BACKGROUND: Strategies to identify patients with early alcohol-associated liver disease (ALD), prior to the development of liver-related decompensated events, and promote alcohol therapy engagement in these patients are urgently needed to stem the rising tide of mortality associated with ALD. METHODS: We compared the rate of incident liver-related decompensating events in hospitalized patients with alcohol use disorder (AUD) seen either by an integrated hepatology and addiction care approach or addiction care alone at 2 academic medical centers. Cox proportional hazards regression model and a Kaplan-Meier analysis were used. FINDINGS: An integrated approach of hepatology and addiction care is associated with a reduced likelihood of future liver-related decompensating events in hospitalized patients with AUD. This finding correlated with an increased uptake of medical alcohol therapy and a reduced likelihood of an alcohol-associated readmission. Integrated hepatology and addiction care for hospitalized AUD patients may help reduce the progression of ALD.