NEW DELHI: Even after being diagnosed with alcohol-related liver disease, many patients continue to drink despite recognising the harm alcohol causes and expressing a desire to quit, a study by researchers at the Institute of Liver and Biliary Sciences (ILBS), New Delhi, has found.
The study, published in the Indian Journal of Medical Research, analysed 3,759 male patients with alcohol-related liver disease and co-existing alcohol use disorder. It found that the severity of alcohol dependence was a key factor associated with continued drinking, even among patients who understood the health risks and said they were ready to change.
Of the patients studied, 2,932 (78%) had consumed alcohol within the preceding 60 days, while 827 (22%) had remained abstinent for more than 60 days. The average age of participants was 43.8 years.
The findings challenge the assumption that simply informing patients about alcohol-related harm or urging them to quit is enough to achieve abstinence. They point to the need to treat alcohol dependence alongside liver disease rather than relying on awareness and motivation alone.
Patients who continued drinking had significantly higher dependence scores than those who had stopped. Their median score on the Severity of Dependence Scale was 9, compared with 7 among abstinent patients, as per the study.
The researchers also found that awareness of alcohol-related harm was not necessarily linked to stopping drinking. Nearly 90% of patients who continued drinking acknowledged that alcohol was harmful, while 76.5% said they were aware of its health risks. About 79% recognised its addictive nature, and 77% considered quitting important after a liver disease diagnosis.
Despite this awareness, alcohol use continued. More than 80% of those still drinking also reported being aware of medicines, counselling or other treatment options.
The findings suggest that dependence can make it difficult to translate the intention to quit into sustained behavioural change. Alcohol use disorder is a chronic, relapsing condition, and long-term alcohol exposure can affect the brain systems involved in reward, stress, craving and impulse control.
The study also found that 57.4% of all participants had tried to quit alcohol at least once. Patients who had stopped drinking were more likely to report multiple previous attempts, suggesting that recovery may follow repeated efforts rather than a single decision to abstain.
Interestingly, patients who had remained abstinent had more severe liver disease at presentation, with a mean Model for End-Stage Liver Disease (MELD) score of 21.7, compared with 20 among those who continued drinking. This raises the possibility that worsening illness may prompt some patients to stop. However, the researchers cautioned that the study could not establish cause and effect.
The research was conducted by Dr Mohit Varshney, Dr Akansha Bhardwaj and Dr Gandhrav Dua from the Department of Psychiatry, ILBS; Dr Jithin Thomas Parel from the College of Nursing, ILBS; and Dr Shasthry S.M. and Dr Shiv Kumar Sarin from the Department of Hepatology, ILBS.
The authors said the findings highlighted the need for closer integration of liver care and addiction treatment. They recommended routine assessment of alcohol dependence in hepatology services and stronger referral pathways to specialised treatment.
The study has limitations. It included only male patients at a single tertiary-care centre, and alcohol use was based on self-reported information. Its cross-sectional design also means the findings show associations rather than proving that dependence severity alone causes continued drinking.
Nevertheless, the large patient sample highlights an important challenge in treating alcohol-related liver disease: knowing that alcohol is harmful and wanting to quit may not be enough without appropriate medical and psychological support.
