Linkage and alcohol use outcomes of a screening, brief intervention, and referral to treatment (SBIRT) program for alcohol-related liver disease: A retrospective cohort study from India.

BACKGROUND: Alcohol-related liver disease (ArLD) and alcohol use disorder remain undertreated. Collaborative care embedding addiction services within medical settings have shown promise. AIM: We evaluated the linkage and alcohol use outcomes of an SBIRT-based collaborative care clinic at a public sector hospital in India, examining rates of linkage to addiction treatment, alcohol use outcomes at follow-up, and factors associated with successful linkage. METHODS: A retrospective cohort study of 500 consecutively enrolled patients was conducted over January 2023-July 2024. Patients with ArLD were systematically screened using the Alcohol Use Disorders Identification Test (AUDIT) and risk-stratified into brief advice, brief counselling, or referral for specialized addiction treatment. RESULTS: All patients were male, predominantly rural (53.3%), and travelled a median of 80 km. The mean AUDIT score was 18.0 ± 9.4. The clinic enrolled a mean of 26.3 patients per month; stable throughout. Of 288 patients referred for addiction treatment, 156 (54.4%; 95% CI 48.4-59.8%) were successfully linked, with a median time to first addiction contact of 3 days. At the 3-month follow-up, retention was 26.1%; among those with a recorded alcohol use status, 35.9% were abstinent. On multivariable logistic regression, no patient-level variable was associated with linkage. The sole significant factor was therapist identity (likelihood ratio χ2 = 22.75, df = 5, P < 0.001), with linkage rates ranging from 17.6% to 72% across counsellors. CONCLUSIONS: Collaborative care model is operationally viable within a public sector hepatology department in India. Marked intertherapist variability in linkage rates underscores the need for competency-based training.