Alcoholic liver disease (ALD) refers to the damage that drinking excessive amounts of alcohol can cause to the liver. Alcohol is the most misused substance in the U.S. and the world, according to the World Health Organization (WHO), and is the leading cause of liver disease.
As ALD worsens, it can scar the liver and cause irreversible damage, resulting in the need for a liver transplant. Fortunately, multiple treatment methods for ALD are available today. Getting and staying sober is the best way to prevent and reverse ALD.
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What Is Alcoholic Liver Disease?
Alcoholic liver disease (ALD) is liver damage that occurs due to drinking excessive amounts of alcohol over long periods of time. The more alcohol you drink, the more you impact your liver function.
Early in the disease, you may not notice any symptoms. As it progresses, your liver may start to scar, a condition called cirrhosis.
In advanced stages, this scarring can lead to reduced liver function, and you may even need a liver transplant.
Early diagnosis is vital to avoiding serious health complications, starting with treating the condition at its root cause — alcohol consumption.
Understanding alcohol consumption
It is important to understand your relationship with alcohol to be aware of alcohol use disorder (AUD) — the pattern of drinking alcohol in an uncontrollable or unhealthy manner. AUD can lead to ALD and other serious health complications, including addiction, mental health disorders, and death.
For men, the moderate amount of alcohol is two drinks a day.
For women, it is one drink a day.
One drink of alcohol is considered:
- 12 oz. of beer.
- 8 to 9 oz. of malt liquor.
- 1.5 oz. of distilled spirits or hard liquor.
- 5 oz of wine.
Drinking more than the moderate level of alcohol, binge drinking, and other disordered drinking patterns contribute to alcoholic liver disease and other alcohol-related illnesses.
What are the stages of alcoholic liver disease?
There are three stages of ALD in order of seriousness are:
- Alcoholic fatty liver, or steatosis — Fat cells build up inside the liver during this early stage of ALD. Fatty liver is common in people who drink heavily, but it's often reversible if you seek immediate care and stop drinking.
- Alcoholic hepatitis — This stage often occurs quickly once liver damage is very advanced. People with ALD will notice more severe symptoms like vomiting and jaundice (the yellowing of the eyes and skin). At this stage, you should seek emergency care immediately.
- Alcoholic cirrhosis — Liver tissue becomes scarred, known as cirrhosis. This advanced liver damage is not reversible.
How common is alcoholic liver disease?
ALD is a common condition, affecting approximately 3% to 5% of the population, including both men and women, in the United States. Advanced stages of ALD are less common, occurring in under 1% of the U.S. population, but anyone with any stage of ALD is at a higher risk for the condition worsening until they get treatment and remain sober.
What causes alcoholic liver disease?
The direct cause of alcoholic liver disease is consuming large amounts of alcohol, also called alcohol use disorder (AUD). While not every person with AUD will develop some form of ALD, it is a necessary component of the condition.
There are many hard-to-control factors that may lead a person to drink heavily. Research shows that these factors all affect alcohol consumption:
- Environmental factors — Acceptance of alcohol use, availability, advertising, and even climate influence heavy consumption.
- Genetics — Alcohol use disorders are known to run in families.
- Mental, social, and emotional factors — Most people with ALD are also getting treatment for PTSD, anxiety, bipolar disorders, depression, or pain disorders.
Drinking more than the moderate level of alcohol consumption can cause ALD. Binge drinking, which is considered drinking four or more alcoholic beverages within a two-hour timeframe, can also cause ALD and other health complications.
It's vital to seek care for any of the above factors to help you stop drinking. This, in turn, will slow the progression of your liver disease.
Alcoholic liver disease risk factors
You're at increased risk for ALD if you:
- Have a family history of liver disease of any kind.
- Have a history of alcohol use disorder.
- Often consume more than two alcoholic drinks in a day.
Complications of alcoholic liver disease
Left untreated, ALD can cause complications like:
- Ascites — Fluid that builds up in the belly.
- Bleeding from varices — Enlarged veins in the esophagus.
- Cirrhosis — Scarring of the liver that can cause end-stage liver disease or liver failure.
