Alcohol related-liver disease refers to liver damage caused by prolonged heavy alcohol use. It can range from fatty changes in the liver through to fibrosis, cirrhosis, and in more advanced cases may lead to liver failure or liver cancer. Some people may also develop alcohol-associated hepatitis, which causes significant inflammation of the liver.
One of the challenges with alcohol-related liver disease is that it can develop without obvious symptoms. Early liver damage may cause a few symptoms, or sometimes none at all, which means the condition may not be recognised until it has progressed further. Alcohol use can also be closely linked with dependence and alcohol use disorder, so treatment may need to address both liver health and the factors contributing to ongoing alcohol use.
What Is Alcohol-Related Liver Disease?
Alcohol-related liver disease describes a range of changes to the liver that can occur following prolonged heavy alcohol use. It may progress through several stages.
- Fatty liver – excess fat builds up within liver cells
- Fibrosis – scar tissue begins to form
- Cirrhosis – extensive scarring changes to the structure of the liver and affects how well it functions
- Liver failure – the liver is no longer able to carry out its normal functions effectively.
Some people may also develop alcohol-associated hepatitis, a potentially serious condition in which the liver becomes significantly inflamed. Not everyone who drinks heavily will experience the same degree of liver damage. Some people develop only fatty changes, while others may progress to fibrosis, cirrhosis, liver failure or cancer. A combination of alcohol use, general health and individual susceptibility can influence how the disease develops.
What Are the Early Signs of Alcohol-Related Liver Disease?
Early alcohol-related liver disease can be difficult to recognise because symptoms are often mild or absent. Around 90% of people with early liver disease can have either no symptoms or only vague symptoms such as fatigue. As the condition progresses, symptoms may become more noticeable. Fatty liver, fibrosis and cirrhosis represent increasing levels of liver damage and scarring. Alcohol-associated hepatitis is different: it refers to a potentially serious episode of liver inflammation that can occur during the course of alcohol-related liver disease, rather than being a separate stage between fatty liver, fibrosis and cirrhosis.
People with alcohol associated hepatitis may experience:
- Fever
- Nausea or vomiting
- Loss of appetite
- Abdominal pain
- Jaundice, which causes yellowing of the skin or eyes.
Cirrhosis, which involves advanced scarring of the liver, can lead to more serious complications such as fluid build-up in the abdomen, gastrointestinal bleeding, confusion and severe jaundice. As early liver damage can develop before noticeable symptoms appear, feeling well does not necessarily mean that the liver has not been affected.
Who Is at Risk for Alcohol-Related Liver Disease?
Heavy alcohol use is the main risk factor for alcohol-related liver disease, but alcohol intake is not the only factor that influences whether someone develops more serious liver damage. Other factors linked with increased risk include:
- Older age
- Obesity
- Type 2 diabetes
- Metabolic syndrome
- Smoking
- Viral hepatitis
- Certain genetic factors
Does The Pattern of Drinking Matter?
How much alcohol a person drinks is important, but the way alcohol is consumed may also affect liver health. Daily drinking, binge drinking and heavy episodic drinking have all been associated with an increased risk of alcohol-related liver disease. This means alcohol-related risk is not necessarily determined by an average weekly amount alone. How often someone drinks, how much they consume at one time and their overall drinking pattern can all be relevant when assessing risk.
Alcohol Use Disorder and Liver Health
Alcohol-related liver disease and alcohol use disorder (AUD) can occur together. Alcohol use disorder involves difficulty controlling alcohol use despite negative effects on a person’s health, relationships, work or other areas of life. Alcohol-related liver disease occurs in about 3.5% of people worldwide, but affects more than half of people with alcohol use disorder. This highlights how common liver disease is among people with AUD compared with the general population.
Alcohol use disorder is treatable. For some people, reducing or stopping alcohol may be made more difficult by cravings, dependence or long-established drinking patterns. In these situations, psychiatric and addiction support can help address both alcohol use and its effects on health.
How Is Alcohol-Related Liver Disease Diagnosed?
Alcohol-related liver disease can be difficult to detect early because symptoms are often mild or absent. As a result, some people are not diagnosed until more significant liver damage has already developed, highlighting the importance of early assessment.
Diagnosis usually involves reviewing a person’s medical and alcohol use history alongside blood tests and, where appropriate, imaging of the liver. One commonly used screening tool is the Fibrosis-4 score, which uses a person’s age and several blood tests to estimate their risk of liver fibrosis. If the results suggest an increased risk of fibrosis, further testing may be recommended. This can include vibration-controlled transient elastography, a type of liver ultrasound that helps assess the amount of scarring in the liver. The tests needed will vary from person to person and should be discussed with a doctor.
Can The Liver Recover After Stopping Alcohol?
In some stages of alcohol-related liver disease, the liver can improve. Stopping alcohol use can reverse fatty liver and, in some cases, liver fibrosis, and is associated with a lower risk of liver related complications and death. Continued alcohol use after alcohol-related liver disease has developed, on the other hand, is associated with a greater risk of liver failure and death. For this reason, stopping alcohol is an important part of treatment for people diagnosed with alcohol-related liver disease.
However, for people with alcohol dependence or alcohol use disorder, stopping may not be straightforward. Ongoing medical, psychological or addiction support may be needed to reduce alcohol use, maintain abstinence and reduce the risk of relapse.
How Are Alcohol-Related Liver Disease and Alcohol Use Disorder Treated?
Treatment often needs to address both the liver disease and the person’s alcohol use.
Psychiatric treatments can play an important role and may include Cognitive Behavioural Therapy and Psychodynamic Psychotherapy. Medication may also be used to help reduce alcohol use or support abstinence. Depending on the individual, these may include medications such as baclofen or naltrexone. Research has linked treatment for alcohol use disorder with improved rates of abstinence and reduced binge drinking, while some studies have also found lower rates of liver disease progression and complications among people receiving treatment.
Treatment should be tailored to the individual, particularly when someone already has liver or kidney problems. Other health conditions may also need to be addressed. Obesity, type 2 diabetes, high blood pressure and other features of metabolic syndrome can increase the risk of progressive liver fibrosis, so managing these conditions can form part of overall treatment.
Mental health is also relevant. Some people may drink in response to stress, trauma, anxiety, depression, sleep difficulties or other concerns. Others may experience cravings or dependence that make reducing their alcohol use more difficult. For this reason, care may involve a combination of psychiatric and addiction support. Addressing the factors contributing to ongoing alcohol use can be an important part of reducing further harm and preventing relapse.
When Should You Seek Help?
Consider speaking with a doctor if you are concerned about how much alcohol you are drinking, have found it difficult to cut down, or think alcohol may be affecting your physical or mental health. Medical assessment is particularly important if symptoms such as jaundice, persistent vomiting, abdominal swelling, gastrointestinal bleeding or confusion develop, as these may occur with more advanced liver disease.
Alcohol-related liver disease can be serious, but recognising the problem early and receiving appropriate medical, psychological or addiction support can make an important difference.
At Eastern Suburbs Psychiatry in Sydney, our psychiatrists can assess and treat alcohol and other drug (AOD) conditions, including alcohol use disorder, particularly where these occur alongside other mental health conditions. Speak with your GP about whether a referral may be appropriate.
To make an enquiry about an appointment to see a Sydney Psychiatrist for an individualised treatment plan, click here.