Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Mar 6;18(1):14.
doi: 10.1186/s13722-023-00370-5.

Grayken lessons: between a rock and a hard place? A 37-year-old man with acute liver injury while enrolled in a managed alcohol program for severe alcohol use disorder

Thomas D Brothers  1   2 , Alexander Y Walley  3 , Helen Rivers-Bowerman  4 , Magnus McLeod  5 , Leah Genge  4   6
Affiliations
Case Reports

Grayken lessons: between a rock and a hard place? A 37-year-old man with acute liver injury while enrolled in a managed alcohol program for severe alcohol use disorder

Thomas D Brothers et al. Addict Sci Clin Pract. .

Abstract

Managed alcohol programs aim to reduce health and social harms associated with severe alcohol use disorder. Here, we describe a young man with severe alcohol use disorder enrolled in a managed alcohol program, who was admitted to hospital with acute liver injury. Fearing that alcohol was contributing, the inpatient care team discontinued the managed alcohol dose in hospital. He was ultimately diagnosed with cephalexin-induced liver injury. After consideration of risks, benefits, and alternative options, the patient and care team jointly decided to restart managed alcohol after hospital discharge. With this case, we describe managed alcohol programs and summarize the emerging evidence-base, including eligibility criteria and outcome measures; we explore clinical and ethical dilemmas in caring for patients with liver disease within managed alcohol programs; and we emphasize principles of harm reduction and patient-centered care when establishing treatment plans for patients with severe alcohol use disorder and unstable housing.

Keywords: Addiction medicine; Alcohol use disorder; Harm reduction; Hepatitis; Managed alcohol programs; Substance use disorders; Substance-related disorders.

PubMed Disclaimer

Conflict of interest statement

MM is the principal investigator in trials funded by Pfizer, Advanz, Allergan and NovoNordisk. MM has been on advisory boards/received honouraria from Advanz, Gilead, Eli Lilly, Eisai, NovoNordisk, Abbvie, and Lupin. The remaining authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Histopathological examination of nontargeted liver biopsy of a 37-year-old man with severe alcohol use disorder admitted to the hospital for acute liver injury. The image shows lobular cholestasis (mostly hepatocellular) with feathery degeneration and bile-laden macrophages
See this image and copyright information in PMC

References

    1. Wood E, Albarqouni L, Tkachuk S, Green CJ, Ahamad K, Nolan S, et al. Will this hospitalized patient develop severe alcohol withdrawal syndrome?: The rational clinical examination systematic review. JAMA. 2018;320(8):825–833. doi: 10.1001/jama.2018.10574. - DOI - PMC - PubMed
    1. Brothers TD, Kaulbach J, Tran A. Unhealthy alcohol use in a 65-year-old man awaiting surgery. CMAJ. 2021;193(32):E1250–E1252. doi: 10.1503/cmaj.202128. - DOI - PMC - PubMed
    1. Pauly BB, Vallance K, Wettlaufer A, Chow C, Brown R, Evans J, et al. Community managed alcohol programs in Canada: overview of key dimensions and implementation. Drug Alcohol Rev. 2018;37(S1):S132–9. doi: 10.1111/dar.12681. - DOI - PubMed
    1. Pauly B, Brown M, Evans J, Gray E, Schiff R, Ivsins A, et al. “There is a Place”: impacts of managed alcohol programs for people experiencing severe alcohol dependence and homelessness. Harm Reduct J. 2019;16(1):70. doi: 10.1186/s12954-019-0332-4. - DOI - PMC - PubMed
    1. Brothers TD, Leaman M, Bonn M, Fraser John, Gillis Amy, Gniewek Michael, et al. Evaluation of an emergency safe supply drugs and managed alcohol program in COVID-19 isolation hotel shelters for people experiencing homelessness. Drug Alcohol Depend. 2022;235:109440. doi: 10.1016/j.drugalcdep.2022.109440. - DOI - PMC - PubMed

Publication types