Understanding Barriers to Alcohol Use Disorder Treatment and Digital Health Engagement Among Patients with Alcohol-Associated Liver Disease: A Mixed-Methods Formative Study

Study of Barriers to Alcohol Use Disorder Treatment in Alcohol-Associated Liver Disease

Age
18 years - 100 years
Gender
All
Phase
N/A
Participants needed
100
Locations
2
Primary Investigator
LN

Lauren Nephew

Accepting referrals by invitation only

Brief description of study

From the patient perspective, stigma and fear of judgment, especially in transplant-adjacent contexts, discourage disclosure of alcohol use and engagement in treatment. Structural challenges, including transportation barriers, unstable housing, caregiving responsibilities, and financial toxicity, further limit participation in treatment. Treatment readiness may also fluctuate with stress, episodes of hepatic decompensation, and social instability, undermining engagement in traditional referral-based models. Collectively, these barriers help explain persistently low treatment rates despite strong evidence that AUD is both treatable and central to improving ALD outcomes. The primary objective of this study is to evaluate the acceptability and multilevel implementation determinants, including individual-level factors and outer setting influences such as socioeconomic context, that shape adoption of and engagement with a digital health intervention for alcohol use disorder among patients with alcohol-associated liver disease.

THIS STUDY IS ENROLLING BY INVITATION ONLY - Eligible patients will be identified by review of clinic schedules and will be approached in person either in clinic or in their hosptial room as in inpatient or via a telephone call by a research coordinator who is not involved in their direct clinical care. The coordinator will briefly describe the study and obtain informed consent prior to survey participation. This can be done either in person or remotely.

Detailed description of study

Participants will complete a survey assessing socioeconomic status (SES), prior treatment for alcohol use disorder (AUD), treatment readiness, digital access, and health literacy (6). To maximize participation among patients with recent alcohol use and limited digital access, surveys will be administered flexibly. Participants may complete the survey in clinic using a tablet or paper survey with assistance from research staff if needed, complete the survey remotely by phone or complete the survey electronically with a secure survey link emailed to the participant in advance.

Eligibility of study

You may be eligible for this study if you meet the following criteria:

  • Conditions: Alcohol-associated or mixed-etiology chronic liver disease
  • Age: 18 years - 100 years
  • Gender: All

Inclusion Criteria
•    Age ≥18 years with alcohol-associated or mixed-etiology chronic liver disease
•    ≤6 months of sobriety by self-report or PEth ≥20 ng/mL within the past 6 months, with the lab value for PEth taken from the EMR
•    Clinically stable with sufficient mental status, cognition to participate (no grade 3–4 hepatic encephalopathy)
•    Able to provide informed consent (care-partner assistance permitted)
•    English proficiency (Of note, at this stage, the study is designed to be a formative mixed-methods project requiring nuanced qualitative interviews and validated survey instruments that are currently only available in English. We can track the number of otherwise eligible patients excluded due to language and report these data as an equity-relevant finding. In subsequent intervention-development phases, a plan to translate instruments, employ bilingual staff, and intentionally recruit patients that are not English speakers is anticipated).
•    Willingness to complete a survey and/or interview regarding alcohol treatment experiences and technology use.

Exclusion Criteria
•    Primary liver disease unrelated to alcohol with no alcohol use in the past year
•    >6 months of sobriety by self-report and PEth negative
•    Inability to consent or participate (e.g., cognitive impairment, language barrier)
•    Severe encephalopathy, delirium, defined as West Haven grade 3-4, or other condition precluding informed participation.
 

The purpose of this research study is to learn what affects whether adults with alcohol-associated liver disease take part in treatment for alcohol use disorder and use a digital health program for alcohol use disorder. The study focuses on things that may make it harder to get care, such as fear of judgment, daily life challenges, and access to technology.

Participants will complete a survey about their life situation and access to resources, past alcohol use disorder treatment, readiness to start or continue treatment, access to digital tools, and health literacy (how well a person can understand and use health information). Participants may complete the survey in different ways, such as in clinic on a tablet or on paper (with help from research staff if needed), by phone, or electronically through a secure link sent by email.

Who can participate:
This study is enrolling by invitation only.
Adults with alcohol-associated or mixed-cause chronic liver disease may be able to participate if they:

  • Are age 18 or older
  • Have had alcohol use within the past 6 months or have had a lab test showing recent alcohol use within the past 6 months
  • Are clinically stable and able to think clearly enough to take part
  • Speak English
  • Are willing to complete a survey and/or interview about alcohol treatment experiences and technology use

Updated on 15 Sep 2026. Study ID: 31886
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Interested in the study?

This study is accepting only persons who receive care at a certain clinic or doctor or who are part of an invited group. Questions about this study can be directed to the study team listed in the description or contact your doctor to see if you are eligible.

Accepting Referrals by Invitation Only