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Substance Use Disorder Increases Liver Disease Risk in Patients With Alcohol Use Disorder

Key findings

  • This cross-sectional study examined links between substance use and the presence and severity of alcohol-associated liver disease (ALD) among 2,848 patients with alcohol use disorder (AUD) who had varying degrees of liver injury and substance use patterns
  • The presence of ALD was positively associated with a history of substance use disorder (SUD) (OR, 1.95; P=0.001)
  • Opioid use disorder was the only individual drug disorder significantly associated with ALD (OR, 1.90; P=0.01)
  • An increasing number of SUD diagnoses in a patient with AUD was also associated with ALD (OR, 1.33; P<0.001)
  • Sedative use disorder, but not other SUDs or SUD overall, was associated with hepatic decompensation in patients with AUD (OR, 2.07; P=0.03)

A wide spectrum of liver diseases can manifest in patients with alcohol use disorder (AUD), underscoring that numerous factors independent of alcohol consumption may contribute to liver injury.

In a cross-sectional study that leveraged a large internal database, researchers at Massachusetts General Hospital determined substance use disorder (SUD) is independently associated with liver disease in patients with AUD. The findings are detailed in Gastro Hep Advances by Augustin G.L. Vannier, BA, a clinical research coordinator in the Alcohol Liver Center, Division of Gastroenterology at Mass General, Vladislav Fomin, MD, a former clinical fellow at the Center, Jay Luther, MD, an attending gastroenterologist at the Center and assistant professor of Medicine at Harvard Medical School, and colleagues.


Using the Mass General Brigham Biobank, the researchers identified 2,848 patients diagnosed with alcohol abuse or alcohol dependence who had completed a questionnaire quantifying their alcohol use. 719 of the patients were also diagnosed with one or more SUDs.

SUD in Patients With AUD + ALD

In multivariate analysis, patients with a history of SUD were nearly twice as likely to be diagnosed with alcohol-associated liver disease (ALD) than those without a history of SUD (OR, 1.95; P=0.001). Furthermore, the number of SUDs was positively related to a diagnosis of ALD (OR, 1.33; P<0.001).

In subgroup analyses, only AUD patients with a concurrent opioid disorder were more frequently diagnosed with ALD (OR, 1.90; P=0.01). There were no associations between ALD and cocaine, cannabis, sedative, stimulant, or inhalant disorders.

SUD and Hepatic Decompensation

Hepatic decompensation was not significantly associated with SUD overall or with most individual SUDs. However, there was a positive association between sedative use disorder and hepatic decompensation (OR, 2.07; P=0.03).

Counseling Patients

Patients who report excessive alcohol use should be educated that some individuals with AUD develop severe alcohol-related hepatitis or cirrhosis, which carries very poor prognoses. Clinicians can acknowledge matter-of-factly that other recreational drug use often accompanies alcohol use, then warn patients that SUDs are modifiable risk factors for advanced liver disease in patients with AUD.

greater risk of alcohol-associated liver disease in patients with alcohol use disorder who also had a substance use disorder

greater risk of hepatic decompensation in patients with alcohol use disorder who also had a sedative use disorder

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