Background
Alcohol exerts direct hepatotoxic effects that exacerbate viral replication, accelerate fibrosis, and promote hepatocellular carcinoma. However, alcohol use remains prevalent among patients with chronic liver disease (CLD), and effective strategies to reduce alcohol use in this vulnerable population are scarce.
Objectives
To evaluate the feasibility and acceptability of mobile chat messaging plus screening-based brief alcohol intervention in reducing alcohol among CLD patients.
Methods
In this two-arm, assessor-blind, pilot randomized controlled trial, Chinese adults with CLD and an Alcohol Use Disorders Identification Test (AUDIT) score of ≥8 were recruited from an outpatient liver clinic in Hong Kong. Participants were computer-randomized (1:1) to either the intervention group or the control group. All participants received screening, brief intervention, and referral to treatment for alcohol reduction and a self-help booklet at baseline. The intervention group additionally received real-time, personalised chat-based support for alcohol reduction via WhatsApp for 3 months from baseline. The feasibility outcomes included the recruitment rate and retention rate. Intervention acceptability was assessed by the participants’ engagement with the chat-based intervention. Treatment outcomes at 3-month follow-up included self-reported weekly alcohol consumption, AUDIT Consumption score (AUDIT-C), total alcohol consumption in the past week, heavy episodic drinking in the past 3 months, and past 7-day abstinence. The primary analysis was by intention-to-treat, assuming participants with missing data had no change in alcohol use from baseline. Trial registration: ClinicalTrials.gov (NCT06587568).
Results
From October 2024 to March 2025, 106 of 168 eligible subjects (recruitment rate = 63%) were randomized to the intervention (N = 53) or control (N = 53) groups. The retention rate was 98% (104 of 106) at 3-month follow-up (end of treatment). In the intervention group, 62% (33 of 53) of participants responded to the chat messages at least once, and 38% (20 of 53) continuously engaged with the intervention over the 3-month intervention period. At 3-month follow-up, both weekly alcohol consumption (mean: 34.58 grams vs. 51.63 grams; P=0.038), and AUDIT-C (mean: 4.40 vs. 6.08; P=0.024) were significantly lower in the intervention group than in the control group. The difference in total alcohol consumption in the past week was non-significant (mean: 90.38 grams vs. 151.16 grams; P=0.21). Proportionately more participants in the intervention group reported no heavy episodic drinking (49% vs 32%, P=0.11) and past 7-day abstinence (26% vs 21%, P=0.65), but the differences were not significant. No adverse events were reported.
Conclusions
Mobile chat messaging shows promising feasibility and acceptability for delivering alcohol reduction support to patients with CLD, with the potential to promote short-term alcohol reduction.
Funding: Health and Medical Research Fund (No. 21222731)