Rehabilitation for Alcohol Use Disorder: Interdisciplinary Advances, Challenges, and Opportunities

Abstract

Alcohol use disorder (AUD) causes 2.6 million deaths annually and over 230 associated conditions, yet fewer than 20% of affected individuals receive treatment and current pharmacotherapies offer only moderate efficacy. This review defines alcohol rehabilitation as a multidisciplinary discipline and synthesizes evidence across six core fields, including public health, addiction medicine, clinical psychology, neuroscience, hepatology, and social sciences, while integrating engineering perspectives spanning neuroengineering, biomedical devices, wearable biosensors, and artificial intelligence (AI)-powered digital health platforms as an emerging transformative frontier. We searched PubMed, PsycINFO, and Cochrane Library from inception to January 5, 2026, using terms including “alcohol use disorder” “alcohol rehabilitation” and related Medical Subject Headings (MeSH), alongside engineering-specific terms (neuromodulation, wearable devices, digital health, machine learning, virtual reality, and transcranial magnetic stimulation). Reference lists of key reviews and World Health Organization reports were hand-searched. We included peer-reviewed original research, systematic reviews, meta-analyses, and high-impact guidelines. The initial search retrieved 1247 records, among which 89 articles were ultimately included after deduplication and rigorous screening. Of these eligible studies, 12 focused on engineering- and technology-driven interventions for AUD, covering neuromodulation devices, wearable biosensors, digital therapeutics, and AI-based predictive models. Alcohol rehabilitation has evolved into an evidence-based interdisciplinary field. Models integrating pharmacotherapy, behavioral interventions, neuroimaging-guided strategies, hepatological monitoring, and culturally adapted community programs outperform siloed approaches. Nevertheless, substantial barriers continue to hinder universal AUD treatment access, including public stigma, workforce shortages, fragmented policy systems, and resource inequities prevalent in low- and middle-income countries. Innovations in digital therapeutics, precision medicine [including glucagon-like peptide-1 (GLP-1) receptor agonists], and task-shifting offer pathways to close treatment gaps. Integrating engineering principles, such as neuroengineering, biomedical devices, wearable biosensors, and AI-driven digital health into rehabilitation represents a transformative frontier. This review is limited by non-exhaustive literature and evolving evidence.

Keywords

Alcohol use disorder / Alcohol rehabilitation / Interdisciplinary care / Precision medicine / Alcohol-associated liver disease / Rehabilitation engineering

1 Introduction

The impact of alcohol-related diseases on global health is profound, with alcohol use disorder (AUD) and its outcomes significantly affecting global morbidity, mortality, and societal resources. The 2024 Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders released by the World Health Organization (WHO) estimates that approximately 400 million people contend with AUD, with 209 million experiencing alcohol dependence alone, a state defined by compulsive consumption, diminished control, and withdrawal-related distress. Moreover, harmful alcohol consumption caused 2.6 million deaths in 2019, representing 4.7% of all global fatalities [1,2]. Of these, 1.6 million deaths were from noncommunicable diseases, primarily including liver cirrhosis, cardiovascular complications (e.g., cardiomyopathy and hypertension), and cancers (e.g., esophagus, liver, and breast) [3]. Alcohol also contributes to 0.6 million deaths involving psychoactive drugs when used in combination, and it is causally linked to more than 230 disease and injury categories, from infectious diseases (e.g., tuberculosis and human immunodeficiency virus) to neuropsychiatric disorders (e.g., depression and anxiety) [4,5].

The associated disability-adjusted life years (DALYs) are also profound. AUD accounts for 1.4 million DALYs among adolescents and young adults, a burden further detailed in the Global Burden of Disease Study 2023 [6], capturing years lost to early death and those lived with impairments such as neuropathy, cognitive deficits, and trauma from accidents or violence [7]. Alcohol ranks among the foremost preventable risk factors for disease and disability, surpassing many other modifiable behaviors in its extensive reach. Beyond direct effects, alcohol causes indirect harms such as interpersonal violence, child maltreatment, and economic losses, contributing to 13% of injury deaths and elevating suicide risk by up to 120-fold in heavy drinkers relative to the general population (Table 1) [8,9]. The COVID-19 pandemic further exacerbated this already severe burden: global surveys documented a surge in hazardous drinking patterns amid widespread stress, social isolation, and disrupted daily routines, leading to a marked increase in alcohol-attributable hospital admissions and fatalities between 2020 and 2022 [10,11]. By the end of 2025, early indicators point to modest consumption declines in some areas post-pandemic, but upward trends continue in many low- and middle-income countries (LMICs), where economic growth and relaxed regulations, and high volumes of unrecorded alcohol consumption drive such increases [12,13].

Despite the urgent need, treatment options for alcohol-related disorders remain limited and insufficient to address their complex physiological, psychological, and social impacts of AUD. Regulatory agencies such as the Food and Drug Administration of the United States (US) and the European Medicines Agency have approved only limited pharmacotherapies: oral and extended-release naltrexone, acamprosate, and disulfiram, while nalmefene is available in Europe for specific harm reduction related to alcohol [14]. Those drugs work by curbing cravings, inducing aversion, or balancing glutamate activity to support early sobriety. However, their impact is moderate, with numbers needed to treat between 7 and 12 for preventing relapse, and adherence in practice frequently dips below 50% owing to adverse effects such as nausea, fatigue, and liver disorders [15]. Off-label alternatives, including topiramate, gabapentin, and baclofen, show promise in reducing heavy drinking but lack broad endorsement and carry risks such as dependency or contraindications in comorbid conditions [16]. Psychotherapies, including cognitive behavioral therapy (CBT), motivational enhancement, and contingency management, bolster these by fostering skills and drive, but they demand skilled practitioners and ongoing commitment, resources that are scarce in underfunded systems. Peer-led groups like Alcoholics Anonymous (AA) provide valuable, low-barrier support, though outcomes vary and cultural fit can be uneven [17]. Collectively, these interventions cannot fully mitigate the long-term consequences of alcohol misuse, including irreversible liver injury, neurological disorders such as Wernicke-Korsakoff syndrome and peripheral neuropathy, cognitive decline, and social disruption [18,19]. Given the limitations of current pharmacotherapeutic and psychosocial interventions in addressing the full spectrum of AUD-related harms, a comprehensive, multidisciplinary approach to alcohol rehabilitation is urgently required.

Here, we define alcohol rehabilitation as a multidisciplinary clinical discipline that aims to help patients with alcohol dependence, harmful use, and alcohol-induced organ damage achieve comprehensive physical and psychological recovery, and ultimately realize the full restoration and enhancement of personal, family, and social functions through systematic assessment, treatment, and long-term support. This approach extends beyond isolated medical interventions and adopts a biopsychosocial perspective [20,21]. It integrates public health for data collection and recovery frameworks, addiction medicine for pharmacologic and psychological management, clinical psychology for behavioral therapies, neuroscience for neural repair and adaptability, hepatology for alcohol-associated liver recovery, and social sciences for confronting stigma, norms, and socioeconomic factors [22,23]. In application, it might involve blended approaches like medication-assisted treatment with CBT, alongside community peer networks and job skills training to counter disability. Such models boost abstinence up to 70% in equipped settings and improve broader outcomes, curbing costs and strains [24]. The field resonates with the WHO SAFER initiative, blending structural changes with personal care, and accounts for genetic factors (like ADH1B variants) alongside environmental influences. Through cross-field partnerships, rehabilitation shifts from mere symptom relief to enabling resilient, fulfilling existence [25].

