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Alcoholism Treatment After Liver Transplantation: Lessons Learned From a Clinical Trial That Failed

Received April 28, 2000; revised October 5, 2000; accepted October 30, 2000. From The University of Pennsylvania Department of Psychiatry and Department of Medicine, Division of Gastroenterology; Philadelphia Veterans Affairs Medical Center Department of Psychiatry; and Horizon for Mental Health, North Wales, Pennsylvania. Address correspondence and reprint requests to Dr. Weinrieb, Treatment Research Center of the University of Pennsylvania, 3900 Chestnut Street, Philadelphia, PA 19104; e-mail: weinrieb_b{at}mail.trc.upenn.edu

Alcoholic liver disease is the second most common indication for liver transplantation in the United States. The lack of alcoholism treatment studies led us to study motivational enhancement therapy (MET) plus naltrexone after transplant. The authors could not complete this study. Sixty alcoholic patients were to receive MET plus naltrexone or placebo for 6 months. Fifty men and 5 women were screened. Nine died and 15 were not approached. Of 31 approached, 20 were ineligible, 11 refused, and 5 entered but dropped out before completion. Barriers to posttransplant alcoholism included infirmity, intensive medical management, and denial for alcoholism treatment. Because 30%–50% of alcoholic patients drink after transplant, the authors suggest using MET alone pretransplant.

Key Words: Alcoholism • Liver Transplantation

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