Alcohol is among the most pervasive recreational substances in the United States. According to a national survey in 2019, 85.6% of people over age 18 have drunk alcohol at least once in their lives. As the vast majority of Americans are exposed to alcohol and alcohol-accepting culture, many develop alcohol use disorders. Around 25% of adults binge drink, and more than 14 million met the criteria for an alcohol use disorder.
Severe alcohol use disorders can damage the liver and eventually lead to liver disease. Alcohol-related liver disease is called alcoholic hepatitis. It can progress to severe liver damage, which is called alcohol cirrhosis. Alcohol liver disease is often the beginning of the end-stage of the disease of alcoholism. It’s important to recognize the signs of alcoholic liver disease and to address alcoholism before it progresses to alcoholic cirrhosis.
Learn more about the signs, stages, and treatment of alcoholic liver disease.
Risk Factors for Alcoholic Liver Disease
The most significant risk factor is a chronic alcohol use disorder. According to the Mayo Clinic, people who have alcohol hepatitis generally drink around 3.5 ounces of alcohol (seven beers) every day for around 20 years. However, there are many variables, such as your size and health conditions.
A long period of heavy drinking can take a toll on your liver. Your liver is responsible for cleaning out your blood. When you drink, your liver filters out as much as it can before it’s overwhelmed, and alcohol is able to reach your brain through your bloodstream. Your liver is usually able to handle moderated drinking, but binging or consistent heavy drinking can be more than your liver can take.
The process of breaking down alcohol in the liver releases harmful, toxic chemicals. Small amounts are fairly harmless, but a pattern of binge drinking can cause extensive damage. These toxic chemicals can cause inflammation in the liver that destroys cells. The liver gets covered in scars overtime. These scars can impair liver function. Widespread scarring on the liver is called cirrhosis, which is the irreversible final stage of liver disease.
Other medical conditions can also contribute to alcoholic cirrhosis. If you have hepatitis C, even moderate drinking can damage your liver and lead to liver disease. Malnutrition and medical and psychological complications that lead to malnutrition can lead to liver damage. In many cases, people with severe alcohol use disorders are malnourished.
Other risk factors include your sex. Women have a higher risk of alcoholic liver disease. People who are overweight or obese may also be at greater risk. Genetic factors can also influence your propensity toward alcoholism and affect your liver health.
Signs and Symptoms of Liver Disease
Alcohol liver disease can come with several uncomfortable symptoms as the disease progresses. A telltale sign that
something is wrong with your liver is jaundice, a yellowing of the skin and eyes. Jaundice is caused by a compound in the body called bilirubin, which is what makes bruises and urine yellow. The liver uses bilirubi
n to make something called bile, which is important for digestion. When the liver becomes damaged to the point where it can no longer process this compound, it’s released into the bloodstream and causes a yellowing of the skin and eyes.
For that reason, jaundice is often associated with a problem in the liver because it means that at least one of the liver’s functions isn’t being properly performed. The whites of the eyes usually have a higher affinity for bilirubin, so yellowing often starts there. While jaundice is often a clear sign of liver disease, there may also be other less obvious signs like:
- Nausea and vomiting
- Abdominal pain
- Loss of appetite
- Low-grade fever
- Easy bruising
- Dark urine
- Pale stool
Severe alcohol hepatitis may also affect other organs like the kidneys. While these organs struggle to go through normal processes, you may have trouble urinating, and fluids may accumulate in your abdomen, causing your stomach to distend. You may also experience swelling in the ankles and legs. It may also start to affect your cognition as toxins build up in your body. This can cause confusion and behavior changes.
What Are the Stages?
Alcohol liver disease can start within a few years of a consistent alcohol use disorder. Each stage of the disease is determined by the damage and impairment of the liver.
The first stage of alcoholic liver disease is called fatty liver. An excessive accumulation of fat in the liver builds up with consistent alcohol misuse. These fat deposits make it difficult for the liver to function normally. This can happen within the first few years of an alcohol use disorder, but it may develop without any obvious symptoms.
Fat in the liver can progress to alcohol hepatitis with continued drinking. Hepatitis is a progression from fat in the liver to inflammation that damages liver cells. This will further inhibit liver function. If you stop drinking, it may improve liver function, but continuing to drink can worsen your liver’s function.
Alcohol cirrhosis is the final stage of alcoholic liver disease. It involves extensive liver scarring that can shut down liver function. Cirrhosis is irreversible and requires a liver transplant to treat.
How Can Alcohol Liver Disease Be Treated?
The best way to deal with alcohol hepatitis is prevention. Alcohol moderation or abstinence can slow or stop the progression of liver scarring. If you have other health conditions like hepatitis C or issues that make you prone to malnutrition, you should avoid alcohol altogether.
If you have a progressing liver problem that’s caused by alcohol use issues, one of the first steps in treatment will be to address your alcoholism. A severe alcohol use disorder often requires medical help to effectively address. Quitting alcohol after a period of chronic misuse can cause potentially dangerous withdrawal symptoms, including tremors, seizures, and a life-threatening condition called delirium tremens (also known as DTs). Getting through alcohol withdrawal safely may involve medical detox and a tapering schedule with the help of a doctor and medications.
In many cases, liver cirrhosis can’t be reversed. However, treatment can slow the progression of the disease. Treatment may include medications like insulin, antioxidant supplements, and SAMe (S-adenosyl-L-methionine). If liver damage is extensive, you may need a liver transplant. If you do have alcohol hepatitis, alcoholism needs to be addressed immediately because alcoholism may exclude you from liver transplant eligibility. To be eligible for a liver transplant, you need to be abstinent from alcohol for at least six months.