Alcohol is possibly the most ubiquitous recreational substance in the world, especially in the United States. Around 85.6% of people have tried alcohol at least once in their lifetime, which is much higher than most other recreational psychoactive substances. The alcohol you can drink in your typical beverages is called ethanol, and it’s the only chemical in the alcohol category that humans can safely consume.
Human beings are thought to consume alcohol because it allows them to eat fruit that had fallen to the ground and fermented. Still, even though we have adapted to consume alcohol, it is a serious psychoactive substance and a chemical that your body will treat as a toxin.
When you drink alcohol, it’s absorbed by your intestines and into your bloodstream. But alcohol isn’t like fats or sugars that the body stores and uses, and it isn’t fibers that pass through the body undigested. Alcohol can’t be stored, so the liver goes to work to filter it out of your blood, break it down, and eliminate it. Your liver can process around one standard drink per hour, depending on your size and weight. Any more than that will get past your liver and affect other parts of your body, such as your brain and heart. Still, your liver is the first defense against many toxins, including alcohol.
Drinking moderate amounts of alcohol every so often isn’t enough to significantly affect your liver. But heavy drinking can lead to serious consequences like alcoholic liver disease. Alcohol can also cause substance use disorders that make it hard to stop drinking, even when it’s causing serious problems like liver damage. In many cases, the best way to address negative health problems that alcohol causes is abstinence from alcohol. However, that may be hard for someone with alcohol use disorder (AUD). You may need to address alcohol addiction to successfully treat alcoholic liver disease.
Alcoholic liver disease is a physical health problem that comes in several different stages. The treatment and recovery time is different at each stage. Learn more about the stages of alcoholic liver disease, how it can be treated, and how long it takes to recover from liver damage caused by alcohol use.
What Are the Stages of Alcoholic Liver Disease?
Alcoholism can affect your liver slowly over time, causing a disease that advances in three different stages. Fatty liver can occur after a brief period of heavy drinking, hepatitis can occur if heavy drinking continues consistently, and cirrhosis usually occurs after years of heavy drinking. At each stage, your road to recovery may be different.
For instance, alcohol abstinence is usually enough to treat a fatty liver, but cirrhosis will need serious medical intervention. As liver disease advances to more severe stages, the need to address a substance use disorder (SUD) becomes even direr. Here’s a breakdown of each of the stages of alcoholic liver disease:
Fatty Liver
Fatty liver is also called steatosis, and it’s the first stage of liver disease. Fatty liver is essentially what it sounds like—an accumulation of fat in the liver that can lead to complications like an enlarged liver. If drinking continues, fatty liver can advance to more dangerous stages of liver disease. Fatty liver can begin quickly; fat can start accumulating in the liver a few hours after a night of heavy binge drinking. However, abstinence can reverse fat accumulation in the liver. Other things can cause fatty liver, including some drugs and pregnancy. Fatty liver from alcohol may be indistinguishable from other causes. But if you have liver problems that other factors cause, excessive alcohol intake can make it worse. Alcohol abstinence is the best way to recover from fatty liver.
Alcoholic Hepatitis
If you continue drinking as fat accumulates in your liver, it can lead to alcoholic hepatitis. Hepatitis refers to inflammation of the liver. Inflammation can lead to liver damage, and it may inhibit liver function. But it also may cause no symptoms at all, causing damage without you knowing. Alcoholic hepatitis is most likely to occur in heavy drinkers who drink for a long time without taking a break to recover. While you may not experience symptoms, hepatitis can also cause bloating, abdominal pain, nausea, vomiting, weight loss, loss of appetite, and yellow skin or eyes. Liver inflammation can also increase a person’s belly size, which may be noticeable.
Cirrhosis
Alcoholic cirrhosis is a severe stage of liver disease that causes extensive scarring on the liver that leads to functional impairment. Scarring causes the liver to become stiff and inflamed, which prevents it from effectively filtering your blood. You may begin to lose muscle tone, bruise easily, loss of appetite, jaundice, swelling of the legs or abdomen, bleeding in the mouth, vomiting blood, and red patches on the palms of your hand.