This review comprehensively examines the historical and cultural evolution, multidisciplinary underpinnings, current clinical challenges, and future research directions of alcohol rehabilitation on a global scale, with the aim of informing evidence-based practice and policy development.

2 Search Methods Employed

We searched PubMed, PsycINFO, and the Cochrane Library for articles and reviews published from database inception to Jan 5, 2026, using the terms (alcohol OR AUD OR rehabilitation OR “Alcohol Use Disorders”[Medical Subject Headings, MeSH] OR “Alcoholic Disease”[MeSH] OR “Alcohol-Associated Liver Disease”[MeSH]). Additional searches were conducted using specific terms related to epidemiology (“alcohol epidemiology” OR “global burden alcohol”), history (“history alcohol rehabilitation”), interdisciplinary aspects (“multidisciplinary AUD treatment” OR “neuroscience alcohol recovery”), challenges (“barriers AUD treatment” OR “stigma alcohol dependence”), and future directions (“precision medicine AUD” OR “digital therapeutics alcohol”). Engineering-specific terms were also incorporated, including “rehabilitation engineering” [MeSH], “neuromodulation”, “wearable electronic devices” [MeSH], “biomedical engineering” [MeSH], “digital health”, “telemedicine” [MeSH], “machine learning”, “virtual reality” [MeSH], and “transcranial magnetic stimulation” [MeSH]. Additional hand-searching of reference lists from key reviews, position papers, and WHO reports (e.g., Global Status Report on Alcohol and Health 2024) was performed to identify seminal historical papers and recent guideline documents. We included peer-reviewed original research (clinical trials, cohort studies, and validation studies), systematic reviews, meta-analyses, and high-impact guidelines or position statements that provided primary data or synthesis on the epidemiology, history, diagnosis, interdisciplinary management, barriers, or innovations in alcohol rehabilitation. We excluded case reports, editorials without data, conference abstracts, non-peer-reviewed sources, and studies focused solely on pharmacological trials without rehabilitation context. We prioritized narrative integration of high-quality evidence and expert consensus documents to construct a comprehensive perspective on the emerging discipline of alcohol rehabilitation. No language restrictions were applied during the initial search. However, the primary databases (PubMed, PsycINFO, and Cochrane Library) are English-language dominant, and hand-searching was primarily conducted on English-language reviews, position papers, and WHO reports. While we made efforts to include non-English publications when translations were available (resulting in the exclusion of only 3 articles due to lack of accessible translations), this approach may introduce regional bias by underrepresenting studies published in local languages or regional journals, particularly from non-Western and LMICs. To mitigate this, we incorporated global sources such as WHO reports and cross-checked reference lists for broader geographic representation. Future systematic reviews could complement this work by incorporating additional regional databases.

3 Results of the Literature Search

A total of 1247 publications were identified in the databases during this search. Following the removal of 213 duplicates, 1034 unique articles underwent title and abstract screening, with 893 excluded for failing to meet pre-specified inclusion criteria, including studies focused solely on alcohol pharmacological mechanisms without rehabilitation context, case reports, editorials, conference abstracts, and non-peer-reviewed sources. The remaining 141 articles proceeded to full-text eligibility assessment, where 52 were further excluded: 28 did not investigate multidisciplinary/interdisciplinary alcohol rehabilitation approaches, 15 were primary pharmacological trials without an integrated rehabilitation or clinical care framework, 6 were narrow-scope systematic reviews/meta-analyses misaligned with this review’s broad conceptual focus, and 3 were non-English publications with no available translations. Ultimately, 89 articles met all inclusion criteria and were included in this narrative review. The included studies spanned multiple geographic regions, with a predominance from high-income countries, reflecting broader patterns in the published literature on AUD rehabilitation. The included literature comprised 21 systematic reviews/meta-analyses, 34 original research studies (including randomized controlled trials, cohort studies, and validation studies), 12 high-impact clinical guidelines or position statements, and 22 historical/foundational articles central to constructing the interdisciplinary framework of alcohol rehabilitation. Among these, 12 articles specifically addressed engineering or technology-driven interventions for AUD, including neuromodulation devices, wearable biosensors, digital therapeutics, and artificial intelligence (AI)-based predictive models. The full workflow is illustrated in Fig. 1.

4 Results of the Studies Reviewed

4.1 Historical evolution of global alcohol rehabilitation

The historical trajectory of alcohol rehabilitation reflects shifts in societal attitudes, from viewing excessive drinking as a moral defect to recognizing it as a complex medical and psychological condition. Ancient civilizations often integrated alcohol into religious and social rituals, but problematic consumption was addressed through informal community or spiritual remedies rather than formal treatment systems [26]. By the 18th century, emerging medical perspectives began to challenge punitive approaches. Benjamin Rush, an American physician and signer of the Declaration of Independence, in his 1784 treatise, described habitual drunkenness as a progressive disease affecting both body and mind, advocating for compassionate care, sobriety houses, and moral therapy instead of imprisonment or shaming [27]. This early conceptualization laid the foundation for viewing AUD as a treatable ailment, influencing subsequent developments in Europe and North America.

The 19th century marked the rise of institutionalized care amid growing temperance movements, which portrayed alcohol as a societal scourge. In the US, the first inebriate asylums opened in the 1840s–1850s, offering residential programs emphasizing rest, nutrition, moral education, and abstinence. These facilities represented an early form of rehabilitation, blending medical oversight with reformatory elements [28]. In Europe, similar asylums incorporating hydrotherapy and occupational therapy had also emerged. For instance, in Britain, the Inebriates Acts (1898) allowed compulsory detention, reflecting a blend of medical and legal frameworks. However, many such programs faltered by the early 20th century due to high relapse rates, funding shortages, and skepticism about their efficacy, exacerbated by the global push toward prohibition [29].

The early 20th century saw a global wave of alcohol prohibition spanning the United States (1920–1933), Finland (1919–1932), and Russia (1914–1925). Intended to eradicate alcohol use, these policies instead inadvertently fueled underground consumption, organized crime, and public health crises, making it imperative to prioritize treatment over criminalization. Post-repeal, the modern AUD movement gained momentum. The founding of AA in 1935 by Bill Wilson and Bob Smith introduced a revolutionary peer-support model. Its rapid global expansion influenced countless self-help groups and shifted rehabilitation toward community-based, non-professional support [30]. Concurrently, state mental hospitals began establishing dedicated AUD units, the ‘Minnesota model’, that integrated multidisciplinary teams, including physicians, psychologists, and counselors with AA principles, setting a standard for residential treatment that emphasized humility, group therapy, and long-term recovery [31]. Building on earlier work, Morton Jellinek’s The Disease Concept of Alcoholism (1960) portrayed it as a chronic, progressive illness with genetic and environmental components, facilitating its inclusion in diagnostic classifications like the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III (1980) and the International Classification of Diseases (ICD)-10 (1992) [32]. The late 20th century introduced behavioral and harm-reduction paradigms. Popularized in the 1970s–1980s, CBT focused on identifying triggers and building coping skills, proving effective in outpatient settings [33]. Outpatient models became prominent, with studies showing their viability for milder cases, though younger age and prior treatment failures were associated with poorer outcomes [34].

