Changes in alcohol use following a diagnosis of alcohol-related liver disease: A clinical cohort study

Background & Aims: Alcohol use is the primary driver of disease progression in alcohol-related liver disease (ALD). We aimed to describe changes in alcohol use following a diagnosis of ALD. Methods: Between 2021 and 2025, we screened 299 consecutive patients newly diagnosed with ALD at Zealand University Hospital, Denmark. At baseline, patients were interviewed about their current and lifetime alcohol use and their motivation to reduce alcohol consumption, and the alcohol biomarker phosphatidylethanol (PEth) was measured. Patients were followed for 90 days to assess changes in alcohol use and predictors of abstinence at 90 days. One standard drink was defined as 12 g of alcohol. Results: Of the 104 patients newly diagnosed with ALD, 30% had decompensated cirrhosis, the median age was 64 years, and 76% were men. Patients reported progressively increasing alcohol consumption during the 30 years preceding their ALD diagnosis, with 76% consuming ≥20 drinks/week during the 5 years before diagnosis. Shortly after diagnosis, only 24% reported consuming ≥20 drinks/week, and 56% reported abstinence, whereas PEth indicated abstinence in only 37% of patients. Approximately 60% of patients reported high motivation and high confidence in achieving abstinence at diagnosis. Among patients who were abstinent at baseline, the risk of relapse within 90 days was 37% (95% CI 26–52). Higher motivation to change, greater confidence in achieving abstinence, and lower baseline PEth concentrations predicted abstinence at 90 days, whereas liver disease severity and AUDIT score were not significantly associated with abstinence. Conclusions: A diagnosis of ALD leads to a profound change in alcohol use, with approximately half of patients reporting abstinence after years of escalating alcohol consumption. However, early relapse remains common. Impact and implications: Our study demonstrated a window for behavioural changeshortly after a diagnosis of alcohol-related liver disease, during which many patients reduced alcohol use or achieved abstinence. These findings highlighted early behavioural change in alcohol consumption but also a considerable risk of relapse after diagnosis. The results support integrating structured treatment for alcohol use disorder into liver clinics, although the observational design, self-reported alcohol use, and small sample size should be considered when interpreting the findings.