Cirrhosis can also cause some cognitive symptoms, such as confusion, poor memory, poor concentration, and brain fog. If you see signs of cirrhosis, you will need medical intervention as soon as possible. Without treatment, it can lead to liver failure, which can be fatal.
Is Alcoholic Liver Disease Reversible?
It’s the liver’s job to deal with toxins in your blood, so it’s designed to be extremely resilient. As little as 30% of your liver can regrow to its
original size and function. However, extensive damage can be a significant problem that’s challenging to treat. It may be possible to reverse alcoholic liver disease depending on a few factors. The first factor is the stage of the disease you are experiencing. Fatty liver can occur quickly after heavy drinking, but your liver can recover from it after taking a break from alcohol.
Alcoholic hepatitis can be harder to treat, but it can be reversed with alcohol abstinence and other interventions such as nutritional planning, infection treatment, and the use of certain medications and therapies. Cirrhosis is not reversible. The extensive damage and scarring have significantly impaired the liver, and you’ll need to go through serious medical treatment to avoid dangerous complications. The prognosis for liver cirrhosis will improve if you can get a liver transplant.
The other factor is your willingness to see treatment for your alcohol use disorder. Abstinence is essential at every level of alcoholic liver disease. If you cannot stop drinking, your liver will just get worse. Alcoholic liver disease may seem like enough cause for anyone to stop drinking, but addiction is a disease that causes powerful compulsions to drink despite serious consequences. Even people with a strong desire to quit drinking may find it difficult to stop on their own. However, addiction is treatable, and it can lead to sobriety and abstinence that allows your liver to heal.
Even if your liver has entered the cirrhosis stage and the damage can’t be reversed, it’s important to treat your alcohol use disorder. Getting a liver transplant usually requires a period of abstinence from drugs and alcohol. These requirements are meant to ensure you will not continue to damage the new liver that is donated to you.
How Long Does It Take to Repair the Liver?
If you’re diagnosed with alcoholic liver disease, even in the early stages, your doctor may recommend that you quit drinking for good. If your plan is to stop drinking long enough to repair your liver, that may not be the best idea for your liver health, especially if you’re struggling with AUD. But how long will it take for your liver to be repaired after damaging it with alcohol?
The liver is unique among the rest of your organs for its amazing power of regeneration. Even after severe damage, your liver can repair itself. For instance, in a case of extreme damage where more than half of liver cells are killed, the liver can regenerate to its original mass within 30 days.
When it comes to alcoholic liver disease, the time it takes to heal the liver will depend on the stage of the disease you’re in. Alcohol abstinence for two weeks may be enough to repair the liver after you develop the first stage of liver disease: fatty liver. Alcoholic hepatitis may involve more extensive damage that takes longer to repair. You may also need other treatment options like nutritional support.
Cirrhosis is an advanced stage of liver disease that can’t be reversed, even with alcohol cessation. The problem is scar tissue that has replaced healthy tissue. The liver can’t regenerate anymore, and the scar tissue isn’t functional. In such cases, you may need a liver transplant.
How Does Alcohol Damage the Liver?
Alcoholic liver disease is caused by the toxic effects of alcohol on the liver. The severity of alcoholic liver disease usually correlates to the amount you drink directly. However, other factors that can cause liver damage may also contribute, like certain drugs or medications. Alcohol can damage the liver because of the toxic chemicals it creates when it breaks it down. Active chemicals that are created when the body breaks down a chemical you consume are called metabolites.
