Key mistakes in alcohol-associated liver disease management and how to avoid them: a narrative review

ABSTRACT Introduction Alcohol-associated liver disease (ALD) encompasses a spectrum from simple steatosis through fibrosis, cirrhosis, and hepatocellular carcinoma. Alcohol-associated hepatitis (AH) represents a severe acute manifestation of ALD carrying substantial short-term mortality. ALD is strongly associated with harmful alcohol use and alcohol use disorder (AUD), though a proportion of patients may engage in hazardous drinking patterns that do not meet full DSM-5 criteria for AUD. Despite being a considerable global health burden, ALD frequently remains underdiagnosed until advanced stages. Areas covered This narrative review examines critical deficiencies in the management of ALD and AUD, from initial recognition through long-term follow-up. This review is informed by structured searches of PubMed/MEDLINE, Embase, and Cochrane Library (2005–2025). Commonly identified pitfalls include delayed screening for AUD, inadequate assessment of consumption patterns, mismanagement of episodes of AH, neglect of nutritional requirements, suboptimal pharmacological approaches, and poor coordination among multidisciplinary teams (MDT). By highlighting recurrent mistakes and providing evidence-based strategies to avoid them, this narrative review aims to equip clinicians with practical tools to improve patient outcomes. Expert opinion The future of ALD management lies at the intersection of technological innovation, therapeutic advancement, systems-level care redesign, and public health policy.