▶ Bae Si-hyeon, Director of Eunpyeong St. Mary’s Hospital, Catholic University of Korea
Bae Si-hyeon, director of Catholic University Eunpyeong St. Mary’s Hospital, explains alcoholic liver disease. [은평성모병원 제공]
“If you ask 100 patients who visit the hospital with alcoholic liver disease, all 100 will answer that they can quit drinking of their own volition. However, if your liver is damaged and you have to go to the hospital, that is not the case. There is even a patient who underwent another liver transplant because he was unable to quit drinking even after receiving his son’s liver. This means that even if you treat a damaged liver, it cannot be a fundamental treatment if you cannot stop your drinking addiction.”
Bae Si-hyeon, director of the Eunpyeong St. Mary’s Hospital of the Catholic University of Korea (professor of gastroenterology), said, “At first, it was difficult, so I started drinking often to soothe my mood, but once you become addicted to drinking, the act of drinking itself becomes important.” When we met him at Eunpyeong St. Mary’s Hospital in Eunpyeong-gu, Seoul on the 6th of this month, he continued, “When alcoholic liver disease gets worse, you are unable to control yourself when it comes to drinking, and your family often turns their backs on you.” Alcoholic liver disease refers to liver disease caused by excessive drinking. These include various diseases such as fatty liver with no symptoms, alcoholic hepatitis, cirrhosis, and liver failure.
“There is a patient with alcoholic liver disease in his late 50s, and his elderly mother, who is over 80 years old, is currently taking care of him. Not long ago, I was hospitalized for hepatic encephalopathy and this time I came to the hospital with my legs swollen like an elephant. I had to go to the hospital several times because my stomach was full of ascites. That was the only time I complained that I was sick and asked for help and promised not to drink. “Once my condition improves and I am discharged, I turn to alcohol again.” Hepatic encephalopathy is a decline in brain function that occurs when toxins accumulate in the blood due to a decline in liver function.
Director Bae emphasized, “Alcoholic liver disease requires both medical and psychiatric treatment.” In fact, the research results published recently in the International Journal of the Korean Association for the Study of the Liver by a joint research team in which he participated support this. Previously, the focus was mainly on restoring liver health and managing related complications.
Using data from the UK Biobank, the researchers looked at 2,417 patients with alcoholic liver disease and observed changes over 20 years in those who received psychiatric treatment after being diagnosed with liver disease and those who did not. As a result, the overall mortality rate, liver disease-related mortality rate, and incidence of cirrhosis in the group that received psychiatric treatment were lower than those in the group that did not receive psychiatric treatment. The median survival time by group (the period from diagnosis of alcoholic liver disease to when half of the patients survived) was 15.0 years in the group that also received psychiatric treatment, but 10.1 years in the group that did not receive psychiatric treatment, which was nearly 5 years shorter. Director Bae explained, “This means that it is important to start psychiatric intervention from the beginning of the diagnosis of alcoholic liver disease.”
However, reality is still far from the research results. He complained, “The proportion of patients who actually visit a mental health clinic after being persuaded that they need psychiatric treatment is only about 2 out of 10 patients with alcoholic liver disease.” That’s why it’s common to use ‘tricks’. “Because they refuse to admit that they have a mental problem, they tell the patient indirectly. Since you are suffering from a sleep disorder, we advise you to go to a sleep clinic, and the psychiatrist at the sleep clinic writes down that you are addicted to drinking in the joint medical examination. “There are many cases where only treating a damaged liver does not improve the condition.”
If the addiction is severe, medication is used as psychiatric treatment. Prescribe medications to prevent a rapid rise in the hormone that feels happy (dopamine) or to relieve withdrawal symptoms. Anti-craving medications are also used to reduce cravings for alcohol. In mild cases, motivational enhancement therapy is provided. Motivation enhancement therapy is a face-to-face treatment method that increases the will (motivation) to overcome problems caused by drinking. It is a method of reminding people of the problems they have experienced in social life and interpersonal relationships due to drinking, and then continuously reminding them of the aspects that are inconsistent with their ideal self. Cognitive behavioral therapy is a method of reducing dependence on drinking by finding behaviors that provide satisfaction even without drinking and repeating these behaviors.
Director Bae said, “If you have heard people around you say, ‘Stop drinking,’ you should definitely check to see if you are alcohol addicted and if there are any problems with your physical health.” He added, “It is definitely a problem to hear such a thing in Korean culture, which is tolerant of drinking.” “Because it means there is,” he said.
Reporter Byun Tae-seop>
Dr. Bae highlighted the importance of integrating psychiatric treatment with medical care for ALD. How can we better train healthcare professionals to identify and address the mental health needs of patients struggling with alcohol abuse and liver disease?
## World-Today-News Exclusive Interview: Unmasking the Silent Epidemic of Alcoholic Liver Disease
**Introduction:**
Welcome to World-Today News. Today, we delve into the silent crisis of alcoholic liver disease (ALD) with two distinguished guests: Dr. Bae Si-hyeon, Director of Eunpyeong St. Mary’s Hospital, Catholic University of Korea, and [Insert Name and Credentials of Second Guest]. We aim to shed light on the multifaceted nature of ALD, encompassing its physical and psychological repercussions.
**Section 1: Understanding the Scope of the Problem:**
* **Dr. Bae, you have extensive experience treating patients with ALD. Would you elaborate on the prevalence of this condition and the alarming impact it has on individuals and society?** (Directed towards Dr. Bae)
* **What societal factors might contribute to the rising incidence of ALD, and how do these factors differ across diverse populations?** (Open to both guests)
**Section 2: The Vicious Cycle of Alcohol Dependence:**
* **Dr. Bae, you highlighted the misconception that many patients believe they can control their drinking. Can you explain why managing alcohol addiction is often more complex than simply stopping consumption?** (Directed towards Dr. Bae)
* **Beyond the physical damage to organs, how does chronic alcohol abuse affect an individual’s mental and emotional well-being? What are some of the psychological barriers to seeking help for both alcohol dependence and the accompanying liver damage?** (Open to both guests)
**Section 3: Breaking Barriers to Treatment: The Need for a Holistic Approach:**
* **Dr. Bae, your research underlines the effectiveness of integrating psychiatric treatment alongside traditional medical care for ALD. Can you share specific examples of how this combined approach has positively impacted patient outcomes?** (Directed towards Dr. Bae)
* **What are some of the challenges healthcare professionals face when trying to encourage patients with ALD to accept dual treatment for both their physical and mental health? Should there be more comprehensive public awareness campaigns to address these misconceptions?** (Open to both guests)
**Section
4: Looking Ahead: Towards Prevention and Early Intervention:**
* **What steps can be taken at the community level to create a more supportive environment for individuals struggling with alcohol dependency and promote early intervention?** (Open to both guests)
* **What message would you give to someone who is concerned about their own drinking habits or those of a loved one? What resources are available for individuals seeking help?** (Open to both guests)
**Conclusion:**
This discussion highlights the urgency to recognize ALD not only as a physical ailment but also as a complex issue intertwined with psychological and social factors. By fostering open conversations, breaking down stigma, and promoting integrated treatment approaches, we can pave the way for more effective prevention, intervention, and ultimately, recovery for those affected by this devastating disease.
