Self-report measures often underestimate the severity of symptoms of alcohol abuse. It is generally supposed that patients who abuse alcohol tend to minimize their drinking behavior. However, the validity of self-reports also can be influenced by external factors such as the setting.
Objective—
To investigate how the setting influences self-reporting on symptoms of alcohol abuse in patients with alcoholic liver disease.
Design, Setting and Participants—
Cross-sectional study in patients before liver transplant (n = 40) and patients in rehabilitation therapy (n = 44).
Main Outcome Measure—
Scores on the Munich Alcoholism Test, which consists of a self-report-scale and an expert-rating scale.
Results—
The discrepancy in scores on the self-report scale and the expert-rating scale differed significantly between patients before liver transplant and patients in rehabilitation therapy. Furthermore, patients in the rehabilitation therapy group reported higher alcoholism scores on the self-report questionnaire than did patients before liver transplant, but the groups did not differ in the expert evaluation value.
Conclusion—
The transplant setting seems to evoke minimizing in self-reports in patients with alcohol abuse. Minimizing or denying symptoms of alcohol abuse does not seem to be a specific characteristic of persons with alcohol abuse, as it is also caused by the circumstances. In the transplant setting, more attention should be given to the psychologically difficult situation for patients with potential alcohol abuse. Implementation of psychoeducational interventions in the treatment process before transplant could be a first step toward reaching this goal.
Get full access to this article
View all access options for this article.
References
1.
AllenJPWurstFMThonNLittenRZ. Assessing the drinking status of liver transplant patients with alcoholic liver disease. Liver Transpl. 2013;19(4):369–376. doi:10.1002/lt.23596.
2.
HempelJMGreif-HigerGKaufmannTBeutelME. Detection of alcohol consumption in patients with alcoholic liver cirrhosis during the evaluation process for liver transplantation. Liver Transpl. 2012;18(11):1310–1315. doi:10.1002/lt.23468.
DiMartiniADayNDewMA. Alcohol use following liver transplantation: a comparison of follow-up methods. Psychosomatics. 2001;42(1):55–62.
5.
BholahHBateJRothwellKAldersleyM. Random blood alcohol level testing detects concealed alcohol ingestion in patients with alcoholic liver disease awaiting liver transplantation. Liver Transpl. 2013;19(7):782–783. doi:10.1002/lt.23664.
6.
CarbonneauMJensenLABainVGKellyKMeebergGTandonP. Alcohol use while on the liver transplant waiting list: a single-center experience. Liver Transpl. 2010;16(1):91–97. doi:10.1002/lt.21957.
7.
LittenRZFertigJ. Self-report and biochemical measures of alcohol consumption. Addiction. 2003;98(suppl 2):iii–iv.
8.
SchwarzN. Self-reports: how the questions shape the answers. Am Psychol. 1999;54(2):93–105. doi:10.1037//0003-066X.54.2.93.
9.
Del BocaFKDarkesJ. The validity of self-reports of alcohol consumption: state of the science and challenges for research. Addiction. 2003;98(suppl 2):1–12.
10.
Del BocaFKNollJA. Truth or consequences: the validity of self-report data in health services research on addictions. Addiction. 2000;95(suppl 3):S347–S360.
11.
OrregoHBlakeJEBlendisLMKapurBMIsraelY. Reliability of assessment of alcohol intake based on personal interviews in a liver clinic. Lancet. 1979;2(8156-8157):1354–1356.
12.
HesselbrockMBaborTFHesselbrockVMeyerREWorkmanK. “Never believe an alcoholic”? On the validity of self-report measures of alcohol dependence and related constructs. Int J Addict. 1983;18(5):593–609.
13.
LuceyMRBrownKAEversonGT. Minimal criteria for placement of adults on the liver transplant waiting list: a report of a national conference organized by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases. Liver Transpl Surg. 1997;3(6):628–637.
14.
RiceJPLuceyMR. Should length of sobriety be a major determinant in liver transplant selection?Curr Opin Organ Transplant. 2013;18(3):259–264.
15.
PfitzmannRSchwenzerJRayesNSeehoferDNeuhausRNusslerNC. Long-term survival and predictors of relapse after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl. 2007;13(2):197–205.
16.
KarimZIntaraprasongPScudamoreCH. Predictors of relapse to significant alcohol drinking after liver transplantation. Can J Gastroenterol. 2010;24(4):245–250.
