Provider attitudes, practices, and barriers in alcohol-associated liver disease care: Findings from the CASL ALD SIG national survey

Background: Alcohol-associated liver disease (ALD) is a growing health care concern, with alcohol use disorder (AUD) being a contributor to liver-related morbidity and mortality. This study examines the practices, perspectives, and challenges faced by Canadian health care providers in managing AUD within the context of ALD. Methods: A nationally representative survey was conducted among health care providers involved in ALD management. The survey evaluated practices related to AUD screening, prescribing pharmacotherapy, addiction services referral, and perceived barriers. Results: Alcohol use screening was common (75%), but standardized tools were rarely used (<10%), with barriers including time constraints (61%) and resource limitations (60%). Less than 15% of patients received AUD pharmacotherapy, with lack of training identified as a key barrier. Notably, 47% of providers had never prescribed AUD pharmacotherapy due to low comfort levels (78%). Early and mid-career providers were more likely to prescribe AUD pharmacotherapy compared to their senior counterparts (71% vs 61%, p = 0.02). Acamprosate and naltrexone were the most frequently prescribed medications. Behavioural therapy referrals were reported by 57% of respondents, although patient reluctance (70%) and financial barriers (53%) hindered access. Knowledge gaps regarding AUD pharmacotherapies were prevalent. Conclusion: This study reveals significant gaps in AUD management within ALD care, marked by insufficient screening, underuse of pharmacotherapies, and limited referrals to addiction services. Addressing these issues requires urgent attention through enhanced provider education, integration of addiction care, and systemic reforms. Collaborative efforts among all health care providers are essential to improving care delivery and outcomes for individuals with ALD and AUD.