Alcohol and the Liver: Liver Damage from Alcohol

Effect of Alcohol on Your Liver

The liver has a few main functions, including:³

1. Converting nutrients (food) into substances the body can use, storing them, and delivering them to organs and cells when needed.
2. Removing toxins and waste products from the bloodstream.
3. Producing bile to aid in the digestion of fats.

When the liver filters and processes alcohol—especially regularly over a prolonged period or in episodic excess quantities (i.e. binge drinking), the liver can become damaged and some of this damage can lead to certain liver diseases.¹

Though alcohol-related liver disease often follows a progression—from fatty liver disease to alcoholic hepatitis to cirrhosis of the liver if heavy drinking continues, this is not always the case.^1,5 Each of these conditions can occur without the development of the others and cause serious long-term health effects, sometimes death if left untreated.⁵

What is Alcoholic Fatty Liver Disease?

Alcoholic fatty liver disease (AFLD) or steatosis is a completely preventable condition, affects nearly all heavy drinkers, and occurs quickly.⁶ Characterized by sustained fat buildup that exceeds the liver’s normal levels of fat, AFLD is one of the earliest conditions that can occur as the result of problematic drinking. Therefore, the condition is common in individuals who misuse alcohol or struggle with alcohol addiction.¹ In fact, research indicates that AFLD develops in more than 90% of individuals who consume 4-5 standard drinks per day over decades. However, it also develops after regular binge drinking—defined as the consumption of 4-5 drinks in 2 hours or less.¹

Regardless of the time frame, excessive alcohol consumption can lead to AFLD. The Centers for Disease Control and Prevention (CDC) defines excessive alcohol use as 15 or more drinks for men per week and 8 drinks or more for women.⁷ Individuals with AFLD, which, internally, causes metabolic changes and dysfunction in the liver, often show no outward symptoms but some individuals may feel some discomfort on the upper right side of the abdomen (where the liver is located).^1,5

The good news is that AFLD is completely reversible if it’s detected early and individuals commit to abstaining from alcohol.¹ However, left untreated, AFLD can progress to more serious conditions, including alcoholic hepatitis or cirrhosis.¹

What is Alcoholic Hepatitis?

Statistics suggest that up to 35% of heavy drinkers will progress from untreated AFLD to alcohol-related hepatitis, a serious inflammatory condition that can range from mild to severe.^1,6 Symptoms of alcoholic hepatitis vary but often come on suddenly and may include:⁸

• Jaundice, or yellowing of the skin.
• Malaise, or a general feeling of discomfort.
• Tender hepatomegaly (an enlargement of the liver).

Alcoholic hepatitis is more serious than AFLD; however, research indicates that milder cases of alcoholic hepatitis may be reversed if the individual stops drinking, though it could take months to resolve completely.⁹ On the other hand, more severe alcoholic hepatitis cases are associated with a high rate of short-term mortality.^1,10 Furthermore, if alcoholic hepatitis remains untreated and if the drinking behavior continues, it can progress to alcohol-induced cirrhosis of the liver.

What is Alcoholic Cirrhosis of the Liver?

The most serious form of alcohol-related liver disease, cirrhosis, is characterized by extensive and permanent scarring—clinically referred to as fibrosis—throughout the liver.¹¹ Over time, in response to injury, the liver tries to repair itself by forming scar tissue to replace the damaged tissue. When repeated, this process leads to an ever-increasing amount of scar tissue, which interferes with the liver’s blood flow and prevents the liver from functioning normally.¹¹  As the condition worsens, the liver fails to filter out toxins, process and store nutrients, and create bile, ultimately leading to liver failure, which can be fatal without a liver transplant.^3,11

Symptoms associated with cirrhosis depend on the stage of the disease. Some individuals in the early stages may not experience any symptoms. Other signs of cirrhosis may not surface until the damage to the liver becomes more extensive. As the disease progresses, symptoms may include:¹²

• Fatigue.
• Nausea or vomiting.
• Unintentional weight loss.
• Increased bruising or bleeding.
• Jaundice, which can make the whites of the eyes yellow or give the skin a yellow tint.
• Urticaria, or severe skin itching.
• Swelling in the legs, ankles, and feet.
• Bloating from the buildup of fluid in the abdomen, known as ascites.
• Hepatic encephalopathy—confusion, memory loss, and personality changes.

Alcohol-related cirrhosis is associated with a high mortality rate as well.³ In 2019, more than 50% of all cirrhosis deaths were alcohol related. Adults between the ages of 25 and 34 made up more than 80% of those deaths.² While there are currently no cures or FDA-approved medications for the treatment of alcohol-induced cirrhosis of the liver, doctors can treat many of the diseases and/or manage the contributing factors that lead to cirrhosis.¹¹

Risk Factors for Liver Damage from Alcohol

Age, gender, genetics, and other factors impact an individual’s overall risk for developing liver disease as well as how quickly and severely alcohol-related liver damage manifests.¹ However, studies suggest that:^1,13

• Consumption patterns and beverage types matter. Individuals who consume between 1 and 3 ounces of ethanol daily over a period of 10-12 years—as well as those who binge drink—have an increased risk of more severe alcohol-related liver diseases, including alcoholic hepatitis and alcoholic cirrhosis.
• Older adults are more susceptible. While it’s not completely clear how age affects the progression of alcohol-related liver disease, older adults are more affected since they don’t metabolize alcohol at the same rate as younger individuals.
• Ethnicity plays a role. Ethnicity affects the age and severity of the presentation of alcohol-related liver disease though it’s unclear as to why. The highest rates of alcoholic cirrhosis, for instance, are among white Hispanic men.
• Obesity poses risks. Research suggests a significant correlation between the risk of liver disease and alcohol consumption among individuals with a high body mass index (BMI).

Can the Effects of Liver Damage from Alcohol be Reversed?

As previously mentioned, heavy alcohol consumption damages the liver, and prolonged and repeated use can lead to the alcohol-related liver diseases discussed in this article.

The liver, however, is remarkably regenerative. Evidence shows that even if AFLD has progressed to fibrosis, for instance, the liver can repair and regenerate itself.¹⁴ The key is that alcohol consumption must stop. If you have been diagnosed with an alcohol-related liver disease, the single most important thing to do is stop drinking. Abstinence is the only way to possibly reverse liver damage, or at a minimum, prevent it from becoming worse. It should be noted that suddenly quitting alcohol use after chronic or excessive use can pose certain health risks, such as alcohol withdrawal. A medically-managed detox program can help you safely stop drinking by managing certain symptoms of withdrawal. Unmanaged alcohol withdrawal can potentially be deadly.

Treatment for Alcohol Addiction

If you or a loved one struggle with alcohol misuse and need help quitting, treatment is available. Individuals who have become dependent on alcohol—meaning their body has become so used to having it present that when use suddenly stops withdrawal symptoms surface—benefit from supervised alcohol detox. While detox helps rid the body of alcohol and other toxins, it is typically not enough to sustain abstinence from alcohol. It is usually the first step in a more comprehensive plan that includes , which can take place in an inpatient program or outpatient setting, depending on your specific needs.¹⁵

To start, reach out to your primary care physician or other healthcare provider, who can perform a thorough assessment and determine your medical needs. You can also call American Addiction Centers (AAC) and speak to one of our compassionate admissions navigators, who can answer your questions, explain your options, and help you get started on your journey to a healthy, alcohol-free life. Don’t delay. Call us today at .