In the 21st century, rehabilitation efforts have increasingly woven in advances from neuroscience and tailored approaches to individual needs, but those longstanding debates still echo through the field, such as topics of abstinence versus moderation, or whether to frame addiction as a medical condition or a social one. This shift highlights a broader global move toward evidence-based and empathetic models of care, even as unequal access persists as a holdover from varying cultural and economic contexts (Fig. 2)[35].

4.2 Interdisciplinary foundations and current global status

Building on the historical paradigm shift toward evidence-based care, modern alcohol rehabilitation has emerged as a robust interdisciplinary field, integrating diverse scientific and clinical expertise to address the multifaceted biological, psychological, and social dimensions of AUD. At its core, rehabilitation encompasses a continuum from acute detoxification to long-term recovery, with evidence showing that multidisciplinary teams comprising public health scientists, physicians, psychologists, neuroscientists, hepatologists, and social scientists yielding good outcomes compared to siloed approaches (Fig. 3). For instance, studies demonstrate that collaborative models reduce relapse rates by up to 30%–50% through shared decision-making and tailored interventions, highlighting the critical role of interdisciplinary cooperation in enhancing treatment adherence, addressing comorbidities, and promoting holistic recovery [36,37]. Without this synergy, rehabilitation risks overlooking key factors like stigma or neurobiological vulnerabilities, leading to fragmented care and poorer prognosis. Around the world today, there is a growing awareness of this pressing need, with bodies like the WHO championing integrated, multidisciplinary approaches to bridge those persistent treatment gaps. Notably, fewer than 20% of people with AUD actually receive any formal help, and the figures are even grimmer in LMICs, leaving a massive shortfall in care [15].

From a public health perspective, AUD is conceptualized as a population-level challenge determined by multiple factors. This view prioritizes prevention across the continuum of alcohol use and advocates for systems-level policies and equity-focused interventions to promote population health. Public health also plays a crucial role in AUD diagnosis through community-based screening programs that identify at-risk populations using validated tools like the alcohol use disorders identification test (AUDIT) or CAGE questionnaire, which have sensitivities exceeding 80% for detecting hazardous drinking in diverse settings. Recent global initiatives, such as digital AUDIT adaptations by WHO, enable scalable diagnosis via mobile apps, improving early identification rates by up to 25% in underserved areas [38–40]. Telehealth systems designed with a rehabilitation engineering framework, incorporating remote monitoring, AI-powered triage algorithms, and interoperable electronic health records, are extending the reach of public health interventions into underserved regions. Harm reduction strategies, including managed alcohol programs, prioritize safety for severe cases. Interdisciplinary cooperation shines in integrated models, where public health specialists collaborate with addiction medicine physicians, hepatologists, and social scientists to address clinical inequities and gaps. Globally, this has advanced through initiatives like WHO’s SAFER framework, which aims for a 20% relative reduction in harmful alcohol use by 2030, partially by promoting multidisciplinary action to boost treatment coverage from current lows [41].

Addiction medicine forms a foundational pillar, focusing on pharmacological and medical management to mitigate withdrawal, reduce cravings, and prevent relapse [42]. The necessity of interdisciplinary cooperation in addiction medicine is paramount, as isolated pharmacological approaches often fall short in addressing the complex interplay of AUD with comorbidities like liver disease or mental health disorders. For example, integrated models combining addiction medicine with hepatology and psychiatry have shown improved outcomes in patients with alcohol-associated liver disease (ALD) and AUD, including higher abstinence rates and reduced hospital readmissions [43]. Another mixed-methods study of an interdisciplinary AUD treatment initiative in a general hospital setting reported enhanced patient satisfaction and lower relapse through collaboration between addiction specialists, psychologists, and social workers, underscoring how such partnerships facilitate holistic assessments and tailored pharmacotherapy [36]. Engineering innovations are expanding the pharmacological armamentarium, biomedically engineered long-acting implantable formulations (e.g., subcutaneous naltrexone depots) can sustain stable therapeutic plasma levels for over five months, addressing adherence challenges associated with daily oral regimens. In diagnosis, addiction medicine relies on standardized DSM-5 or ICD-11 criteria, which classify AUD according to 11 symptoms encompassing tolerance, withdrawal, and impaired control, with sensitivities exceeding 85% in clinical validation studies [44]. Biomarkers such as carbohydrate-deficient transferrin and ethyl glucuronide provide objective confirmation of recent use, showing 70%–80% specificity for chronic heavy drinking when integrated with clinical history [45]. In global practice, addiction medicine increasingly collaborates with other fields to manage comorbidities, such as ALD, where hepatologists and psychiatrists co-develop protocols to optimize outcomes.

Clinical psychology contributes evidence-based psychotherapies that address behavioral and cognitive aspects of AUD. CBT led to significant reductions in alcohol consumption, with an average effect size of 0.45, indicating a moderate yet clinically meaningful impact [46]. Motivational interviewing enhances engagement by resolving ambivalence, while contingency management uses rewards to reinforce sobriety. Family and group therapies extend this to relational dynamics, improving social support networks [47]. The importance of interdisciplinary ties is evident here: psychologists often partner with neuroscientists to incorporate neurological insights, such as targeting reward circuitry through exposure techniques, leading to more personalized interventions. These therapies are globally adapted for diverse settings, ranging from outpatient clinics in high-income countries to community programs in LMICs, highlighting how collaboration addresses accessibility disparities.

Neuroscience provides a biological lens, elucidating how chronic alcohol exposure alters brain structure and function, informing targeted rehabilitation strategies. Functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) studies reveal disruptions in prefrontal cortex executive control and mesolimbic reward systems, with neuroplasticity offering hope for recovery through prolonged abstinence and cognitive training [48]. Emerging neuromodulation techniques, like transcranial magnetic stimulation (TMS), show promise in reducing cravings by modulating these circuits [49]. These neuroscience insights are increasingly translated into clinical practice through neuroengineering innovations, such as closed-loop neuromodulation systems that deliver feedback based on real-time neural activity, and portable neurostimulation devices designed for home-based rehabilitation. Interdisciplinary collaboration is essential for public health experts to use neuroscience data to advocate for early interventions, preventing irreversible damage. Moreover, neuroscientists need to work with psychologists to design therapies that leverage plasticity, such as combining mindfulness with neuroimaging feedback to enhance self-regulation [50]. Neuroimaging techniques, such as functional MRI for assessing cue-reactivity in the ventral striatum, aid in AUD diagnosis by predicting relapse risk with accuracies of 70%–80%, complementing clinical criteria and enabling precision-based stratification [51]. Current global efforts include research consortia mapping AUD’s neural correlates across populations, emphasizing the need for cooperative frameworks to translate findings into practice.

