Table 3:

Psychosocial domains to be assessed in AH transplant candidates. Most of these predictors are for sustained or harmful relapse (not slips).

Domain Assessed/Questions Asked	Factors that May Predict Relapse
1. Alcohol Use History
Length of use over time, when did use start, consumption patterns, context of use, periods of abstinence Diagnostic criteria for alcohol use disorder (reference DSM-V) Problems with cravings/urges to drink Sobriety attempts-voluntary and mandated Alcohol use treatment history-types of treatment tried, sobriety duration after treatment, experiences with treatment, successes and failures. Attitudes towards alcohol use: assess insight and acceptance of alcohol as problem, readiness for change, commitment to sobriety and alcohol treatment Recent changes in alcohol use in relation to life stressors with assessment of potential modifiable behaviors and situations.	Younger age at onset of drinking >10 drinks per day at time of transplant consideration Multiple failed rehab attempts History of legal problems due to alcohol use Shorter pre-transplant abstinence Lack of insight into alcohol use problems Lack of acceptance of alcohol use as a problem Lack of candor and/or deceptive behavior with respect to transplant team Severe AUD
2. Other Substance Use History
Length of use over time, onset of use, consumption patterns, context of use Diagnostic criteria for substance use disorder Treatment history (as above)	Active, untreated polysubstance use (except marijuana) Comorbid tobacco use, relapse to tobacco use
3. Mental Health History
History of psychiatric diagnoses Presence of suicide attempts History of any mental health treatment, including inpatient treatment Response to mental health treatment	Active, untreated mental health diagnosis Recent suicide attempt
4. Treatment Adherence History
Past and current adherence to medical and mental health treatment plan Ability to understand and adhere to transplant treatment plan	History of extensive nonadherence to medical or mental health treatment
5. Social Criteria
Sober support system Number of support persons, relationship to patient, ability to dedicate time/resources to medical and mental health care	Lack of sober support network Only 1 sober support person
Optimal Assessment Criteria
1. Awake, alert patient (not comatose, altered, or intubated), able to be directly interviewed
2. Psychosocial team assess patient first to obtain unbiased evaluation of above factors.
3. Consistent history and commitment verbalized by patient
4. Multiple assessments over time
5. Active involvement and sober support by family/caregivers
6. Corroboration of history from patient collaterals