- Hepatic encephalopathy — Impaired brain function due to built-up toxins.
- Hepatic hydrothorax — Fluid between the chest and lungs.
- Hepatorenal syndrome — Kidney decline or failure.
You're also at an increased risk of liver cancer if you have ALD.
How can I prevent alcoholic liver disease?
You can prevent ALD by drinking less alcohol or none at all.
It can be challenging to stop drinking on your own. You should speak to your doctor about your drinking and seek care for your mental and emotional health. There are resources available to stop drinking and maintain sobriety.
What Are the Signs and Symptoms of Alcoholic Liver Disease?
ALD is a silent disease. That means you will likely not notice any symptoms, sometimes for years, as your liver disease worsens.
At later stages, you might have symptoms such as:
- Abdominal pain.
- Confusion.
- Fatigue.
- Loss of appetite.
- Mood swings.
- Nausea or stomach pain.
- Visible blood vessels on your skin.
- Vomiting.
- Weakness.
- Weight loss.
Advanced liver damage can cause symptoms like:
- Light-colored stools.
- Jaundice, or yellow eyes or skin.
- Swelling in your legs or belly.
When should I see a doctor about my alcoholic liver disease symptoms?
If you have any of the above symptoms and regularly consume alcohol, or if you don’t have any presentable symptoms but are trying to quit drinking, talk with your primary care physician right away. Treating ALD early can lead to a better outcome for your liver and overall health.
How Do You Diagnose Alcoholic Liver Disease?
First, you can expect your doctor to ask you questions about your alcohol use, symptoms, medical history, and family history.
It is common for people to downplay or avoid discussing their alcohol habits with their doctors, but it is crucial to be honest about your alcohol consumption so you can receive an accurate diagnosis and adequate treatment.
Your doctor may perform a physical examination depending on your answers and symptoms.
Next, they will take blood samples and run tests. These blood tests help confirm that another liver condition isn’t causing your liver damage. From there, they may perform a noninvasive scan to screen your liver.
If needed, they may remove a tissue sample from your liver to study it. This test is called a liver biopsy and can help diagnose worsening ALD conditions.
You may need other testing so doctors can learn more about your liver's health.
How Do You Treat Alcoholic Liver Disease?
If you have ALD, it is crucial that you stop drinking. Getting and staying sober can reverse ALD damage, improve other organ function, and relieve mental health conditions. Finding a way to remain abstinent from alcohol should be the first priority in treating ALD.
For some, this will require an in-person detoxification program or outpatient rehabilitation program. For others, they may be able to stop drinking on their own. No matter where you are on your drinking journey, it is important to be honest with yourself and seek the appropriate methods to get sober.
Many people find that a combination of different treatment methods and tactics for staying sober is necessary for overcoming their AUD and ALD.
Counseling to treat ALD
Finding a trusted center for addiction counseling can help treat the underlying causes of your alcohol consumption.
These treatments may include:
- Cognitive therapy.
- Mindfulness meditation.
- Motivational counseling.
- Training in stress control techniques.
Lifestyle changes for ALD
If you have an alcohol addiction, it can be beneficial or even lifesaving to make appropriate lifestyle changes that better align with a sober, healthy life.
Your doctor might suggest:
- Creating a living environment that avoids alcohol or anything that may be triggering.
- Eating a special diet to help with weight gain.
- Taking supplements to get the nutrients your body needs.
Medicine to treat ALD
Your doctor might prescribe certain drugs to treat the early stages of liver damage from ALD.
These drugs include:
- Medicine that reduces cravings for alcohol.
- Steroids, such as prednisone, to reduce liver inflammation.
- Vitamin K to help control bleeding (such as bleeding from varices).
- Water pills to help your body get rid of excess fluids.
Surgery to treat ALD
If ALD advances to alcoholic cirrhosis, you may experience liver failure. In these cases, the only treatment is liver transplant.
In liver transplant surgery, doctors replace your liver with a healthy liver from a donor.
For many hospitals around the country, a period of sobriety is required for people with ALD or other alcohol-related liver failure to become eligible for a liver transplant.