Hepatology plays a pivotal role in alcohol rehabilitation, particularly in managing the hepatic complications that often dominate the clinical picture of chronic AUD. Hepatologists specialize in diagnosing and treating ALD, an umbrella term including alcohol steatosis, hepatitis, fibrosis, and cirrhosis, which account for a significant portion of alcohol-attributable mortality worldwide. Their involvement includes regular monitoring of liver function tests through biomarkers (e.g., liver functions and FibroScan for fibrosis detection), guiding abstinence to halt disease progression, and coordinating with addiction specialists for integrated care plans that address both liver health and dependence [52]. In severe cases, hepatologists oversee interventions like paracentesis for ascites or evaluate candidacy for liver transplantation, emphasizing the need for sustained sobriety post-procedure [53]. Diagnosis of ALD increasingly relies on non-invasive tools, such as transient elastography (FibroScan), which achieves sensitivity and specificity exceeding 90% for detecting advanced fibrosis (F ≥ 3) and cirrhosis (F4) in validated cohorts, complemented by serum biomarker panels like the Enhanced Liver Fibrosis (ELF) score, which predicts disease progression and decompensation with area under the curve (AUC) values of 0.85–0.95 [54,55]. Emerging applications incorporate AI-enhanced ultrasound and quantitative imaging techniques for early hepatic steatosis detection, demonstrating diagnostic accuracy improvements of 15%–25% over conventional ultrasound in high-risk populations, including those with AUD [56]. Interdisciplinary cooperation is essential for the collaboration between hepatologists and psychologists to incorporate motivational strategies that promote adherence to alcohol cessation, reducing decompensation risks, as shown in studies where multidisciplinary teams improved survival rates in ALD patients [52]. Globally, this has advanced through guidelines like those from the American Association for the Study of Liver Diseases and the European Association for the Study of Liver, which advocate for hepatology-led models in rehabilitation to enhance early detection and personalized management of comorbidities [57,58].

Relevant social science fields complete the interdisciplinary framework, providing critical insights into the sociocultural determinants of AUD that underpin both prevention and treatment. Sociologists and anthropologists examine how factors like poverty, discrimination, and community norms exacerbate vulnerability to AUD, informing stigma-reduction initiatives that integrate with medical protocols to improve treatment uptake and adherence [59]. For prevention, social scientists collaborate with public health experts to design community-level interventions, such as culturally tailored education campaigns that address social pressures and inequities, reducing initiation rates among at-risk groups as evidenced by longitudinal studies [60]. In treatment, their qualitative research of ethnography and social network analysis helps adapt rehabilitation programs to diverse contexts, ensuring that psychological therapies account for relational dynamics and economic barriers. This cooperation extends to policy development, where social scientists partner with addiction medicine specialists to advocate for inclusive models that incorporate lived experiences, fostering recovery-oriented systems that emphasize empowerment and social reintegration [61]. Globally, this integration has supported harm-reduction strategies in varied settings, though persistent challenges like workforce shortages highlight the need for ongoing multidisciplinary training to fully realize these collaborative benefits. In many LMICs, task-shifting models that train community health workers to deliver brief alcohol interventions have shown promise in expanding coverage where specialist services are unavailable, though sustained funding and supervision remain critical barriers to scalability [62].

4.3 Engineering-enabled rehabilitation technologies for AUD

Beyond the core biomedical and psychosocial disciplines, engineering principles are increasingly being translated into tangible technologies that augment or automate key components of alcohol rehabilitation. These engineering-enabled solutions can be organized across three integrated layers: sensing and analytics, targeted intervention, and system integration (Fig. 4).

At the sensing and analytics layer, wearable biosensors [e.g., electrodermal activity monitors, wrist-worn accelerometers, and portable electroencephalography (EEG) headbands] enable continuous, real-time monitoring of physiological states associated with craving and stress. Machine learning algorithms applied to these data streams can predict impending relapse with moderate to high accuracy, providing opportunities for just-in-time adaptive interventions. Passive behavioral sensing via smartphone metadata (e.g., geolocation, social interaction patterns) further enriches risk prediction models.

The targeted intervention layer includes a range of neuromodulation and digital therapeutic devices. TMS, particularly repetitive TMS (rTMS) targeting the dorsolateral prefrontal cortex, has shown efficacy in reducing craving and heavy drinking days in randomized controlled trials. Transcranial direct current stimulation (tDCS) offers a portable, low-cost alternative for home-based self-administration under clinical supervision. Beyond brain stimulation, closed-loop neurofeedback systems, combining real-time fMRI or EEG with visual/auditory feedback, train patients to self-regulate craving-related brain networks. Virtual reality (VR) platforms deliver immersive cue-exposure therapy in safe, controlled environments, with emerging evidence supporting their use for extinction learning and coping skill rehearsal.

At the system integration layer, engineering solutions connect patients, providers, and health systems into a continuous care continuum. Telehealth platforms with integrated remote monitoring dashboards allow clinicians to track patient progress, adjust medications, and deliver teletherapy. AI-driven clinical decision support systems embedded in electronic health records can flag high-risk patients and suggest evidence-based interventions. Long-acting implantable formulations (e.g., subcutaneous naltrexone depots) represent a biomedical engineering advancement that bypasses daily oral adherence barriers, maintaining therapeutic drug levels for months.

Collectively, these engineering-enabled technologies are shifting alcohol rehabilitation from episodic, clinic-based encounters toward a connected, data-driven, patient-centered ecosystem. However, most remain in early to mid-stages of clinical validation, and implementation barriers of cost, training, data privacy, and equitable access must be addressed before widespread deployment.

Since AUD is a staged condition per DSM-5 criteria, classified as mild (2–3 symptoms, e.g., occasional loss of control), moderate (4–5 symptoms, including social impairment), or severe (≥ 6 symptoms, with physiological dependence and comorbidities like alcohol-induced liver disease), these interdisciplinary tools enable stage-adapted rehabilitation strategies [63]. For mild AUD, rehabilitation centers on brief interventions and harm reduction to avert escalation. Motivational interviewing is often used to resolve ambivalence with effect sizes of 0.3–0.5 for reducing consumption [64], complemented by social sciences-informed culturally adapted apps for self-monitoring, boosting engagement by up to 25% in primary care. This stage leverages neuroscience via early cue-reactivity assessments to predict risk, potentially reducing progression risk by up to 86% in high-reactivity subgroups [65]. Moderate AUD requires combined approaches, blending addiction medicine with clinical psychology for drinking reduction. Hepatology monitors emerging liver changes via biomarkers while social sciences address relational barriers through family therapy, improving adherence. Interdisciplinary clinics show up to 60% remission in long-term multidisciplinary models [66]. Severe AUD demands intensive strategies for dependence and organ damage. Detoxification under addiction medicine oversight mitigates withdrawal, with hepatology managing ALD via FibroScan. Neuroscience tools like TMS reduce cravings, while long-term psychological and social support (e.g., 12-step programs) fosters reintegration, reducing relapse by 20%–40% in multidisciplinary models [43].