17.
DiMartiniADewMADayN. Trajectories of alcohol consumption following liver transplantation. Am J Transplant. 2010;10(10):2305–2312. doi:10.1111/j.1600-6143.2010.03232.x.
18.
DewMADiMartiniAFSteelJ. Meta-analysis of risk for relapse to substance use after transplantation of the liver or other solid organs. Liver Transpl. 2008;14(2):159–172. doi:10.1002/lt.21278.
19.
FaureSHerreroAJungB. Excessive alcohol consumption after liver transplantation impacts on long-term survival, whatever the primary indication. J Hepatol. 2012; 57(2):306–312. doi:10.1016/j.jhep.2012.03.014.
20.
CuadradoAFabregaECasafontFPons-RomeroF. Alcohol recidivism impairs long-term patient survival after orthotopic liver transplantation for alcoholic liver disease. Liver Transpl. 2005;11(4):420–426.
21.
IasiMSVieiraAAnezCI. Recurrence of alcohol ingestion in liver transplantation candidates. Transplant Proc. 2003;35(3):1123–1124.
22.
WebzellIBallDBellJ. Substance use by liver transplant candidates: an anonymous urinalysis study. Liver Transpl. 2011;17(10):1200–1204. doi:10.1002/lt.22370.
23.
WeinriebRMVan HornDHMcLellanATLuceyMR. Interpreting the significance of drinking by alcohol-dependent liver transplant patients: fostering candor is the key to recovery. Liver Transpl. 2000;6(6):769–776.
24.
SterneckMYeglesMvon RothkirchG. Determination of ethyl glucuronide in hair improves evaluation of long-term alcohol abstention in liver transplant candidates. Liver Int. 2014;34(3):469–476. doi:10.1111/liv.12243.
25.
DimartiniAFDewMA. Monitoring alcohol use on the liver transplant wait list: therapeutic and practical issues. Liver Transpl. 2012;18(11):1267–1269. doi:10.1002/lt.23529.
SowaJPAtmacaOKahramanA. Non-invasive separation of alcoholic and non-alcoholic liver disease with predictive modeling. PLoS One. 2014;9(7):e101444. doi:10.1371/journal.pone.0101444.
28.
DecheneASowaJPGieselerRK. Acute liver failure is associated with elevated liver stiffness and hepatic stellate cell activation. Hepatology. 2010;52(3):1008–1016. doi:10.1002/hep.23754.
29.
JohannBLorenzenJ. Psychosomatic Evaluation of Liver Transplantation Patients. Practical Use of the Transplant Evaluation Rating Scale. Lengerich, Germany: Pabst Science Publishers; 1997:43.
30.
TwillmanRKManettoCWellischDKWolcottDL. The Transplant Evaluation Rating Scale. A revision of the psychosocial levels system for evaluating organ transplant candidates. Psychosomatics. 1993;34(2):144–153.
31.
ZigmondASSnaithRP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67(6):361–370.
32.
BjellandIDahlAAHaugTTNeckelmannD. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002;52(2):69–77.
33.
HerrmannCBussUSnaithRP. HADS-D Hospital Anxiety and Depression Scale: Deutsche Version. Bern, Germany: Verlag Hans Huber; 1995.
34.
FeuerleinWRingerCKufnerHAntonsK. The diagnosis of alcoholism—the Munich Alcoholism Test (MALT). Int J Rehabil Res. 1979;2(4):533–534.
35.
StewartKEHartRPGibsonDPFisherRA. Illness apprehension, depression, anxiety, and quality of life in liver transplant candidates: implications for psychosocial interventions. Psychosomatics. 2014;55(6):650–658.
36.
ErimYBeckmannMKleinCPaulABeckebaumS. Psychosomatic aspects of organ transplantation. Psychother Psychosom Med Psychol. 2013;63(6):238–249. doi:10.1055/s-0033-1343191.
37.
ErimYBeckmannMTagayS. Stabilisation of abstinence by means of psychoeducation for patients with alcoholic liver disease awaiting liver transplantation [in German]. Z Psychosom Med Psychother. 2006;52(4):341–357.
38.
ErimYMollerEBeckebaumSGerkenGBroelschCESenfWE. Manualised group therapy concept for patients with alcoholic cirrhosis awaiting liver transplantation [in German]. Z Psychosom Med Psychother. 2006;52(3):243–258.
