Mandana Khalili, MD, is Chief of Clinical Hepatology and Director of Clinical and Translational Research in Hepatology at San Francisco General Hospital, and directs the UCSF T32 Hepatology Training Program.

Mandana Khalili, MD

A telehealth-delivered stepped alcohol treatment (SAT) model was associated with greater reductions in weekly alcohol consumption among patients with 

 and unhealthy alcohol use compared with usual care, according to findings from a randomized controlled trial. 

Although SAT did not significantly improve the trial’s primary endpoint of achieving less-than-moderate alcohol use at 3 and 6 months, participants receiving SAT had significantly greater reductions in mean drinks per week at both time points after adjustment for study site and baseline characteristics.

Telehealth Stepped Alcohol Care Reduced Drinking in Liver Disease

The study highlights a persistent challenge in hepatology, where unhealthy alcohol use is common among patients with CLD, and guidelines recommend integrating evidence-based alcohol treatment into liver care despite limited availability of these services in routine clinical practice.

“We wanted to really test a practical, scalable model that could be incorporated into routine hepatology practice and adapted for patients that may have changing needs over time,” senior author Mandana Khalili, MD, told 

How the Telehealth Alcohol Treatment Trial Was Designed

Investigators enrolled 157 adults with CLD and unhealthy alcohol use across 3 hepatology clinics in Northern California, including Zuckerberg San Francisco General Hospital and 2 Veterans Affairs health systems. These participants were randomly assigned to receive SAT (n = 81) or usual care (n = 76) and were followed for 6 months.

The cohort had a median age of 61 years, 86% were male, 48% had cirrhosis, and 78% met criteria for alcohol use disorder. Mean alcohol consumption at baseline was approximately 32 drinks per week.

SAT consisted of up to 3 telehealth motivational interviewing sessions delivered over 6 weeks. Participants who continued unhealthy alcohol use at 3 months were stepped up to addiction medicine services, including structured counseling and pharmacotherapy when appropriate.

The investigators designed the model as a practical and scalable approach that could be incorporated into routine hepatology practice and adjusted based on patients’ changing treatment needs. Usual care consisted of routine alcohol screening and brief provider counseling.

The primary endpoint was the proportion of participants reporting less-than-moderate alcohol use at 3 and 6 months. Secondary outcomes included mean drinks per week, 30-day abstinence, and heavy episodic drinking.

Telehealth Alcohol Treatment Reduced Weekly Drinking but Missed Primary Endpoint

The trial did not meet its primary endpoint. At 6 months, 56% of participants receiving SAT and 53% receiving usual care reported less-than-moderate alcohol use, a nonsignificant difference.

However, after adjustment for study site and baseline characteristics, participants assigned to SAT experienced significantly greater reductions in mean drinks per week compared with usual care at both 3 and 6 months.

“One of the most important findings was that the participants receiving the step care treatment had a significantly higher reduction in the amount of average alcohol intake that they had per week,” Khalili said.

30-day abstinence at 6 months occurred in 29% of participants receiving SAT compared with 18% of those receiving usual care, although the difference did not reach statistical significance. Investigators also observed a trend toward less heavy episodic drinking with SAT.

Alcohol consumption declined in both groups over time. Khalili noted this likely reflects the impact of ongoing hepatology care itself but said the structured intervention produced an additional reduction in alcohol use beyond usual care.

The reduction in drinks per week appeared greater among women. Independent of treatment assignment, Latino participants and those with higher baseline motivation to reduce alcohol use were more likely to achieve the primary endpoint.

Among participants reporting 30-day abstinence, alcohol biomarkers confirmed abstinence in nearly 70% of those tested. Follow-up remained high, with completion rates of 90% at three months and 89% at six months. Rates of hospitalization, death, new cirrhosis, and hepatic decompensation did not differ significantly between groups.

Clinical Pearl: Why Harm Reduction Matters in Chronic Liver Disease

Although the trial did not achieve its primary endpoint, the reduction in weekly alcohol consumption may still be clinically meaningful for patients with chronic liver disease, explains Khalili.

Continued alcohol use can contribute to liver disease progression and negatively affect quality of life and mental health. For patients who are not immediately able to achieve abstinence, reducing alcohol consumption may represent an important treatment goal while they engage with behavioral interventions, addiction medicine, and pharmacotherapy.

“Even reducing alcohol consumption short of complete abstinence is meaningful clinically in this population with chronic liver disease and is also consistent with a model of harm reduction,” Khalili said.

How Telehealth Alcohol Treatment Could Expand Hepatology Care

Current liver disease guidelines recommend alcohol screening, behavioral counseling, pharmacotherapy when appropriate, and referral to addiction services. However, integrated alcohol treatment remains uncommon in hepatology clinics.

Khalili said the findings support integrating alcohol treatment directly into hepatology practices rather than relying exclusively on specialty addiction referrals.

“Rather than thinking of alcohol treatment as something that happens only in specialty addiction services, hepatology clinics themselves can play an active role in engaging patients in this type of evidence-based care,” she said.

The stepped-care model allows treatment intensity to increase according to patient needs, beginning with motivational interviewing and escalating to addiction medicine services and medication management when appropriate.

Investigators also found strong patient engagement with the approach. Despite enrolling patients from safety-net and Veterans Affairs health systems, populations that may experience socioeconomic barriers, mental health challenges, and difficulty accessing care, follow-up rates were approximately 90% at both three and six months.

“This lets us know that chronic liver disease patients are receptive to discussing alcohol use and engaging in treatment if it’s offered in patient-centered and accessible ways,” Khalili said.

Editor’s Note: Khalili reports relevant disclosures with Gilead, GSK, Resolution, and Intercept. 

A randomized controlled trial of stepped treatment to reduce unhealthy alcohol use in patients with chronic liver disease.

 Published online June 24, 2026. doi:10.1097/HEP.0000000000001796.

Yes, telemedicine can reduce alcohol use for liver disease patients.

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Telehealth stepped alcohol treatment reduced weekly drinking, but not the primary endpoint, among patients with chronic liver disease.

Mandana Khalili, MD

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