Alcohol use disorders (AUDs) are among the most prevalent yet undertreated mental health conditions, affecting more than 7 % of the world population aged 15 and older (World Health Organization, 2024). Globally, alcohol consumption is one of the leading causes of preventable morbidity and mortality, contributing approximately 2.6 million deaths and 116 million disability-adjusted life years (DALYs) each year (Rehm et al., 2014; World Health Organization, 2024). While chronic heavy alcohol consumption can affect many organs, effects on the liver contribute significantly to morbidity and mortality. The burden of chronic liver disease has been primarily attributable to two distinct conditions: nonalcoholic fatty liver disease (NAFLD) and alcohol-associated liver disease (ALD) (Díaz et al., 2023; Younossi & Henry, 2016). NAFLD, recognized as the hepatic manifestation of metabolic syndrome and other cardiometabolic risk factors, affects an estimated 30 % of the global population (Younossi et al., 2023). Alcohol-associated liver disease (ALD) is a common consequence of AUD and affects an estimated 55 % of individuals with AUD and 3.5 % of the general population (Amonker et al., 2023).

Although NAFLD and ALD have traditionally been classified as separate disease entities, metabolic dysfunction and heavy alcohol consumption often coexist (Åberg et al., 2023), and share overlapping biological and pathogenic mechanisms (Boyle et al., 2018; Romeo et al., 2020; Valenti et al., 2009). To better reflect this intersection, a Delphi consensus introduced metabolic and alcohol-associated liver disease (MetALD) as a new diagnostic category (Rinella et al., 2023). As part of this updated diagnostic framework, the term metabolic dysfunction-associated steatotic liver disease (MASLD) has replaced NAFLD, with MASLD, MetALD, and ALD recognized as distinct subtypes within the steatotic liver disease (SLD) spectrum. This updated liver disease framework supports the conceptualization of SLD subtypes as part of a dynamic and overlapping spectrum, thereby allowing for recognition of both the distinct and combined effects of metabolic dysfunction and alcohol consumption on liver disease progression (see Fig. 1).

In this narrative review, we use the term metAUD to describe individuals with current AUD who meet at least one cardiometabolic criterion. While conceptually related, metAUD is distinct from MetALD, with the latter being is defined by hepatic steatosis and distinct alcohol consumption levels. MetAUD is intended to capture a broader clinical phenotype relevant to psychiatric, liver-related, and systemic health outcomes.

While the diagnostic framework for MASLD, MetALD, and ALD helps clarify risk factors and guide treatment approaches, this narrative review focuses on the combined impact of AUD and metabolic dysfunction, defined as obesity, hypertension, type II diabetes (T2D), and dyslipidemia. We begin by examining the morbidity and mortality associated with MetALD, then parallel this research to explore common comorbidities of AUD, the effects of AUD treatment on liver-related outcomes, and how current therapies for ALD and MASLD may inform more effective treatment strategies for individuals with co-occurring AUD and metabolic dysfunction (metAUD).