Alcohol-Associated Liver Disease and Drug-Induced Liver Injury

Alcohol-associated liver disease is the leading cause of cirrhosis in the United States and has become the top indication for liver transplantation since direct-acting antivirals allowed for cure of hepatitis C. The COVID-19 pandemic compounded existing concerns about a rising prevalence of alcohol-associated hepatitis, with a notable increase in women in their 30s and 40s. Insufficient access to health care continues to exacerbate socioeconomic disparities in screening and treatment. People identifying as American Indian or Alaska Native have had the greatest increase in mortality due to alcohol-associated liver disease. Alcohol use screening is essential for all adults. Abstinence from alcohol remains the cornerstone intervention for alcohol-associated liver disease, although pharmacotherapies are under evaluation. Noninvasive liver disease assessment, including serum and imaging modalities, is expanding access to advanced liver disease evaluation in primary care settings. Other causes of substance-based liver injury include prescription and nonprescription medications, herbal products, and dietary supplements.