Overall, the interdisciplinary essence of alcohol rehabilitation underscores its strength: by uniting fields, it achieves holistic, effective care that isolated efforts cannot match. Stage-specific adaptation of that discipline significantly enhanced the prognosis of those AUD patients (Table 2). Current global advancements, from integrated clinics to research networks, demonstrate this potential, yet sustained cooperation is vital to overcome barriers and realize equitable outcomes for all people with AUD, particularly those in LMICs.

4.4 Challenges and barriers in global alcohol rehabilitation landscapes

Effective alcohol rehabilitation faces a multitude of entrenched challenges and barriers that hinder access, engagement, and outcomes worldwide. These obstacles operate at individual, clinician, system, and societal levels, often intersecting to exacerbate disparities, particularly in LMICs (Fig. 5). Addressing them requires targeted strategies informed by recent evidence, as the COVID-19 pandemic has further amplified many of these issues, leading to increased hazardous drinking and disrupted clinical/social services.

At the individual level, stigma remains one of the most pervasive barriers, fostering shame, denial, and reluctance to seek help. Recent studies highlight how internalized stigma manifests as a lack of self-awareness about AUD or embarrassment, which prevents treatment initiation. In a 2023 scoping review, skepticism was endorsed by 46% of participants with AUD who desired but did not receive treatment, underscoring how negative perceptions undermine engagement [67]. Fear of withdrawal symptoms also acts as a major hurdle, contributing to diagnostic inaccuracies and relapse, since patients may misattribute symptoms to mental disorders, complicating recovery [68]. On top of that, everyday challenges like finding childcare can create major barriers in some situations. Women who serve as primary caregivers might hold back from seeking treatment out of fear over mandatory reporting laws and the risk of child removal, and this can worsen when healthcare providers lack proper training in substance use treatment or fail to clearly explain those reporting requirements [69]. Comorbid mood or anxiety disorders further compound these, with comorbid groups perceiving higher unmet needs (18% vs. 12%) and reporting more barriers, such as financial constraints (19% vs. 10%) [70].

Clinician-level barriers include inadequate training and discomfort in managing AUD, leading to underdiagnosis and suboptimal care. A recent review notes that many healthcare providers lack specialized skills, resulting in poor implementation of integrated models for AUD and ALD, despite evidence that multidisciplinary teams reduce relapse [71]. This discomfort is exacerbated by time constraints and limited resources, with clinicians often prioritizing acute conditions over behavioral interventions. Recent data from the US indicate that only a minority of primary care providers routinely screen for AUD, citing knowledge gaps as a key issue [15]. In LMICs, workforce shortages are acute, with fewer than one addiction specialist per million people in many regions, severely limiting capacity for evidence-based treatments [72].

System-level challenges encompass fragmented policies, insurance limitations, and insufficient investment in AUD services. In insurance-based systems such as the US, financial barriers deter access, with high out-of-pocket costs and restrictive coverage for rehabilitation programs [73]. Globally, reluctance to fund AUD treatment stems from its lower prioritization compared to other disorders, despite its high burden. A recent analysis calls for broadening medication endpoints and increasing screening to close gaps [74]. In LMICs, upstream social determinants like poverty and weak regulations amplify risks, with calls for policy interventions such as taxation to reduce consumption. The post-COVID era has worsened these, with lockdowns increasing both any alcohol use and heavy alcohol use in the US, for example, leading to higher unmet needs [72,75].

Societal barriers, including cultural normalization of drinking and misinformation, further impede progress. Latent class analyses reveal heterogeneous barrier patterns, from attitudinal (e.g., denial) to structural (e.g., access), with tailored interventions needed [76]. Overall, these challenges underscore the urgency for global strategies: enhancing training, reducing stigma through education, and investing in integrated care to make rehabilitation more accessible and effective.

4.5 Future directions: global innovations and culturally adapted strategies

The traditional bio-psycho-social model is increasingly being augmented by technological innovations, creating a de facto ‘bio-psycho-social-technological’ approach to alcohol rehabilitation. Those innovations may help overcome current limitations, as well as enhance the accessibility, personalization, and efficacy for AUD patients. Recent advancements emphasize scalable solutions that integrate interdisciplinary insights, with a focus on closing treatment gaps in diverse global contexts. By prioritizing evidence-based strategies, the field can move toward more equitable outcomes, as advocated in recent translational research frameworks [77].

Digital therapeutics represent a promising frontier, offering low-cost, accessible interventions via apps, telehealth, and virtual reality. These tools deliver CBT modules, real-time monitoring, and personalized feedback, with meta-analyses showing small but significant reductions in alcohol consumption compared to controls [78]. For instance, smartphone-based programs have demonstrated feasibility in reducing hazardous drinking, particularly in underserved populations, through gamified elements and AI-driven relapse prediction [79]. Interdisciplinary collaboration is also important in integrating digital platforms with pharmacological reminders to improve adherence, as evidenced by trials where combined approaches boosted retention by 20%–30% [43]. Globally, scaling these could address workforce shortages, with ongoing studies exploring virtual reality for cue exposure to simulate high-risk scenarios safely [80].

Precision medicine holds transformative potential, tailoring treatments based on genetic biomarkers, and phenotypic profiles to improve response rates. Pharmacogenetics, for example, identifies responders to naltrexone via OPRM1 variants, with recent trials showing enhanced efficacy in stratified groups [81,82]. Low-dose ondansetron, a serotonin antagonist, has emerged as a candidate for heavy drinkers with specific genetic markers, reducing drinking days by up to 50% in phase 3 studies [83]. Biomarkers like phosphatidylethanol enable objective monitoring, informing adaptive protocols [84]. This approach integrates neuroscience, using neuroimaging to guide dosing and predict outcomes, potentially reducing relapse risk by up to 86% in targeted cohorts [84]. Recently, it was reported that even low-dose semaglutide could reduce craving and some drinking outcomes, justifying larger clinical trials to evaluate glucagon-like peptide-1 (GLP-1) receptor agonists for AUD [85]. This finding opened the gate for the control of alcohol cravings in obese people, who often have synergistic metabolic damage from the alcohol and lipid dysregulation.

Culturally adapted strategies are essential for global applicability, modifying evidence-based treatments to align with local norms and values. Systematic reviews indicate that adaptations, such as incorporating community rituals or indigenous healing practices, reduce substance use more effectively than standard interventions, with effect sizes up to 0.5 [86]. For indigenous populations, culturally tailored programs blending motivational interviewing with traditional storytelling have shown sustained abstinence improvements. These adaptations foster engagement by addressing stigma and social determinants, with interdisciplinary teams (psychologists, anthropologists, and clinicians) co-designing interventions to enhance relevance [87].

Engineering-driven innovations continue to advance across multiple pivotal frontiers to refine and democratize AUD rehabilitation. These key advances encompass next-generation closed-loop adaptive systems, which integrate real-time physiological biosignals with continuous learning algorithms to deliver dynamically optimized, context-aware therapeutic interventions precisely at moments of heightened relapse risk; precision neuroengineering strategies that establish patient-tailored neuromodulation protocols based on individual neuroimaging and electrophysiological signatures, thereby improving treatment response rates and mitigating adverse side effects; human-centered rehabilitation engineering design, which involves co-developing digital therapeutics and wearable devices with individuals with lived experience of AUD to enhance system usability, sustained patient engagement, and long-term treatment adherence in real-world recovery scenarios; and engineering-enabled implementation science, which focuses on developing scalable, low-cost, and low-bandwidth digital health platforms adaptable for large-scale deployment in low-resource and low- and middle-income country settings, effectively bridging global healthcare and digital divides in addiction treatment.

