The prevalence of
alcohol use disorder (AUD) has been steadily increasing over the past decade. In parallel, alcohol-associated
liver disease (ALD) has been increasing at an alarming rate, especially among young patients. Data suggest that most patients with ALD do not receive AUD
therapy. Although
liver transplantation is the only curative
therapy for end-stage ALD, transplant candidacy is often a matter of debate given concerns about patients being under-treated for AUD and fears of post-
transplantation relapse affecting the allograft. In this Review, we discuss diagnosis, predictors and effects of relapse, behavioural
therapies and
pharmacotherapies, and we also propose an integrative, multidisciplinary and multimodality approach for treating AUD in patients with
cirrhosis, especially in the setting of
liver transplantation. Notably, this approach takes into account the utility of AUD
pharmacotherapy in patients on immunosuppressive medications and those with renal impairment after
liver transplantation. We also propose a comprehensive and objective definition of relapse utilizing contemporary
biomarkers to guide future clinical trials. Future research using the proposed approach and definition is warranted with the goal of optimizing AUD treatment in patients with
cirrhosis, the transplant selection process and post-
transplantation care of patients with AUD.