Bridging Care for Liver Disease and Alcohol Use Disorder: UPMC Liver Health and Recovery Clinic

The UPMC Center for Liver Care team is proud to announce the establishment of UPMC Liver Health and Recovery Clinic. This multidisciplinary clinic provides total care for patients with alcohol-associated liver disease and alcohol use disorder (AUD). Our team evaluates and designs a care plan to treat both liver disease and AUD.

Through this integrated approach that brings together substance use disorder and behavioral health treatment with hepatology services, patients experience better outcomes when compared to treatment of these conditions in isolation.

Continued alcohol use is a primary factor leading to liver injury such as hepatitis, fibrosis, and cirrhosis and is a major predictor of morbidity among patients with liver disease.

According to the National Institute on Alcohol Abuse and Alcoholism, in 2023, 44.5% of the 96,610 U.S. liver disease deaths in people ages 12 and older involved alcohol. In the ten-year period between 2007 and 2017, the number of patients with alcohol-associated liver disease (ALD) listed for liver transplantation rose by 63%.

Alcohol-Associated Liver Disease and Access to Liver Transplantation

Liver transplantation is the only treatment for end-stage liver failure. In the past, many transplant centers required patients with alcohol-associated liver disease to demonstrate six months of sobriety to be eligible for a liver transplant. This six-month eligibility policy could be a barrier to transplant access.

Today, many centers do not require six months of sobriety. Instead, transplant centers consider several factors, such as the patient’s desire or effort to seek treatment, when determining a patient’s eligibility for liver transplant.

This change in inclusion criteria benefits patients with alcohol-associated liver disease, especially patients who develop acute alcohol-associated hepatis. Acute alcohol-associated hepatitis is a severe and rapidly progressing syndrome, and patients are at risk of death if they do not receive transplants.

Although patients with alcohol-associated liver disease may have increased access to liver transplant as a liver disease treatment option, they still encounter barriers to alcohol use treatment.

Barriers to Alcohol Use Disorder Treatment

AUD treatment, across inpatient, outpatient, and community settings, can provide support to patients who want to stop or reduce their alcohol use. However, patients contemplating or seeking AUD treatment may face personal, social, and systemic barriers, including social stigma surrounding AUD and a lack of access to AUD treatment.

The UPMC Liver Health and Recovery Clinic’s Mission

The UPMC Liver Health and Recovery Clinic, led by Alison J. Faust, MD, MHS, was founded to simultaneously address barriers to care for liver disease and alcohol use disorder. To do this, the clinic considers each individual’s whole health through a treatment model that integrates hepatology, behavioral health, and addiction medicine services.

The clinic team partners with each patient to develop an individualized treatment plan for the patient’s liver disease and alcohol use disorder. The clinic providers strive to make each patient’s experience as positive and impactful as possible through constant and open dialogue.

The UPMC Liver Health and Recovery Clinic is part of UPMC’s commitment to total liver care. UPMC’s total liver care model provides lifelong, holistic care to patients with different types and stages of liver diseases. At the clinic, patients can access hepatology, behavioral health, and addiction medicine services. The single point-of-access reduces administrative burdens for the patient and care partners, such as scheduling multiple appointments.

"From my perspective, the biggest strengths of our Liver Health and Recovery Clinic are that we lower barriers to getting care by providing everything in one place and that we view each patient individually to come with a holistic, comprehensive plan that will work for them,” Dr. Faust says.

“By forming relationships with our patients, they have felt comfortable coming to us when they are struggling or experience an alcohol relapse, and then we can change our plan to help them. To me, this is a success of the clinic,” Dr. Faust says. “We know that management of alcohol use disorder is not a simple matter of stopping alcohol use — people really struggle, and we want to be there for them and help them to achieve optimal health."

Liver Health Care Access

The clinic’s hepatology specialists work with each patient to improve both their overall health and liver health. The clinic providers work to manage complications of the patient’s liver disease and address any physical conditions that may contribute to the patient’s alcohol use. They also seek to treat any electrolyte or mineral imbalances that can be associated with alcohol use.

For patients with earlier stages of liver disease, the clinic aims to provide care so that patients can avoid a liver transplant if possible.

Some patients may have end-stage liver disease and need a liver transplant. The clinic providers help these patients maintain optimal health as they wait to become eligible for a liver transplant. When a patient is determined to be eligible for a liver transplant, the Liver Health and Recovery Clinic team works with the Liver Transplant Program team to provide seamless care before, during, and after their transplant.

Behavioral Health Care Access

The UPMC Liver Health and Recovery Clinic is a partnership between the UPMC Center for Liver Care and the UPMC Western Behavioral Health Center for Psychiatric and Chemical Dependency Services. The UPMC Western Behavioral Health Center for Psychiatric and Chemical Dependency Services offers access to a range of behavioral health and addiction medicine support and treatments, including intensive outpatient programs.

At the clinic, patients meet with a licensed therapist who specializes in both substance use and behavioral health treatments. In person and telemedicine options are available.

The clinic’s behavioral health care is patient-centered and integrates harm reduction strategies. Treatment plans are shaped by each patient’s goals and may include referrals to external programs, such as inpatient, intensive inpatient, or outpatient rehabilitation services. Other treatment options may include medications or individual and group counseling sessions.

Referral Requirements

Only health care provider referrals are currently accepted.

• Liver Disease
  • Patients may present with liver disease or may be at risk of developing liver disease.
• Alcohol Use
  • Patients should be willing to discuss their alcohol use and interested in receiving alcohol use treatment.
  • Patients do not need to self-identify as having an alcohol use disorder.
  • Patients can be seen at the clinic while still actively drinking.
• Other Substance Use Disorders
  • Patients can have other substance use disorders, but their primary need should be alcohol use disorder.

What Patients Can Expect

First Visit

The patient’s first clinic visit will be in-person. The clinic is in the UPMC Digestive Health Center in UPMC Presbyterian.

The patient’s first clinic visit will be 2 to 4 hours. During their initial visit, they will meet with the clinic team, including a physician or physician assistant who specializes in liver disease and a licensed clinician who specializes in addiction medicine.

The goal of the first visit is to evaluate the patient’s health, discuss the patient’s current health and treatment goals, and make treatment recommendations for their liver disease and alcohol use disorder.

The visit may include blood tests to track the patient’s liver health and alcohol use. These tests are to measure the clinic’s progress and the patient’s health. The tests are not to measure the patient’s adherence to treatment.

Follow-up Visits

Follow-up visits can be in-person or telemedicine. The timing and cadence of both liver care and behavioral health follow-up visits depend on the individual patient’s clinical status. Liver care follow-up visits can be scheduled monthly. Behavioral health follow-up visits can be scheduled weekly or biweekly.

Referral Information

To learn more about the UPMC Liver Health and Recovery Clinic or to refer a patient, email lharc@upmc.edu.