Addiction specialist's role in liver transplantation procedures for alcoholic liver disease

Table 1 Assessment alcoholic liver disease patients for liver transplantation

Dimension	Variable
Severity alcohol use (disorder)	Amount of alcohol use and baseline alcohol use (TLFB)
	AUD diagnosis severe (DSM5)
	Family-history AUD
	Age-at-onset AUD
	Duration
Abstinence	Duration pre-LT abstinence
Treatment indicators	Earlier treatments for AUD
	(Longstanding) periods of abstinence
	Compliance medical treatment
Co-morbidity	Psychiatric
	Other substance (mis) use (Illicit drugs, tobacco)
Cognitive	Memory
	Executive
Social	Partner and family
	Living in supportive, clean, circumstances
	Employment
Personal	Motivation
	Self-efficacy

TLFB: Timeline follow-back; DSM5: Diagnostic and Statistical Manual, 5^th ed (APA, 2013); AUD: Alcohol use disorders.

Table 2 Role of the addiction specialist (team) in the screening, treatment and monitoring liver transplantation candidates

Screening	Category	Waiting list period	LT	Post-LT physical rehabilitation	Long term follow-up (> yr)
Following items need to be	"Low risk"	Who:		Psychosocial support	"Low intensity follow-up"
surveyed to decide upon which category patient will enter treatment traject:		Addiction treatment team integrated within transplant/hepatology department		patient and family	(1) Who: Addiction treatment team integrated within transplant/hepatology department; or, addiction counselor in the living area of patient
		What:			(2) What:
		Motivation enhancement and			Motivation enhancement
		relapse prevention strategies			Counseling
					Relapse prevention
					Anticraving medication: baclofen/acamprosate
	Monitoring alcohol, drug and use tobacco use
	"High risk"			Psychosocial support patient and family	"High intensity follow-up"
		Who:			(1) Who:
		Addiction treatment team integrated within transplant/hepatology department			Comprehensive addiction treatment program/care provide/living area patient
		What:			(2) What:
		Motivation enhancement and relapse prevention strategies			Comprehensive integrated treatment including different treatment options that can be put in function of specific patient needs:
					Complex behavioral interventions helping patients to control alcohol and comorbid substance (drug, nicotine) use and prevent relapse: CBT, CRA
					Diagnosis and psychosocial treatment interventions psychiatric co-morbidities
					Pharmacotherapy directed at craving control (baclofen, acamprosate, nalmefene)
					Availability of settings: assertive outreach, (semi) residential programs

CBT: Cognitive behavioral therapy; CRA: Community reinforcement approach.