Evaluation of Perinatal and Developmental Outcomes in Neonates with Abstinence Syndrome Admitted to NICU

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.

Alcohol liver disease: A review of current therapeutic approaches to achieve long-term abstinence

Harmful alcohol drinking may lead to significant damage on any organ or system of the body.Alcoholic liver disease(ALD) is the most prevalent cause of advanced liver disease in Europe.In ALD,only alcohol abstinence was associated with a better long-term survival.Therefore,current effective therapeutic strategy should be oriented towards achieving alcohol abstinence or a significant reduction in alcohol consumption.Screening all primary care patients to detect those cases with alcohol abuse has been proposed as population-wide preventive intervention in primary care.It has been suggested that in patients with mild alcohol use disorder the best approach is brief intervention in the primary care setting with the ultimate goal being abstinence,whereas patients with moderate-to-severe alcohol use disorder must be referred to specialized care where detoxification and medical treatment of alcohol dependence must be undertaken.

Global research production in neonatal abstinence syndrome: A bibliometric analysis

BACKGROUND Recently,neonatal abstinence syndrome(NAS)emerged as a significant global concern with a dramatic increase in healthcare expenditures.The incidence of the NAS has increased notably in the past decade and emergence as a global public health problem.AIM To evaluate the development and trend of global NAS research from 1958 to 2019 by bibliometric analysis.METHODS Analyzed aspects included publication output per year,language,document types,journals,countries/territories,h-index,authors,and top research priorities.The VOSviewer was used to determine the top research priorities,and trends,and to present bibliometric networks concerning various dimensions,such as coauthorship,authors,and countries.RESULTS A total of 1738 articles were retrieved in the Scopus database from 1958 to 2019.It was found that the great majority of the total NAS documents(n=1295)were original articles followed by reviews(n=268)and letters(n=48).The most productive countries in the NAS field were the United States(n=833),Canada(n=112),the United Kingdom(n=111),and Germany(n=77).Treatment and hospital outcomes in NAS,evidence-based nurse-driven interventions for the care of newborns with NAS,and a systematic reviews and network meta-analysis for therapeutic approaches of NAS were found in recent years(after 2010),compared with terms such as pathophysiology,mechanisms of NAS,and signs and symptoms in the early years.CONCLUSION Treatment and pediatric outcomes and the effectiveness of pharmacological treatment may be frontiers in the NAS field,and continued efforts from researchers are needed in those topics.

Personal Accounts of Mothers’ Use of Social Media to Support Abstinence from Alcohol

Alcohol consumption by professional educated women and mothers is rising. Drinking alcohol in the home is, for many, becoming a normalised and daily ritual. Previous research focuses on causality, risk factors and health related damage. Few studies focus on mothers of school age children specifically or why some mothers pursue and sustain alcohol free lives. The role of social media in enacting and sustaining abstinence is under researched, as are other factors important for this group in remaining abstinent. Aims: This qualitative study explored the reasons why mothers drank alcohol, and factors contributing to their decision to become alcohol free. It also explored the value and utility of social media in the form of a specific website aimed at providing support in abstinence. Methods: Six UK mothers with school age children who had become abstinent after previously drinking over official limits were recruited via social network website and interviewed. Transcripts were analysed thematically and inductive themes emerged. Results: Participants used alcohol to self-medicate, as a reward/relaxation strategy and because it was a normal part of their professional and daily lives. Reported reasons for abstinence included the negative effects alcohol had upon lives, inability to moderate/drink within guidelines and “trigger” events. Participants reported that their use of social media was inspirational, giving them a platform to share stories and help others and was preferred to traditional support. The use of social media in this way represented a supportive community and assisted vigilance toward the danger of relapse. Positive parenting identity, alternatives to alcohol, abstinence rewards and support from abstinent others were all factors in sustaining abstinence. Conclusions: Health professionals should recognise this hidden and hard to reach group and the potential efficacy of social media in assisting recovery from alcohol related issues.

Abstinence Design

Abstinence design is a design that helps people to get rid of bad habits or hobbies for self-management purposes,which seems to limit people’s“freedom”and is contrary to the idea of designing“people-oriented”.However,it is not difficult to find out that only the design that can resist“human desire”is the design of“true freedom.”Abstinence design has the idea of green design and minimalist design.It is more in line with the Chinese culture and philosophy,and has positive significance for the improvement of the quality of individuals and even the whole nation.In designing abstinence products,in addition to the degree of desire and need to be treated differently,more guidance on design methods,such as fun,gamification,peak-end principle,etc.,is required to enable users to achieve self-management more effectively.

