Failure to fully disclose during pretransplant psychological evaluation in alcoholic liver disease: a driving under the influence corroboration study

Abstract

The prevention of recidivism in alcoholic liver disease is one of the aims of pretransplant psychological evaluation (PE). Failure to fully disclose the extent of alcohol use is evidence of ongoing alcoholism. Driving under the influence (DUI) represents objective evidence of alcohol abuse, but verifying DUIs through official records is not standard during PE. The aim of this study was to determine whether there was failure to fully disclose alcohol abuse on the part of patients on the basis of the Wisconsin Department of Transportation (DOT) DUI rate. Demographics, alcohol abuse/abstinence history, and DUIs admitted by the patient on PE were collected for 82 alcoholic patients with cirrhosis. The DOT was queried for DUIs before PE for all patients. Discrepancies between PE and DOT DUI numbers were evaluated and re-presented to the psychologist without identifiers. Psychosocial recommendation was then evaluated in light of DOT/PE DUI discrepancies. Six patients did not drive. The remaining 76 had 29 +/- 8 years of alcohol abuse and reported sobriety for 55 +/- 64 months before PE. Eighteen DUIs that were not originally admitted were discovered; 63% of DUIs occurred in the period during which patients claimed to be sober. Two patients had been rejected for transplant for other causes. Re-presenting the case to the psychologist with the new knowledge of DUIs would have prevented transplant clearance for the remaining 16 (21%, P = 0.000005 versus prior PE). In conclusion, official DUI records in prospective transplant candidates may identify patients who do not fully disclose the extent of their alcohol abuse and may be at risk for adverse outcomes.