Policy reforms and community-led, interdisciplinary care models will underpin these innovations. Expanding harm reduction, like managed alcohol programs, has reduced emergency visits by up to 47% in pilot studies [88]. Recommendations include WHO-aligned training curricula and AI-integrated screening in primary care to boost early detection [89]. Ultimately, sustained investment in research consortia will drive these directions, transforming rehabilitation into a more inclusive, effective global endeavor.

5 Conclusions

In this review, we have traced the historical evolution of alcohol rehabilitation from moralistic and punitive origins to a sophisticated, evidence-based field. We also delineated its interdisciplinary foundations that integrate public health, addiction medicine, clinical psychology, neuroscience, hepatology, and social sciences. Moreover, persistent challenges and barriers that impede global access and efficacy were examined. We also outlined promising future directions through innovations like digital therapeutics, precision medicine, and culturally adapted strategies. These elements collectively underscore the transformative potential of alcohol rehabilitation in mitigating the profound global burden of AUD, which claims millions of lives and imposes immense socioeconomic costs annually.

Central to this discourse is the reaffirmation of alcohol rehabilitation as a multidisciplinary clinical discipline that aims to help patients with alcohol dependence, harmful use, and alcohol-induced organ damage achieve comprehensive physical and psychological recovery, and ultimately realize the full restoration and enhancement of personal, family, and social functions through systematic assessment, treatment, and long-term support. This definition encapsulates the holistic, biopsychosocial approach that distinguishes modern rehabilitation from earlier, narrower interventions. By emphasizing systematic assessment (e.g., AUDIT screening and neuroimaging), targeted treatments (e.g., medication-assisted therapy combined with cognitive-behavioral approaches), and ongoing support via community networks and digital platforms, this discipline addresses not only acute symptoms but also the chronic, relapsing nature of AUD. It recognizes the interplay of biological vulnerabilities, psychological patterns, and social determinants, ensuring that recovery extends beyond abstinence to encompass improved quality of life, reduced comorbidities like liver disease, and reintegration into society.

As we emphasized, formidable barriers from stigma and workforce shortages to policy fragmentation and resource inequities continue to thwart progress, leaving vast treatment gaps that demand urgent, collaborative action. The interdisciplinary essence of the field offers a pathway forward, as evidenced by recent advancements that blend neuroscience-informed therapies with culturally sensitive adaptations, promising higher engagement and sustained outcomes. Looking ahead, the imperative is clear: policymakers, clinicians, and researchers must prioritize investments in multidisciplinary training, innovative technologies, and equitable systems to realize the full potential of alcohol rehabilitation. By doing so, we can envision a future where alcohol rehabilitation serves as a cornerstone of global public health, empowering individuals across all socioeconomic and cultural contexts to overcome AUD and thrive. This review has several limitations. As a narrative rather than formal systematic review, the literature selection, while comprehensive within the defined scope, may not be exhaustive and is subject to potential regional bias stemming from reliance on English-dominant databases and sources. Although no language restrictions were applied and efforts were made to include global perspectives through WHO reports and reference hand-searching, studies from non-English-speaking regions and LMICs published in local journals may be underrepresented. Additionally, our interdisciplinary framework, while evidence-informed, requires further empirical validation across diverse healthcare settings. The rapidly evolving evidence base, particularly regarding digital therapeutics, precision medicine (including GLP-1 receptor agonists), and engineering-enabled technologies, means some recommendations may need updating as new data emerge. These limitations notwithstanding, we believe this synthesis provides a timely and holistic perspective on alcohol rehabilitation as an emerging multidisciplinary discipline.

References

[1] World Health Organization. Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders. Geneva: World Health Organization, 2024

[2] Shield K , Franklin A , Wettlaufer A . et al. National, regional, and global statistics on alcohol consumption and associated burden of disease 2000-20: a modelling study and comparative risk assessment. The Lancet Public Health, 2025, 10(9): e751–e761

[3] GBD 2016 Alcohol Collaborators . Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 2018, 392(10152): 1015–1035

[4] Osna N A , New-Aaron M , Dagur R S . et al. A review of alcohol-pathogen interactions: new insights into combined disease pathomechanisms. Alcoholism: Clinical and Experimental Research, 2022, 46(3): 359–370

[5] Visontay R , Mewton L , Slade T . et al. Moderate alcohol consumption and depression: a marginal structural model approach promoting causal inference. American Journal of Psychiatry, 2023, 180(3): 209–217

[6] GBD 2023 Disease , Injury Factor Collaborators . Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet, 2025, 406(10513): 1873–1922

[7] Danandeh K , Rasoulian P , Seyedmirzaei H . et al. Burden of alcohol use disorder and its consequences in Iran from 1990 to 2019: findings from the global burden of disease study. Preventive Medicine Reports, 2024, 46: 102872

[8] Blakey S M , Griffin S C , Grove J L . et al. Comparing psychosocial functioning, suicide risk, and nonsuicidal self-injury between veterans with probable posttraumatic stress disorder and alcohol use disorder. Journal of Affective Disorders, 2022, 308: 10–18

[9] Moran P , Chandler A , Dudgeon P . et al. The Lancet Commission on self-harm. The Lancet, 2024, 404(10461): 1445–1492

[10] Michalak A , Lach T , Szczygieł K . et al. COVID-19, possible hepatic pathways and alcohol abuse-What do we know up to 2023?. International Journal of Molecular Sciences, 2024, 25(4): 2212

[11] Shuey B , Halbisen A , Lakoma M . et al. High-acuity alcohol-related complications during the COVID-19 pandemic. JAMA Health Forum, 2024, 5(4): e240501

[12] Rehm J , Assanangkornchai S , Hendershot C S . et al. Alcohol use disorders. The Lancet, 2025, 406(10516): 2269–2281

[13] Probst C , Fleischmann A , Gmel G . et al. The global proportion and volume of unrecorded alcohol in 2015. Journal of Global Health, 2019, 9(1): 010421

[14] Witkiewitz K , Litten R Z , Leggio L . Advances in the science and treatment of alcohol use disorder. Science Advances, 2019, 5(9): eaax4043

[15] Koob G F . Alcohol use disorder treatment: problems and solutions. Annual Review of Pharmacology and Toxicology, 2024, 64: 255–275

[16] Burnette E M , Nieto S J , Grodin E N . et al. Novel agents for the pharmacological treatment of alcohol use disorder. Drugs, 2022, 82(3): 251–274

[17] Kelly J F , Humphreys K , Ferri M . Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews, 2020, 3(3): CD012880

[18] McPheeters M , O’Connor E A , Riley S . et al. Pharmacotherapy for alcohol use disorder: a systematic review and meta-analysis. JAMA, 2023, 330(17): 1653–1665

[19] Tareen K , Clifton E G , Perumalswami P . et al. Treatment of alcohol use disorder: behavioral and pharmacologic therapies. Clinics in Liver Disease, 2024, 28(4): 761–778

