcohol use is important, rather than a doctor telling their patient, “I think you need to quit drinking.” Kahler stressed the importance of referring the patient to a liver specialist so they can examine actual negative impacts instead of making assumptions.

“Catching patients early or getting patients in who are at high risk for developing disease, so they never develop disease… are critical pieces to the puzzle that…need more attention,” Luther said.

Check out the first half of the discussion: https://www.hcplive.com/view/recognizing-stigma-impact-care-alcohol-related-liver-disease

Our experts:

Hersh Shroff, MD, MPA, a transplant hepatologist and an assistant professor of medicine at the University of North Carolina School of Medicine

Jay Luther, MD, an assistant professor of medicine at Harvard Medical School and director of the Massachusetts General Hospital Alcohol Liver Center

Chris Kahler, PhD, a professor of behavioral and social sciences, a professor of psychiatry and human behavior, and the director of the Center for Alcohol and Addiction Studies at Brown University

Shroff, Luther, and Kahler have no relevant disclosures.

References

1. ^{Schomerus G, Leonhard A, Manthey J, et al. The stigma of alcohol-related liver disease and its impact on healthcare. J Hepatol. 2022;77(2):516-524. doi:10.1016/j.jhep.2022.04.026}
2. ^{Mahle R, Okanlawon A, Luther J, Louissaint J, Zhang W. Stigmatizing Language for Alcohol Use Disorder and Liver Disease on Liver Transplant Center Websites. JAMA Netw Open. 2024;7(2):e2355320. Published 2024 Feb 5. doi:10.1001/jamanetworkopen.2023.55320}
3. ^{Brooks, A. The Power of Words: Liver Transplant Centers Continue to Use Stigmatizing Language. HCPLive. February 17, 2024. https://www.hcplive.com/view/the-power-words-liver-transplant-centers-continue-use-stigmatizing-language. Accessed April 30, 2024.}