The effect of alcohol and eligibility for liver transplant:a critical review

Background:Alcohol-related liver disease(ALRD)has emerged as a significant global health concern,primarily attributed to the overconsumption of alcohol.While alcoholism has the potential to impact various organs,it is the liver that is especially vulnerable.Methods:This review comprehensively examines the challenges encountered during the pre-transplant,intra-transplant,and post-transplant phases,a significant number of which are attributable to alcohol misuse.Historically,liver transplant(LT)programmes have excluded patients with alcohol-related liver disease(ARLD)due to mandatory abstinence requirements and apprehensions regarding potential graft shortages for other hepatic diseases.This review counters these concerns by highlighting the minimal usage of grafts for early liver transplantation.It strongly advocates for the incorporation of severe alcoholic hepatitis into the model for end-stage liver disease allocation,devoid of any stigmatization.The selection of ARLD individuals for LT necessitates the critical involvement of a multidisciplinary team,inclusive of addiction specialists.Results:Despite the complexities associated with LT for patients with ARLD,this review underscores its therapeutic advantages,particularly for those anticipated to experience severe adverse effects.This review accentuates the necessity of ensuring equitable access to medical interventions for all patients,irrespective of their lifestyle choices.Conclusion:The examination of genetic and epigenetic variables that play a role in the onset and advancement of ALD.The identification of potential therapy strategies is also an important area of study.The formulation of intricate eligibility rules for LT in patients with a past of alcohol abuse needs essential interactions between medical practitioners and researchers.The use of new technologies such as genomics and epigenomics could boost the accuracy of ALD diagnostic and prognostic approaches.These targeted investigations could potentially lead to major improvements in the management and treatment results of ALD.

The effect of age and abstinence time on semen quality:a retrospective study

This study analyzed the effects of male age and abstinence time on semen quality and explored the best abstinence time for Chinese males among different age groups.Semen parameters,including sperm kinetics,morphology,and DNA fragmentation index(DFI),were reviewed from 2952 men.Samples were divided into six age groups(≤25 years,26–30 years,31–35 years,36–40 years,41–45 years,and>45 years)and were divided into six groups according to different abstinence time(2 days,3 days,4 days,5 days,6 days,and 7 days).The differences in semen quality between the groups were compared,and the effect of age and abstinence time on semen quality was analyzed.Significant differences were observed in semen volume,progressive motility(PR),and DFI among the age groups(all P<0.05),and no significant differences were observed in sperm morphological parameters(all P>0.05).There were significant differences in semen volume,PR,and DFI among different abstinence time groups(all P<0.05)and no significant differences in sperm morphological parameters(all P>0.05).Pearson analysis showed that male age and abstinence time were both significantly correlated with sperm kinetics and DFI(both P<0.05),while no significant correlation was found with sperm morphological parameters(all P>0.05).The box plots and histograms of men’s age,abstinence time,and semen quality show that most semen quality parameters differ significantly between the 2 days and 7 days abstinence groups and other groups at different ages.Except for the sperm morphology parameters,sperm kinetic parameters and sperm DFI are linearly related to male age and abstinence time.

No effect of abstinence time on nerve electrophysiological test in premature ejaculation patients

The nerve electrophysiological tests may differentiate the treatment of primary premature ejaculation （PPE） in our previous studies. However, no study verifies if the results will be affected by abstinence time. From January to December in 2016, fifty PPE patients ejaculated within 2 min and 28 control subjects were enrolled. The nerve electrophysiological tests, including dorsal nerve somatosensory evoked potential （DNSEP）, glans penis somatosensory evoked potential （GPSEP）, and penile sympathetic skin response （PSSR）, were recorded before and immediately after ejaculation. The abstinence day was not correlated with the latencies of SEPs or PSSR neither in PE group （P = 0.170, 0.064, and 0.122, respectively） nor in control group （P = 0.996, 0.475, and 0.904, respectively）. No statistically differences were found in the latencies of SEPs and PSSR before and after ejaculation in PE patients （P = 0.439, 0.537, and 0.576, respectively） or control subjects （P = 0. 102, 0. 198, and 0.363, respectively）. Thus, abstinence time does not interfere with the nerve electrophysiological test, which is stable in determining the nerve function of PPE patients.