[20] Cheng H Y , McGuinness L A , Elbers R G . et al. Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis. BMJ, 2020, 371: m3934

[21] Gratacós-Ginès J , Bruguera P , Pérez-Guasch M . et al. Medications for alcohol use disorder promote abstinence in alcohol-associated cirrhosis: results from a systematic review and meta-analysis. Hepatology, 2024, 79(2): 368–379

[22] Haber P S, Riordan B C, Winter D T, et al. New Australian guidelines for the treatment of alcohol problems: an overview of recommendations. Medical Journal of Australia, 2021, 215 S7: S3–S32

[23] Kurata T , Hashimoto T , Suzuki H . et al. Effect of a multidisciplinary approach on hospital visit continuation in the treatment of patients with alcohol dependence. Neuropsychopharmacology Reports, 2023, 43(4): 542–552

[24] McCarty D , Braude L , Lyman D R . et al. Substance abuse intensive outpatient programs: assessing the evidence. Psychiatric Services, 2014, 65(6): 718–726

[25] Gapstur S M , Mariosa D , Neamtiu L . et al. The IARC perspective on the effects of policies on reducing alcohol consumption. New England Journal of Medicine, 2025, 392(17): 1752–1759

[26] Vallee B L. Alcohol in human history. In: Jansson B, Jörnvall H, Rydberg U, et al, eds. Toward a Molecular Basis of Alcohol Use and Abuse. Basel: Birkhäuser, 1994, 1–8

[27] Katcher B S . Benjamin Rush’s educational campaign against hard drinking. American Journal of Public Health, 1993, 83(2): 273–281

[28] White W L . The role of recovering physicians in 19th century addiction medicine: an organizational case study. Journal of Addictive Diseases, 2000, 19(2): 1–10

[29] London M . History of addiction: a UK perspective. The American Journal on Addictions, 2005, 14(2): 97–105

[30] Volenik A . Spiritual principles of alcoholics anonymous. Psychiatria Danubina, 2021, 33(S4): 974–980

[31] Anderson D J , McGovern J P , Dupont R L . The origins of the Minnesota model of addiction treatment–a first person account. Journal of Addictive Diseases, 1999, 18(1): 107–114

[32] Kelly J F . E. M. Jellinek’s disease concept of alcoholism. Addiction, 2019, 114(3): 555–559

[33] Larimer M E , Palmer R S , Marlatt G A . Relapse prevention: an overview of Marlatt’s cognitive-behavioral model. Alcohol Research & Health, 1999, 23(2): 151–160

[34] Pettinati H M , Belden P P , Evans B D . et al. The natural history of outpatient alcohol and drug abuse treatment in a private healthcare setting. Alcoholism: Clinical and Experimental Research, 1996, 20(5): 847–852

[35] Gitto S , Golfieri L , Caputo F . et al. Multidisciplinary view of alcohol use disorder: from a psychiatric illness to a major liver disease. Biomolecules, 2016, 6(1): 11

[36] Kools N , Dekker G G , Kaijen B A P . et al. Interdisciplinary collaboration in the treatment of alcohol use disorders in a general hospital department: a mixed-method study. Substance Abuse Treatment, Prevention, and Policy, 2022, 17(1): 59

[37] Barrio P , Gual A . Patient-centered care interventions for the management of alcohol use disorders: a systematic review of randomized controlled trials. Patient Preference and Adherence, 2016, 10: 1823–1845

[38] Díaz L A , König D , Weber S . et al. Management of alcohol use disorder: a gastroenterology and hepatology-focused perspective. The Lancet Gastroenterology & Hepatology, 2025, 10(5): 475–490

[39] Díaz L A , Fuentes-López E , Idalsoaga F . et al. Association between public health policies on alcohol and worldwide cancer, liver disease and cardiovascular disease outcomes. Journal of Hepatology, 2024, 80(3): 409–418

[40] O’Brien C P . The CAGE questionnaire for detection of alcoholism: a remarkably useful but simple tool. JAMA, 2008, 300(17): 2054–2056

[41] Singh H , Sittig D F . A sociotechnical framework for safety-related electronic health record research reporting: the SAFER reporting framework. Annals of Internal Medicine, 2020, 172(11S): S92–S100

[42] Grissom M O , Reed B C , Starks S M . et al. Addiction medicine: alcohol use disorder. FP Essentials, 2024, 546: 7–15

[43] Shroff H , Gallagher H . Multidisciplinary care of alcohol-related liver disease and alcohol use disorder: a narrative review for hepatology and addiction clinicians. Clinical Therapeutics, 2023, 45(12): 1177–1188

[44] Grant B F , Goldstein R B , Saha T D . et al. Epidemiology of DSM-5 alcohol use disorder: results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry, 2015, 72(8): 757–766

[45] Jones A W . Brief history of the alcohol biomarkers CDT, EtG, EtS, 5-HTOL, and PEth. Drug Testing and Analysis, 2024, 16(6): 570–587

[46] Magill M , Ray L , Kiluk B . et al. A meta-analysis of cognitive-behavioral therapy for alcohol or other drug use disorders: treatment efficacy by contrast condition. Journal of Consulting and Clinical Psychology, 2019, 87(12): 1093–1105

[47] Minozzi S , Saulle R , Amato L . et al. Psychosocial interventions for stimulant use disorder. Cochrane Database of Systematic Reviews, 2024, 2(2): CD011866

[48] Egervari G , Siciliano C A , Whiteley E L . et al. Alcohol and the brain: from genes to circuits. Trends in Neurosciences, 2021, 44(12): 1004–1015

[49] Belgers M , Van Eijndhoven P , Markus W . et al. rTMS reduces craving and alcohol use in patients with alcohol use disorder: results of a randomized, sham-controlled clinical trial. Journal of Clinical Medicine, 2022, 11(4): 951

[50] Donato S , Ray L A . Neurobiology and the treatment of alcohol use disorder: a review of the evidence base. Substance Abuse and Rehabilitation, 2023, 14: 157–166

[51] Bach P , Weil G , Pompili E . et al. Incubation of neural alcohol cue reactivity after withdrawal and its blockade by naltrexone. Addiction Biology, 2020, 25(1): e12717

[52] Arab J P , Addolorato G , Mathurin P . et al. Alcohol-associated liver disease: integrated management with alcohol use disorder. Clinical Gastroenterology and Hepatology, 2023, 21(8): 2124–2134

[53] Mackowiak B , Fu Y J , Maccioni L . et al. Alcohol-associated liver disease. The Journal of Clinical Investigation, 2024, 134(3): e176345

[54] Thiele M , Madsen B S , Hansen J F . et al. Accuracy of the enhanced liver fibrosis test vs FibroTest, elastography, and indirect markers in detection of advanced fibrosis in patients with alcoholic liver disease. Gastroenterology, 2018, 154(5): 1369–1379

[55] Pearson M , Nobes J , Macpherson I . et al. Enhanced liver fibrosis (ELF) score predicts hepatic decompensation and mortality. JHEP Reports, 2024, 6(6): 101062

