Table 1.

Summary of studies included in the review

	Author, year published, and country
	Kuchipudi et al. [25], 1990, USA	Zilberfein et al, [26], 2001, USA	Andersen et al. [34], 2013, Denmark	Verma et al. [29••], 2019, USA	Craig et al. [28], 2020, Canada	Carrique et al. [27••], 2021, Canada
Study aims	To assess the effect of a motivational intervention emphasizing the need for and the benefit of treatment for alcohol use disorder	To examine social work practices and psychosocial interventions with pre- and post-liver transplant patients and their families	To establish an outpatient rehabilitation clinic for patients with alcohol-related liver disease with a recent hospital admission for hepatic encephalopathy	To implement a behavioral health program in an ambulatory hepatology setting for alcohol use disorder, substance abuse, and depression, assess the acceptability to patients, and explore the effectiveness of this program in improving quality of life and reducing the targeted illnesses over time	To evaluate the use of a coping skills group therapy intervention conducted by transplant social workers qualified to provide psychosocial interventions aimed at decreasing depression and anxiety, and increasing healthy coping skills in a population of transplant candidates	To determine patient suitability for transplantation and risk for relapse through the use of selective criteria, to operationalize a multidisciplinary team of clinicians to assess and mitigate this risk, and to monitor for alcohol use both pre- and post-liver transplant and intervene when appropriate
Design	Interventional study with a control arm	A practice-based, retrospective observational study without a control group	A prospective study with a historical control group	A pragmatic quality improvement study to implement screening for alcohol use disorder, substance use disorder, or depression and referral to a behavioral intervention program in an ambulatory hepatology setting. No control group	Intervention study (pre-post design) comparing coping skills, depression, and anxiety symptoms pre- and post-intervention, and at 1 month follow-up. No control group	Pilot interventional study with a historical control arm
Number of patients included	114 patients admitted to hospital with cirrhosis (n=71), ulcer, or pancreatitis who were currently drinking and not currently active in alcoholism treatment. Patients were randomly assigned to motivational interventional therapy group (n=59) or control group (n=55)	286 liver transplant recipients (29% with substance use problems pre-transplant) who had a psychosocial assessment done by social workers before and after transplant	19 patients with alcohol-related liver disease recently hospitalized with hepatic encephalopathy in outpatient rehabilitation clinic group and 14 historical controls with hepatic encephalopathy discharged 1 year prior to the intervention	95 patients with chronic liver disease who screened positive. Data was collected prospectively	Convenience sample of 16 patients awaiting kidney transplant and 25 awaiting liver transplant	44 patients with alcohol-related liver disease receiving the intervention and a liver transplant and 111 historical controls (patients with alcohol-related liver disease receiving transplants with >6 months of abstinence within our program in the 18 months before the institution of our pilot program)
Recruitment period	Not reported	1992–1994	2008–2010	2015–2016	2011–2013	2018–2020
Type of health professionals involved in the intervention	A lead clinician, a trainee clinician, a principal nurse on the floor or the gastroenterology fellow, and a social worker. Patients were also offered to participate in a group discussion with a psychiatric nurse therapist	Mostly social workers; over two-thirds of the patients also had a consultation with a psychiatrist	Nurse, a physician (if needed), and two employees from the Social Services of Copenhagen	Social worker trained in behavioral therapies. Some patients with severe symptoms received referrals to a behavioral health speciality (for alcohol and substance use disorder) or psychiatry (for depression) in addition to receiving the brief intervention	Social workers who were Master of Social Work (MSW)-level practitioners authorized to provide psychosocial interventions	A multidisciplinary team including hepatologists, addiction and consultation-liaison psychiatrists, social workers, and a nurse practitioner
Study endpoints	Outcome measures were utilization of alcoholism programs (inpatient or outpatient); attendance at three outpatient follow-up clinics in internal medicine or gastroenterology; and self-reported sobriety at about 10 weeks (interview on drinking status with the patient and with household companions)	Therapeutic social work and psychiatric interventions as well as concrete services were eramined to determine frequency of use both pre- and post-transplant. Number and percentage of patients using services were described	The primary endpoints were 1-year survival and hospital readmissions. Economic costs of subsequent hospital admissions were a secondary outcome. Clinical, demographic and biomedical parameters, including severity of liver disease and alcohol consumption	Primary outcomes were patient acceptability and change in quality of life from baseline to 3 months. Secondary outcomes included change in illness severity scores over time and sustainability of change in quality of life at 6 months	Study endpoints included coping skills; depression; and anxiety	Study outcomes included post-transplant survival and return to alcohol use
Measurement tools	The Comprehensive Drinker Profile questionnaire was used at baseline. No specific tool was used to assess sobriety at follow-up	No specific tools were used to measure study endpoints	No specific tool was used to measure alcohol consumption	The Chronic Liver Disease Questionnaire (CLDQ) [27••] was used to assess quality of life. Illness severity was assessed using validated questionnaires for alcohol use disorder (Alcohol Use Disorders Identification Test [AUDIT]) [28], substance use disorder (Drug Abuse Screen Test [DAST-10]) [29••], or depression (Patient Health Questionnaire-9 [PHQ-9]) [30]	The Brief COPE questionnaire with 14 coping-related subscales [35], Hamilton Depression Rating Scale [HAM-D] [36], and Hamilton Anxiety Rating Scale [HAM-A] [37] were used to assess study endpoints	Alcohol use post-transplant was assessed through patient self-report and biomarker testing