SYNCRIP controls miR-137 and striatal learning in animal models of methamphetamine abstinence

Abstinence from prolonged psychostimulant use prompts stimulant withdrawal syndrome.Molecular adaptations within the dorsal striatum have been considered the main hallmark of stimulant abstinence. Here we explored striatal miRNA-target interaction and its impact on circulating miRNA marker as well as behavioral dysfunctions in methamphetamine(MA) abstinence. We conducted miRNA sequencing and profiling in the nonhuman primate model of MA abstinence, followed by miRNA qPCR,LC-MS/MS proteomics, immunoassays, and behavior tests in mice. In nonhuman primates, MA abstinence triggered a lasting upregulation of miR-137 in the dorsal striatum but a simultaneous downregulation of circulating miR-137. In mice, aberrant increase in striatal miR-137-dependent inhibition of SYNCRIP essentially mediated the MA abstinence-induced reduction of circulating miR-137. Pathway modeling through experimental deduction illustrated that the MA abstinence-mediated downregulation of circulating miR-137 was caused by reduction of SYNCRIP-dependent miRNA sorting into the exosomes in the dorsal striatum. Furthermore, diminished SYNCRIP in the dorsal striatum was necessary for MA abstinence-induced behavioral bias towards egocentric spatial learning. Taken together, our data revealed circulating miR-137 as a potential blood-based marker that could reflect MA abstinence-dependent changes in striatal miR-137/SYNCRIP axis, and striatal SYNCRIP as a potential therapeutic target for striatum-associated cognitive dysfunction by MA withdrawal syndrome.

Effect of Electro-acupuncture Intervention on Cognition Attention Bias in Heroin Addiction Abstinence—A Dot-probe-based Event-related Potential Study

Objective：To study the changes of cognitive attention-related brain function in the heroin addicts before and after electro-acupuncture（EA） intervention for exploring the concerned neuro-mechanism of addictive relapse and the central action role of EA intervention.Methods：Adopting event-related potential（ERP） technique,the ERP at 64 electrode spots in 10 heroin addicts（test group） were recorded before and after EA intervention with dot-probe experimental form during implementing cognitive task on positive emotional clue （PEC）,negative emotional clues（NEC）,and heroin-related clue（HRC）.The P200 amplitude components on the selected observation points（Fz,Cz,and Pz） were analyzed and compared with those obtained from 10 healthy subjects as the control.Results：Before EA,the ERP of attention on HRC in the test group was higher than that on PEC and NEC（P0.05） and significantly higher than that in the control group（P0.05）;after EA,the P200 amplitude of attention on HRC at Cz and Pz was significantly lowered（P0.05） and that on PEC at Fz was significantly elevated（P0.05）.After EA,the P200 amplitude at Pz was ranked as NECPECHRC,but in the control group,it showed PECHRC at all three observation points and PECNEC at Pz.Conclusion：Heroin addicts show attention bias to HRC,which could be significantly reduced by EA intervention,illustrating that EA could effectively inhibit the attention bias to heroin and so might have potential for lowering the relapse rate.

Magnetic resonance imaging for smoking abstinence:symptoms,mechanisms,and interventions

Tobacco smoking is the leading preventable cause of morbidity and mortality worldwide.Although a number of smokers are aware of the adverse outcomes of smoking and express a strong desire to stop smoking,most smoking quit attempts end in relapse within the first few days of abstinence,primarily resulting from the aversive aspects of the nicotine withdrawal syndrome.Therefore,studying the neural mechanisms of smoking abstinence,identifying smokers with heightened relapse vulnerability prior to quit attempts,and developing effective smoking cessation treatments appear to be promising strategies for improving the success of quit attempts.In recent years,with the development of magnetic resonance imaging,the neural substrates of smoking abstinence have become extensively studied.In this review,we first introduce the psychophysiological changes induced by smoking abstinence,including affective,cognitive,and somatic signs.We then provide an overview of the magnetic resonance imaging-based evidence regarding abstinencerelated functional changes accompanied by these psychophysiological changes.We conclude with a discussion of the neural markers that could predict relapse during quit attempts and a summary of the psychophysiological interventions that are currently often used to help with smoking cessation.This review extends our understanding of the role of the central nervous system in smoking abstinence.

Colonic Dialysis Therapy of Chinese Herbal Medicine in Abstinence of Heroin Addicts-Report of 75 Cases

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Liver transplantation and alcoholic liver disease:History,controversies,and considerations

Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.

