enhancing alcohol treatment engagement in associated liver disease (ald) patients

Conditions: Alcohol-related Liver Disease; Liver Diseases

Summary: the purpose of this trial is to see if providing patients with alcohol-related liver disease with tailored alcohol use treatment options will increase engagement with treatment and correct possible misconceptions.

eligible participants will be randomized to stage 1 of treatment which consists of a previously pilot-tested behavioral application (app), the engage-ald app, consisting of a knowledge improvement module and a preference-sensitive treatment matching module. those who do not engage in aud treatment after randomization ('non-responders') will be re-randomized at 3-months and continue on this in stage two if considered a responder (met treatment engagement). participants that were not considered to have met "treatment engagement" will be re-randomized at 3-months to a treatment facilitation bundle consisting of a barriers to treatment survey followed by a health coaching session.

Eligibility criteria:
inclusion criteria: * willingness to comply with all study procedures and availability for the duration of the study * willing and able to provide informed consent * enrolled at university of michigan (um) hepatology clinics or inpatients at um hospitals * documented diagnosis of alcohol-related liver disease (ald) (per protocol) * recent alcohol use of any amount within the past 6 months as assessed by either patient interview, medical chart review, or positive alcohol biomarker (e.g. blood alcohol level, urinary ethyl glucuronide, urinary ethyl sulfate, or phosphatidylethanol) in the medical record. * no alcohol use treatment within the past 1 month including, but not limited to: * any professionally lead therapy with a mental health counselor (such as, one-on-one therapy, group therapy, couples or family therapy) with a primary aim of alcohol abstinence or reduction in alcohol use. * community-based alcohol recovery groups (such as, alcoholics anonymous, smart recovery, celebrate recovery, refuge recovery) * community-based church support groups primarily focused on alcohol abstinence or reduction in use. * residential (inpatient) alcohol treatment * intensive outpatient programs * any telehealth version of the above options * access to a smartphone or computer for purposes of follow-up. those who do not have a smartphone will be provided one along with a calling/data plan at no cost to subject by the study team for the duration of the research stud. * ability to speak and comprehend english exclusion criteria: * unable to provide voluntary informed consent for any reason * substantially cognitively impaired as evidenced by westhaven grade 2 or higher hepatic encephalopathy or a score \>=10 on the short blessed test for cognitive impairment. * unable to read or understand english * undergoing active evaluation for liver transplantation, is listed for liver transplant, or is post-transplantation * is enrolled in the multidisciplinary ald clinic at michigan medicine * any other medical condition or circumstance that precludes safe and meaningful participation in the study * history of nonadherence to previous clinical or research studies

Keywords: online web application engagement alcohol use disorder (aud) treatment alcohol-related cirrhosis smart trial behavioral treatment