Transient Elastography Increases Readiness for Change in Inpatients With Alcohol Use Disorder: The ELISA Pilot Study

TL;DR

Using a liver stiffness test called transient elastography with hospitalized patients who have alcohol use disorder increased their motivation to change their drinking behavior.

Contribution

This study shows that transient elastography can serve as an effective opportunistic intervention to boost readiness for change in patients with alcohol use disorder.

Findings

Readiness for change scores significantly increased after transient elastography.

Cirrhosis and moderate to severe fatty liver were detected in 17% and 35% of patients, respectively.

There was no significant change in alcohol insight scores after the intervention.

Abstract

Opportunistic interventions (OIs) are health events facilitated by healthcare providers through education that can motivate individuals to adopt risk‐reducing behaviours. Our aim was to evaluate transient elastography (TE) as an OI in patients with AUD by assessing changes in validated psychometric scores (PS) of alcohol insight and readiness for change. In this prospective, proof‐of‐concept pilot study, patients with AUD without TE in the past year were enrolled from an inpatient addiction unit. At baseline, three PS assessing insight and readiness to change were administered: Hanil Alcohol Insight Scale (HAIS), revised Readiness Ruler (RR) and Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES‐8A). TE was performed, interpreted, and followed by repeat PS testing. The primary outcome was change in PS. Secondary outcomes were prevalence of fibrosis and steatosis on TE, alcohol use and linkage to hepatology care. From 4 January 2022 to 4 January 2023, 23 patients were enrolled: mean age: 51 years (SD ± 12), 74% male, 61% White and all with severe AUD, and mean of 20 (± 9) daily drinks, 286 g (± 127 g) or 35.7 (± 15.9) units of alcohol, for a median of 14 years (IQR 10–21.5). After TE, there were significant increases in revised RR and SOCRATES‐8A from 5 to 8.6 (± 2.1, p < 0.01) and 81.5 to 85.0 (± 8.0, p = 0.04), respectively, indicating improved motivation and readiness for change. HAIS did not change: 11.1–11.0 (± 3, p = 0.36). Cirrhosis and steatosis grade ≥ 2 were detected in 4/23 (17%) and 8/23 (35%), respectively. In this pilot study, performing and interpreting results of TE to inpatients with AUD increase readiness for change and efficiently detects advanced fibrosis.

In this prospective, proof‐of‐concept pilot study of transient elastography as an opportunistic intervention in patients admitted to an addiction unit by assessing changes in validated psychometric scores of alcohol insight and readiness for change. Opportunistic interventions are health events facilitated by healthcare providers that can motivate individuals to adopt risk‐reducing behaviours. After transient elastography, there were significant increases in readiness for change scores, but no change in insight.

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