The role of social workers in supporting patients (type of intervention)	The motivational intervention included at least 3 separate discussions of the relationship of patient’s disease to continued drinking, namely: the patient’s health and drinking history was reviewed by the lead of the unit; 1 h later the trainee clinician reinforce the message; 2 days later the principal nurse or the gastroenterology fellow reviewed the patient and the need for therapy and support; a social worker discussed the available programs and facilities that may benefit the patient*; and lastly a group session with a psychiatric nurse *This component was needed for the intervention to be considered delivered	The specific interventions used by health workers were not described. All patients were assessed by all members of a multidisciplinary team (including a social worker) to determine their eligibility for liver transplant. The common reasons for social work consultation post-op included insurance problems, mental and behavioral symptoms, family problem, adjustment to new medical diagnosis, physical discomfort, and transportation	The specific interventions used by nurse, physician, and employees from the Social Services of Copenhagen were not described in the paper. Patients referred to the rehabilitation program were seen by a trained nurse within 1–3 weeks after discharge and by a physician if needed to assess patients’ clinical, psychological, and social problems including alcohol consumption. Two employees from the Social Services of Copenhagen collaborated closely with the rehabilitation clinic and addressed issues such as housing, economic, medical, and other needs for patients	Social workers provided a brief intervention (15–20 min) based on principles of motivational interviewing and cognitive behavioral therapy and targeted six elements: feedback on behavior and consequences, responsibility to change, advice, menu of options to bring about change, empathy, and self-efficacy for change. The social worker identified ambivalence, taught motivation and self-efficacy techniques, and coached the patient to build a commitment to change. For depression, the social worker offered cognitive behavioral therapy and facilitated conversations from negative to positive thoughts leading to changes in attitudes and behaviors. A repeat brief intervention occurred at 3 months	Qualified social workers provide psychosocial interventions aimed at enhancing patients’ repertoire of coping skills to allow them to better manage the psychosocial demands associated with the pre-transplant experience. The program was designed around cognitive-behavioral, narrative, and mindfulness interventions	The social worker met with each patient and their support people to assess the availability of the emotional and instrumental support typically needed for transplantation and conducive to alcohol abstinence. The specific tools used during this assessment were not described. The intervention (relapse prevention therapy), developed by addiction psychiatrists and an addiction therapist (a registered social worker with specific prior training in addiction therapy), consisted of 6 core sessions provided to all patients, and an additional 4 optional sessions. Booster sessions were available for patients who requested them and for those with severe alcohol-related liver disease
Major findings	Self-reported sobriety at ∼10 weeks did not differ between the intervention and control group (37.8% vs. 37.5%, respectively). Attendance of two-to-three outpatient follow-up clinics was associated with sobriety (p<0.01) The sample size was sufficient to provide 41% power to detect a 25% improvement in sobriety rate, and 82% power to detect a 50% improvement	There was an increase in the use of therapeutic social work and psychiatric interventions and concrete services from pre- to post-transplant. Of the interventions noted, the most frequently used post-transplant included: individual counselling (70%), family counselling (3.5%), liver transplant support group (32.9%), evaluated by a psychiatrist (32.2%). Of the concrete services noted, the most utilized post-transplant were assistance with insurance (15.4%), transportation (15.4%), and home care (36.7%)	1-year survival was 84% in the intervention group vs. 36% in the historical controls (p=0.012). There was no difference in hospital readmissions and hospital costs between individuals in the intervention and historical control groups. The majority (17/19) of patients in the control group had decreased alcohol consumption	For the 95 patients who underwent the brief intervention, quality of life improved from baseline to 3 and 6 months (p<0.001). AUDIT and DAST-10 scores also improved significantly at 6-month follow-up (p=0.0048 and p=0.038, respectively). Patients with depression had an improvement in their PHQ-9 scores by 3.7 points at 6 months (p<0.0001) and their quality of life improved the most among the study participants. There was a significant improvement in the percentage of patients with severe disease scores on the AUDIT, DAST-10, and PHQ-9 scales between baseline and 6 months (p<0.05). Depression was the only independent predictor of change in quality of life over time. Of the enrolled patients, 82% agreed the brief intervention improved their overall care and 87% indicated a desire to continue with the behavioral program	Over the 3 time periods, the pilot study showed that patients experienced increases in acceptance (p<0.047) and religious coping strategies (p<0.042), and decreases in denial (p<0.039) and self-blame (p<0.025). There was a reduction in anxiety and depression between pre- and post-intervention and between pre-intervention to 1 month follow-up (p values for these comparisons were <0.001)	This pilot study showed no significant differences in survival rates (p=0.07) and proportion of patients returning to alcohol use (6.8% vs. 16%, p=0.21) between patients receiving transplants through the pilot program versus a historical control group with >6 months of abstinence prior to transplant