Metadoxine improves the three- and six-month survival rates in patients with severe alcoholic hepatitis

AIM:To evaluate the impact of metadoxine(MTD) on the 3- and 6-mo survival of patients with severe alcoholic hepatitis(AH).METHODS:This study was an open-label clinical trial,performed at the"Hospital General de México,Dr.Eduardo Liceaga".We randomized 135 patients who met the criteria for severe AH into the following groups:35 patients received prednisone(PDN)40 mg/d,35patients received PDN+MTD 500 mg three times daily,33 patients received pentoxifylline(PTX)400 mg three times daily,and 32 patients received PTX+MTD 500 mg three times daily.The duration of the treatment for all of the groups was 30 d.RESULTS:In the groups treated with the MTD,thesurvival rate was higher at 3 mo(PTX+MTD 59.4%vs PTX 33.3%,P=0.04;PDN+MTD 68.6%vs PDN20%,P=0.0001)and at 6 mo(PTX+MTD 50%vs PTX18.2%,P=0.01;PDN+MTD 48.6%vs PDN 20%,P=0.003)than in the groups not treated with MTD.A relapse in alcohol intake was the primary independent factor predicting mortality at 6 mo.The patients receiving MTD maintained greater abstinence than those who did not receive it(74.5%vs 59.4%,P=0.02).CONCLUSION:MTD improves the 3-and 6-mo survival rates in patients with severe AH.Alcohol abstinence is a key factor for survival in these patients.The patients who received the combination therapy with MTD were more likely to maintain abstinence than those who received monotherapy with either PDN or PTX.

含酒精的肝炎的管理: 当前的概念

Alcoholic hepatitis is a devastating form of acute liver injury seen in chronic alcohol abusers with significant morbidity and mortality.It is a multisystem disease that is precipitated by ingesting large quantities of alcohol with genetic and environmental factors playing a role.Prognostic criteria have been developed to predict disease severity and these criteria can serve as indicators to initiate medical therapy.Primary therapy remains abstinence and supportive care,as continued alcohol abuse is the most important risk factor for disease progression.The cornerstone of supportive care remains aggressive nutritional support,and although acute alcoholic hepatitis has been extensively studied,few specific medical therapies have been successful.Corticosteroids remain the most effective medical therapy available in improving short term survival in a select group of patients with alcoholic hepatitis;however,the long-term outcome of drug therapies is still not entirely clear and further clinical investigation is necessary.While liver transplantation for acute alcoholic hepatitis have demonstrated promising results,this practice remains controversial and has not been advocated universally,with most transplant centers requiring a prolonged period of abstinence before considering transplantation.Extracorporeal liver support devices,although still experimental,have been developed as a form of liver support to give additional time for liver regeneration.These have the potential for a significant therapeutic option in the future for this unfortunately dreadful disease.

Liver transplantation in acute alcoholic hepatitis:Current status and future development

Acute alcoholic hepatitis (AH) is a distinct clinical entity amongst patients with chronic alcohol abuse.Patients with severe AH are at risk of dying in about 20%-25% cases despite specific treatment with corticosteroids and/or pentoxifylline.Clearly,a need for an additional more effective treatment option is unmet currently.Liver transplantation (LT),a definitive treatment option for alcoholic cirrhosis requires 6 mo abstinence.However,this rule cannot be applied to patients with AH as these patients are actively drinking prior to their presentation.Shortage of donors,ethical issues,and fear of recidivism after transplantation with less than 6 mo pretransplant abstinence are some of the reasons behind this rule of 6 mo of abstinence and hesitancy of transplanting patients with AH.These issues are debated at length in this manuscript.Further,retrospective studies have shown that patients undergoing transplantation for alcoholic cirrhosis and having histological changes of AH have been shown to fare as well when compared to patients without these histological changes.Recently,French workers have reported a case matched prospective study showing encouraging data on the usefulness of LT for patients who are non-responders to cortico-steroid and/or pentoxifylline therapy.Future studies are needed to identify patients with severe AH who are going to benefit most with LT.In the light of emerging data on the efficacy of LT in improving survival of patients with severe acute AH who do not respond to corticosteroids,the time is ripe to re-evaluate our policy of LT in patients with AH.

Alcohol Cessation in Late Life is Associated with Lower Risk of Cognitive Impairment among the Older Adults in China