[56] Li B W , Tai D I , Yan K . et al. Accurate and generalizable quantitative scoring of liver steatosis from ultrasound images via scalable deep learning. World Journal of Gastroenterology, 2022, 28(22): 2494–2508

[57] Bertha M , Choi G , Mellinger J . Diagnosis and treatment of alcohol-associated liver disease: a patient-friendly summary of the 2019 AASLD guidelines. Clinical Liver Disease, 2021, 17(6): 418–423

[58] European Association for the Study of the Liver (EASL) , European Association for the Study of Diabetes (EASD) , European Association for the Study of Obesity (EASO) . EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology, 2024, 81(3): 492–542

[59] Perini I , Pabst A , Martinez D . et al. Modeling social cognition in alcohol use disorder: lessons from schizophrenia. Psychopharmacology, 2025, 242(5): 1157–1166

[60] Collins S E . Associations between socioeconomic factors and alcohol outcomes. Alcohol Research: Current Reviews, 2016, 38(1): 83–94

[61] Trangenstein P J , Peddireddy S R , Cook W K . et al. Alcohol policy scores and alcohol-attributable homicide rates in 150 countries. American Journal of Preventive Medicine, 2021, 61(3): 311–319

[62] Saunders C J , Oporia F , Lukaszyk C . et al. Leave no one behind: an African perspective on the first World Health Organization Global Status Report on Drowning Prevention. African Journal of Emergency Medicine, 2026, 16(1): 100944

[63] Hasin D S , O’Brien C P , Auriacombe M . et al. DSM-5 criteria for substance use disorders: recommendations and rationale. American Journal of Psychiatry, 2013, 170(8): 834–851

[64] Vasilaki E I , Hosier S G , Cox W M . The efficacy of motivational interviewing as a brief intervention for excessive drinking: a meta-analytic review. Alcohol and Alcoholism, 2006, 41(3): 328–335

[65] Sohi I , Shield K D , Rehm J . et al. Digital interventions for reducing alcohol use in general populations: an updated systematic review and meta-analysis. Alcohol, Clinical and Experimental Research, 2023, 47(10): 1813–1832

[66] Moos R H , Moos B S . Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction, 2006, 101(2): 212–222

[67] Wolfe D M , Hutton B , Corace K . et al. Service-level barriers to and facilitators of accessibility to treatment for problematic alcohol use: a scoping review. Frontiers in Public Health, 2023, 11: 1296239

[68] Jamalamadaka T , Griffith E , Steer H . et al. Fear of illness recurrence and mental health anxiety in people recovering from psychosis and common mental health problems. British Journal of Clinical Psychology, 2020, 59(3): 403–423

[69] Ammit M, River J, Montebello M, et al. Factors that facilitate treatment uptake for women with alcohol use disorders in high-income countries: a systematic review. Women’s Health, 2025, 21: 17455057251363713

[70] Kaufmann C N , Chen L Y , Crum R M . et al. Treatment seeking and barriers to treatment for alcohol use in persons with alcohol use disorders and comorbid mood or anxiety disorders. Social Psychiatry and Psychiatric Epidemiology, 2014, 49(9): 1489–1499

[71] Lékó A H , Leggio L . Barriers to alcohol use disorder treatment in patients with alcohol-associated liver disease. Clinics in Liver Disease, 2024, 28(4): 779–791

[72] Nadkarni A , Gandhi Y , Bhatia U . et al. Closing the treatment gap for alcohol use disorders in low- and middle-income countries. Cambridge Prisms: Global Mental Health, 2023, 10: e3

[73] Wray C M , Lopez L , Khare M . et al. Cost-related access barriers, medical debt, and dissatisfaction with care among privately insured Americans. Journal of General Internal Medicine, 2023, 38(4): 938–945

[74] Nieto S J , Ray L A . Advancing medication development for alcohol use disorder: a narrative review integrating preclinical, human laboratory, and clinical trials. Alcohol, Clinical and Experimental Research, 2025, 49(12): 2649–2659

[75] Ayyala-Somayajula D , Dodge J L , Leventhal A M . et al. Trends in alcohol use after the COVID-19 pandemic: a national cross-sectional study. Annals of Internal Medicine, 2025, 178(1): 139–142

[76] Grigg J , Manning V , Cheetham A . et al. A latent class analysis of perceived barriers to help-seeking among people with alcohol use problems presenting for telephone-delivered treatment. Alcohol and Alcoholism, 2023, 58(1): 68–75

[77] Ray L A , Grodin E N , Leggio L . et al. The future of translational research on alcohol use disorder. Addiction Biology, 2021, 26(2): e12903

[78] O’Logbon J , Wickersham A , Williamson C . et al. The effectiveness of digital health technologies for reducing substance use among young people: a systematic review & meta-analysis. Journal of Mental Health, 2024, 33(5): 645–673

[79] Kiluk B D , Benitez B , DeVito E E . et al. A digital cognitive behavioral therapy program for adults with alcohol use disorder: a randomized clinical trial. JAMA Network Open, 2024, 7(9): e2435205

[80] Kwan I , Burchett H E D , Macdowall W . et al. How effective are remote and/or digital interventions as part of alcohol and drug treatment and recovery support? A systematic review and meta-analysis. Addiction, 2025, 120(8): 1531–1550

[81] Boness C L , Witkiewitz K . Precision medicine in alcohol use disorder: mapping etiologic and maintenance mechanisms to mechanisms of behavior change to improve patient outcomes. Experimental and Clinical Psychopharmacology, 2023, 31(4): 769–779

[82] Schacht J P , Randall P K , Latham P K . et al. Predictors of naltrexone response in a randomized trial: reward-related brain activation, OPRM1 genotype, and smoking status. Neuropsychopharmacology, 2017, 42(13): 2640–2653

[83] Johnson B , Alho H , Addolorato G . et al. Low-dose ondansetron: a candidate prospective precision medicine to treat alcohol use disorder endophenotypes. European Journal of Internal Medicine, 2024, 127: 50–62

[84] Clark S L , Hartwell E E , Choi D S . et al. Next-generation biomarkers for alcohol consumption and alcohol use disorder diagnosis, prognosis, and treatment: a critical review. Alcohol, Clinical and Experimental Research, 2025, 49(1): 5–24

[85] Hendershot C S , Bremmer M P , Paladino M B . et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry, 2025, 82(4): 395–405

[86] Hai A H , Lee C S , Abbas B T . et al. Culturally adapted evidence-based treatments for adults with substance use problems: a systematic review and meta-analysis. Drug and Alcohol Dependence, 2021, 226: 108856

[87] Link K M , Bryant B E , Boness C L . Reducing stigma and enhancing care for people who use alcohol. Journal of Health Service Psychology, 2025, 51(1): 31–41

[88] Vallance K , Stockwell T , Pauly B . et al. Do managed alcohol programs change patterns of alcohol consumption and reduce related harm? A pilot study. Harm Reduction Journal, 2016, 13(1): 13

[89] Romero-Rodríguez E , Pérula de Torres L Á , Ruiz Moral R . et al. Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study. BMC Health Services Research, 2020, 20(1): 877

Rights & permissions

The Author(s) 2026. This article is published by Higher Education Press.