Alcoholism is the most common root cause of end stage liver disease in the United States. By the time cirrhosis with liver failure is diagnosed, there are often no viable alternatives to liver transplantation even for the then-abstinent alcoholic. Liver transplant surgery is costly and donor organs are scarce. Once selected for transplant, patients typically wait two years for an organ and must remain """"""""medically and psychologically stable"""""""". Data from our studies indicate that 15 percent of listed alcoholic liver transplant candidates admit drinking - and we believe this may be an underestimate. Further, studies have shown that cirrhotic alcoholics who continue to drink have high rates of mortality. Once listed, alcoholic patients are typically referred off-site for alcohol treatment or to AA meetings. But, our research has shown that greater than 50 percent of alcoholic patients who received liver transplants never attended formal substance abuse treatment or AA. Based on the data from these pilot efforts and from the larger literature on promising therapies for alcohol dependence, we plan to test a modified and expanded version of Motivational Enhancement Therapy (MET) combined with case management techniques (STD-MET), for use in the treatment of alcoholics awaiting liver transplant. We will test this integrated alcohol treatment in a randomized controlled design comparing two samples of 100 listed alcoholic liver transplant patients, each receiving supplemental treatments for their alcoholism over a six month period while listed. Both groups will receive standard referral to AA and community treatment. One group will receive on-site, integrated STD-MET while the second group will receive an equal number of sessions, on-site, viewing alcohol educational videos (STD-VID). Hypotheses: 1.During the pre-transplant """"""""wait list"""""""" period - patients receiving STD-MET will show better engagement into the liver transplant regimen, reduced drinking and better general function than patients assigned to (STD-VID). STD-MET group will show: a) greater compliance with appointments and medical regimen - measured by standard measures of attendance, medical status, recall and understanding of their medication regimen, b) more awareness and acceptance of alcohol, smoking and/or other drug problems - measured by the (SOCRATES) stage of change, c) more attendance at standard off-site alcohol treatment programs and AA meetings - measured by standard checks on treatment attendance as well as TSR from subjects and collaterals, d) greater and more lasting reductions in drinking, cigarette and other drug use - measured by urine screens, breathalyzer, self-report and collateral TLFB measures, e) lower levels of depression and anxiety - measured by the BDI, BAI and the ASI psychiatric scale every three months, f) less mortality and morbidity prior to organ transplant - than the STD-VID group. 2. For patients who ultimately receive a liver transplant - STD-MET patients will show better general recovery than patients assigned to the alcohol education video series STD-VID. The STD-MET will show: a) fewer complications during during hospitalization measured by standard surgical records, b) better general function at one- month post hospital discharge-measured by standard medical evaluation and ASI than the STD-VID group.
