Damaged human livers can repair themselves. Even livers badly scarred from excessive alcohol use, including alcohol-related hepatitis and cirrhosis, have the potential to improve with a treatment plan that includes medication, abstinence and emotional support.
This integrated trio of care wasn't always available to patients with liver disease, says Courtney Sherman , MD, hepatologist and associate professor at UC San Francisco.
"In medical school, we were mostly taught to manage symptoms of the liver disease, such as elevated liver tests and complications from cirrhosis including fluid retention, but we rarely received training or focused on the management of the underlying problem - the addiction itself," Sherman said.
The result, much of the time, was that patients continued to drink, increasing their liver damage, and physicians felt limited to managing ever-worsening symptoms. It was a lose-lose situation.
Inspired by a successful University of Michigan initiative that integrated hepatology, mental health and addiction care, Sherman and Davina Martinez , LCSW, MPH teamed up in 2023 to launch UCSF's first multidisciplinary clinic for patients with liver disease and alcohol addiction called HALT - Healing Alcohol-Associated Liver Disease Together . HALT is currently the only multidisciplinary alcohol-associated liver disease clinic in Northern California.
More than 10% of people over 12 years old have alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism, and alcohol addiction is worse in some ethnic groups than others.
According to the NIH, 11.6% of American Indian or Alaska Native people have alcohol addiction, 11% of White people, 10.8% of Hispanic or Latino people and 9.6% of Black or African American people.
People need to know that there is help and this can be turned around, said Martinez, an addiction counselor who works with Sherman to provide HALT patients emotional guidance and support in overcoming their addiction.
"My motivation is to make these communities aware of this important resource," said Martinez, a member of the Native American Chemehuevi tribe.
Root of the problem
HALT patients meet with both Sherman and Martinez. Sherman first addresses the condition of their liver and how best to manage their liver-related complications in addition to their alcohol intake. Sherman discusses all treatment options, including a potential liver transplant if appropriate.
A consult with Martinez immediately follows to explore the patient's ability to commit to sobriety. Martinez and the patient identify alcohol-use triggers, explore methods of controlling impulses, and jointly develop and execute a relapse prevention plan.
All HALT patients are also offered an optional visit with Triveni Defries, MD, an addiction medicine expert who, if needed, can prescribe medications to control patients' cravings and withdrawals.
Patients benefit from this integrated model for alcohol addiction and alcohol-associated liver disease, according to a February 2025 study by Cleveland Clinic published in Hepatology Communications. The study, of a program very similar to HALT, outlines the positive results of their similarly integrated alcohol addiction clinic. Cleveland researchers found about 45% of their patients were in remission from alcohol by their first follow-up visit, and improved their MELD (Model for End-Stage Liver Disease) scores, which assess the severity of their liver disease.
The goal of HALT is to provide more holistic care - care not just for the liver but for the whole person."
"After engaging in (the multidisciplinary clinic) patients ... experienced significant improvements in markers of liver injury, severity of liver disease, alcohol use and remission in alcohol use disorder," Cleveland researchers noted.
Sherman and Martinez, who are collecting data about HALT's effectiveness, have jointly treated more than 300 patients since its launch two years ago. Patients are referred to HALT by primary care physicians and gastroenterologists.
"Studies show that an integrated program of pharmacologic and mental health is most effective in healing a patient's liver damaged from Alcohol Use Disorder," Sherman said. "The goal of HALT is to provide more holistic care - care not just for the liver but for the whole person."
A reversal of fate
HALT patients suffer from a variety of ailments related to alcohol addiction. Some patients' livers are so damaged they need a transplant to survive. Others hope for healing without surgery. Many are overwhelmed by the challenge of sobriety. Sherman and Martinez let them know they are not alone and that research supports the idea that recovery is possible.
"I've seen countless patients with advanced liver failure who need a liver transplant but do not qualify because of continued alcohol use or other psychosocial challenges. With alcohol abstinence, many patients improve to the point that they no longer need a transplant and resolve many of their liver-related symptoms," Sherman said.
"Alcohol is toxic to the liver. If you remove the toxin, the liver can heal," she said.
