In their analysis using UK Biobank cohort data, Yang et al. demonstrated that psychiatric interventions, including both consultation with psychiatrists and pharmacological treatment, are key factors in reducing all-cause mortality, liver-related mortality, and the incidence of cirrhosis among patients with ALD [1]. The use of propensity score matching (PSM) in the study, a 2-year landmark analysis, and subgroup analyses enhanced the reliability of its findings. While prior studies primarily focused on short-term outcomes such as abstinence rates, alcohol consumption, and the occurrence of decompensation events in patients with cirrhosis [2-4], this study went a step further by evaluating the long-term (up to 18 years) survival impact of psychiatric interventions. Furthermore, Yang et al.’s study stands out not only because of its long-term evaluation but also because it encompassed a broad range of psychiatric medications, including anti-cravings, antidepressants, anxiolytics, and other psychiatric drugs. This comprehensive evaluation underscores the significant positive impact of integrated treatment models, those combining medication and consultation, on patient outcomes, further reinforcing the necessity for a multidisciplinary approach.

However, as the authors acknowledge, one limitation of the study is the lack of detailed information regarding the specific nature of consultations with psychiatrists. A previous study has shown that brief interventions and motivational enhancement are most effective for those with mild AUD, while more intensive treatments are required for patients with moderate-to-severe AUD [5]. A more detailed analysis of how different interventions affect various levels of alcohol consumption would have added depth to the findings. Additionally, while Yang et al. speculated that improved survival rates might be attributed to a reduced incidence of cirrhosis, the exact mechanisms by which psychiatric interventions contribute to survival have not been thoroughly explored. Another limitation is the study’s reliance on UK Biobank data, which raises questions about the generalizability of the results to populations of different sociocultural backgrounds. Given that AUD often manifests in ways that are deeply influenced by social and cultural factors, further research is required to determine whether these findings are applicable to other healthcare systems and patient populations.

Given the complex, multifactorial nature of AUD, spanning personal, familial, and socioeconomic dimensions, a multidisciplinary approach is not only beneficial but also essential for managing ALD. A recent review of integrated care models for AUD and ALD highlights the range of approaches, from “unaffiliated” models where clinicians work independently, to “co-located” models where AUD and ALD treatments are provided side by side in the same clinic [6]. An example of a successful integrated care model is found at the Germans Trias i Pujol Hospital in Barcelona, where since 2015, all patients admitted for ALD receive addiction medicine consultations. During hospitalization, the team evaluated alcohol consumption and withdrawal, prescribed appropriate medications, and provided interventions emphasizing the importance of abstinence. Upon discharge, the patients were referred to addiction medicine clinics for follow-up every eight weeks until they achieved six months of abstinence. At Yale-New Haven Health and Yale Medicine in the United States, an integrated care model combines hepatology and addiction medicine to provide holistic treatment for patients with both ALD and AUD. The Yale Program in Addiction Medicine has successfully embedded AUD and substance use disorder treatments in various medical settings, including primary care, emergency departments, and specialty clinics. In addition to care models incorporating components of addiction treatment in hepatology clinics, multidisciplinary teams consisting of hepatologists, psychiatrists, psychologists, nurses, and social workers are emerging as effective treatment providers for patients with advanced ALD, including those with cirrhosis and acute alcohol-associated hepatitis. In one notable case, the patient underwent a comprehensive liver health assessment along with psychiatric evaluations during a half-day clinic visit. Patients are contacted by the clinic team before their first visit to encourage and confirm attendance, receive educational materials, and have a comprehensive assessment of their liver health, alcohol and other substance use, and psychiatric symptoms [7].

In conclusion, psychiatric intervention and a multidisciplinary approach are not optional for patients with ALD; they are essential strategies for improving treatment outcomes. Integrated care models combining psychiatric and medical interventions can improve patient survival and liver-related outcomes. As more research emerges and healthcare systems continue to evolve, the expansion of these integrated models is critical for providing comprehensive and holistic care for patients with ALD. Government support and institutional leadership are vital for ensuring that these multidisciplinary programs are developed and sustained to meet the needs of the growing patient population.