Objective Evidence regarding alcohol consumption and cognitive impairment is controversial.Whether cessation of drinking alcohol by non-dependent drinkers alters the risk of cognitive impairment remains unknown.This study prospectively evaluated the potential association between the history of lifetime alcohol cessation and risk of cognitive impairment.Methods This study included 15,758 participants age 65 years or older,selected from the Chinese Longitudinal Healthy Longevity Survey(CLHLS)that covered 23 provinces in China.Current alcohol use status,duration of alcohol cessation,and alcohol consumption before abstinence were self-reported by participants;cognitive function was evaluated using Mini-mental State Examination(MMSE).Causespecific hazard models and restricted cubic splines were applied to estimate the effect of alcohol use on cognitive impairment.Results Among the 15,758 participants,mean(±SD)age was 82.8 years(±11.9 years),and 7,199(45.7%)were males.During a mean of 3.9 years of follow-up,3,404 cases were identified as cognitive impairment.Compared with current drinkers,alcohol cessation of five to nine years[adjusted HR,0.79(95%CI:0.66-0.96)]and more than nine years[adjusted HR,0.82(95%CI:0.69-0.98)]were associated with lower risk of cognitive impairment.Conclusion A longer duration of alcohol cessation was associated with a lower risk of cognitive impairment assessed by MMSE.Alcohol cessation is never late for older adults to prevent cognitive impairment.

Using Umbilical Cord Tissue to Identify Prenatal Exposure to Fentanyl and Other Commonly Abused Drugs

Background: Prenatal exposure to fentanyl may lead to Neonatal Abstinence Syndrome (NAS), a constellation of symptoms observed when newborns begin withdrawing from addictive substances such as opioids. The use of umbilical cord tissue segments (UC) for newborn toxicology has been increasing due to its apparent long detection window, sensitivity, and ease of collection. However, very little has been reported in the literature concerning the prevalence of in utero exposure to fentanyl and co-exposure with other commonly abused substances. Specific aim: The specific aims of this retrospective study are twofold. We will report prevalence of neonatal exposure to fentanyl for a nationwide high-risk population using UC submitted to a national reference laboratory for routine forensic toxicology analysis and the co-exposure patterns observed for these fentanyl-exposed neonates. Methods: A secondary analysis was performed using historical data for UC received between January 1, 2020 and December 31, 2020 for routine forensic toxicology analysis. Results: During the study period, our laboratory received 23,104 UC for analysis and 9667 (41.8%) of those UC were positive for at least one drug. The prevalence of fentanyl detection was 1.9% (n = 429). Of these 429 specimens there were 407 UC where both fentanyl and norfentanyl were detected. There were 14 UC where only fentanyl was detected and 8 UC where only norfentanyl was detected. When detected, the median concentrations of fentanyl and norfentanyl were 4029 pg/g (IQR: 1696, 9230 pg/g) and 10,756 pg/mg (IQR: 3925, 25,288 pg/g), respectively. Of the 429 positive fentanyl and/or norfentanyl UC, 33 (7.7%) were only positive for fentanyl and/or norfentanyl. Of the 396 polypositive UC, morphine was the highest co-exposure with 243 UC (56.6%) being positive for both fentanyls and morphine. The second most prevalent co-exposure observed was methamphetamine/amphetamine (n = 173;40.3%) followed by cannabinoids (n = 113;26.3%) and benzoylecgonine (cocaine metabolite;n = 106;24.7%). Conclusions: Nonmedical use of fentanyl is an alarming trend in this country including this maternal demographic reported here. Fentanyl was typically found with other commonly abused substances.

General aspects of the treatment of alcoholic hepatitis

General measures for treating patients with alcoholic hepatitis(AH) are similar irrespective of the disease severity.Alcohol abstinence is the cornerstone of treatment and can be achieved with appropriate social support,Alcoholics Anonymous and sometimes pharmacological therapy.Alcohol withdrawal should be anticipated and treatment initiated to prevent this complication.Treatment for complications of cirrhosis should be as for any other patient with cirrhosis.AH patients are particularly prone to infections and malnutrition.These should be identified and treated appropriately using broad spectrum antibiotics and nutritional support respectively.

Perceptions of post-transplant recidivism in liver transplantation for alcoholic liver disease

Although alcoholic liver disease(ALD) is regarded as a common indication for liver transplantation(LT), debatable issues exist on the requirement for preceding alcoholic abstinence, appropriate indication criteria, predictive factors for alcoholic recidivism, and outcomes following living-donor LT. In most institutions, an abstinence period of six months before LT has been adopted as a mandatory selection criterion. Data indicating that pre-transplant abstinence is an associated predictive factor for alcoholic recidivism supports the reasoning behind this. However, conclusive evidence about the benefit of adopting an abstinence period is yet to be established. On the other hand, a limited number of reports available on living-donor LT experiences for ALD patients suggest that organ donations from relatives have no suppressive effect on alcoholic recidivism. Prevention of alcoholic recidivism has proved to be the most important treatment after LT based on the resultant inferior long-term outcome of patients. Further evaluations are still needed to establish strategies before and after LT for ALD.