Alcoholic Liver Disease

Alcoholic liver disease is a spectrum of conditions a person can develop as a result of alcohol abuse. 

As a person drinks alcohol, it can damage the liver. After years of abuse, this damage can accumulate enough that a person begins to develop serious or even life-threatening health complications. 

What Is Alcoholic Liver Disease?

Alcoholic liver disease refers to a spectrum of diseases that occur due to liver damage as a result of long-term alcohol abuse. This condition is very serious and represents one of the biggest long-term dangers of abusing alcohol.

Alcohol liver disease typically progresses in the following three stages:

• Alcoholic fatty liver: Fat accumulates inside the liver. You may have no symptoms at this stage.   
• Alcoholic hepatitis: The liver begins to swell. You may have mild symptoms, such as poor appetite, nausea, and belly pain.
• Alcoholic cirrhosis: The liver fills with scar tissue. You may have severe symptoms at this stage, such as yellow-colored skin, redness on the palms, and easy bruising.

In the past, researchers thought men were more susceptible to liver disease than women. However, in 2023, researchers pointed out that the gap between men and women is closing. As women begin to drink more alcohol than they did previously, they’re developing liver disease at higher rates too.

Alcoholic liver disease is often diagnosed in people between ages 40 and 50, but it can occur earlier or later in life, depending on your drinking habits.

Cause of Alcoholic Liver Disease

As the name implies, alcoholic liver disease is caused by the damage alcohol can do to the liver over time. Eventually, this damage can be significant enough to cause serious and even life-threatening harm to a person’s liver. 

The more a person drinks and the longer they have been abusing alcohol, the more likely they are to develop alcoholic liver disease. Because of biological differences, cisgender women may develop alcoholic liver disease with less drinking compared to cisgender men. 

Notably, alcoholic liver disease can occur even if a person doesn’t get noticeably drunk on a regular basis. Alcohol can still tax the liver if a person drinks often, even if they avoid binge drinking and similar practices. It also appears that some people may inherit an increased risk of developing alcoholic liver disease. 

How Alcohol Damages the Liver

The liver is a key part of how the body processes alcohol. Normally, it can process occasional, moderate amounts of alcohol without significant issue. 

However, excessive alcohol consumption can force the cells in a person’s liver to work harder than normal. Over time, this can damage a person’s liver cells, which can cause them to develop health issues. 

Consistent alcohol abuse can eventually cause major damage to the liver, which may cause what is called cirrhosis. This is serious liver damage that may eventually require a person to get a liver transplant. 

Symptoms of Alcoholic Liver Disease

The early stages of alcohol liver disease don’t always cause significant symptoms, although symptoms often become more pronounced after a period of heavy drinking. 

Common early signs of alcohol liver disease include the following:

• Nausea
• Belly pain
• Poor appetite
• Weight loss
• Fatigue or lethargy
• Blood vessels appearing on the skin in a spider-web-like pattern

More advanced liver disease can cause symptoms such as these:

• Edema (fluid buildup in the legs)
• Ascites (fluid buildup in the abdomen)
• Jaundice (yellowing of the eyes, skin, and mucous membranes)
• Redness on the palms
• Impotence
• Shrinking of the testicles
• Breast swelling
• Confusion
• Pale or clay-colored stools

The final stages of alcohol liver disease can cause liver cirrhosis and what is called end-stage liver disease (ESLD).

Diagnosis

The diagnostic process to detect alcohol liver disease can involve checking for a number of different signs. Generally, a doctor will begin with a physical exam. They will look for some of the more obvious visual signs of alcohol liver disease, such as swelling, jaundice, shrunken testicles, and other visual indicators that a person may have alcohol liver disease.

Diagnosing liver disease can involve the following tests:

• Complete blood count to rule out infections and identify complications
• Liver function tests to determine how well the organ is working
• Prothrombin time to assess how serious the problem is
• Ultrasound to look for liver tumors or obstructions
• Metabolic profiles to assess kidney failure
• Screening blood tests to rule out other diseases
• Endoscopy to look for bleeding
• Biopsy to diagnose the problem when other tests are unclear

Treatment of Alcoholic Liver Disease

One of the more important steps in treating alcohol liver disease is changing one’s habits. For the best prognosis, a person will generally need to radically change the amount of alcohol they drink. 

If a person needs a liver transplant, they can often only get approved for one after a period of sobriety lasting at least six months. Even if they don’t need a transplant, drinking alcohol at the rate that led them to develop alcohol liver disease will cause their condition to worsen and is likely to eventually become life-threatening.

A doctor may prescribe a number of treatments as appropriate to combat a person’s symptoms, including prescribing diuretics to reduce fluid buildup, vitamin K or blood products for excessive bleeding, medications to help reduce mental confusion, and antibiotics for infections.

Potential Complications 

Alcoholic liver disease can cause significant complications, including the following:

• Hemorrhages
• Fluids in the abdomen (also known as ascites)
• Infections (also known as spontaneous bacterial peritonitis)
• Kidney failure
• Swelling
• Brain injuries (also known as hepatic encephalopathy)

While a number of serious complications are possible, alcoholic hepatitis and cirrhosis mean a person has caused extensive damage to their liver as a result of alcohol consumption. This can mean the liver will be unable to fully heal and return to its normal function.

Prognosis

Alcoholic liver disease exists on a spectrum, and so does a person’s prognosis if they suffer from it. Caught early and with the right interventions, a person can have a relatively good prognosis. 

However, prognosis worsens significantly in people who develop cirrhosis, especially in those who cannot stop drinking. Cirrhosis is most life-threatening to women and the elderly. 

Survival rates used to be significantly lower for late-stage alcoholic liver disease before liver transplants were viable. However, the demand for liver transplants exceeds the current supply. It is important that a person stops drinking if they’re to be considered for a transplant.

Regardless of a person’s current condition, changing the way you drink alcohol is critical to a good prognosis. If someone has difficulty stopping drinking on their own, they should seek out evidence-based treatment programs that can help them reduce their dependence on alcohol and overcome their struggles with alcohol abuse.

Prevention

You can prevent alcoholic liver disease by making sure not to drink in excess and seeking help early if you find you frequently cannot stop drinking even when you know it might be negatively impacting your life. Here are some tips to avoid excessive alcohol consumption:

• Try low-alcohol drinks.
• Avoid binge drinking.
• Set alcohol-free days for yourself.
• Follow alcoholic beverages with multiple non-alcoholic ones.
• Wait after an alcoholic drink before drinking another.

For many people, it helps to avoid situations in which you may be pressured (intentionally or not) to abuse alcohol. Common situations that cause a person to drink more than they should include the following:

• Drinking with others who frequently abuse alcohol
• Drinking in rounds, where people buy a group of friends drinks all at once
• Drinking when feeling negative emotions, such as stress or anxiety
• Going to places where drinking is socially expected, such as bars

Even if you have not yet developed alcoholic liver disease, excessive alcohol consumption can have a negative impact on your health and social relationships. Seek help if you cannot stop abusing alcohol. 

Even if you cannot see yourself ever stopping your drinking, evidence-based treatment programs can help you resist alcohol abuse and can greatly improve your chances of overcoming any addiction or other issues with alcohol you may have.

Medically Reviewed By Dr. Alison Tarlow

Dr. Alison Tarlow is a Licensed Clinical Psychologist in the States of Florida and Pennsylvania, and a Certified Addictions Professional (CAP). She has been a practicing psychologist for over 15 years. Sh... Read More