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

The management of alcohol use disorder (AUD) in patients with alcohol-associated liver disease (ALD) 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, 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advise against potentially stigmatizing language for AUD and ALD, many liver transplant centers continue to use outdated terms like “alcoholism” and “alcoholic,” potentially hindering patient care and their willingness to seek treatment.1

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.

In part 2 of an interview with HCPLive, 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.2

“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.”

Check out part 1 of the interview here: 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.

References

1. 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

2. 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