In the liver, an enzyme called alcohol dehydrogenase breaks ethanol down into acetaldehyde. Then another enzyme called acetaldehyde dehydrogenase (ALDH) converts the acetaldehyde into acetate. Acetaldehyde is toxic in the liver and can cause liver damage. People with low levels of ALDH may experience a buildup of the toxin after binge drinking. This process also increases the production of fatty acids in the liver and decreases the breakdown of these fatty acids. This causes fat to build up in the liver.
Other processes related to alcohol in the body cause inflammation. Consistent heavy drinking can cause chronic inflammation, which damages the liver and causes the buildup of scar tissue. Scar tissue in the liver is not able to filter the blood like healthy liver tissue. Too much scar tissue can severely impair liver function, leading to cirrhosis and end-stage liver disease.
Some of the cognitive symptoms of alcoholic liver disease are caused because the liver is not able to filter the blood properly, and toxic chemicals can make it to the blood to the brain, causing damage or impairment.
What Is Decompensated Alcoholic Liver Disease?
Decompensated alcoholic liver disease specifically refers to liver disease in which liver function has deteriorated. This term is typically used to refer to patients with cirrhosis of the liver. It may also come with jaundice, bleeding or clotting, fluid in the abdomen, and nervous system damage. At this severe stage of liver disease, you will need aggressive treatment, and the disease has a high rate of mortality. If your condition is able to be stabilized, decompensated alcoholic liver disease may also require a liver transplant, but you will first need to achieve sobriety.
What is a Sedative?
How Common Is Alcoholic Liver Disease?
Alcoholic liver disease is common among frequent, heavy drinkers. Because the first stage can develop quickly and has no symptoms, people who drink heavily may have the disease without realizing it. People who engage in heavy drinking for a time and then cut back may not experience advanced stages of liver disease, even if they do have fatty liver. However, as much as a third of chronic binge drinkers develop alcoholic hepatitis. Still, they may have no symptoms. Unless they stop drinking or cut back, they risk end-stage liver failure.
Anyone can be affected by liver disease, though it typically takes years of chronic drinking to develop cirrhosis of the liver. At that point, severe alcoholic liver disease may start to have symptoms like dark urine color, jaundice, abdominal swelling, and nausea.
Alcoholic Liver Disease with an Alcohol Use Disorder
An alcohol use disorder is a disease that affects your relationship to alcohol, how your brain processes alcohol use, and your brain chemistry. Alcoholism, or severe alcohol use disorder, is a chronic disease that affects the reward center of the brain and makes it difficult to control your drinking. Like alcohol liver disease, alcohol use disorders are diagnosed in three stages.
According to the DSM-5, you may experience a mild, moderate, or severe substance use disorder. Addiction is also a progressive disease, which means a mild disorder may advance to a severe disorder. The DSM-5 identifies the severity of an alcohol use disorder by the number of the 11 common symptoms you experience.
Two or three symptoms indicate a mild disorder, four or five symptoms indicate a moderate disorder, and six or more symptoms indicate a severe disorder. In many cases, a substance use disorder that is left unaddressed will increase in severity over time. Here are the 11 common symptoms of an alcohol use disorder according to the DSM-5:
- You drink more and for longer periods than you intend to. You may drink more in one sitting than you planned.
- Even though you desire or try to stop drinking, you cannot cut back or stop.
- You spend an increasing amount of time getting alcohol, drinking, and recovering from intoxication.
- Cravings and compulsions to drink are hard to resist.
- Alcohol and frequent drinking is causing problems at home, work, or school.
- You continue to drink despite social problems or problems in your interpersonal relationships.
- You give up typical activities, including hobbies and obligations, to spend more time drinking.
- Continued dangerous drinking that causes an increased risk of harm to yourself or others. This may include drunk driving.
- Continued drinking despite serious physical or psychological problems that are caused or worsened by drinking. This can include alcoholic liver disease.
- You have a growing tolerance to alcohol which causes an increased need for alcohol. You may drink more frequently or in higher amounts. The same amount of alcohol has diminishing effects.
- Uncomfortable withdrawal symptoms occur when you stop drinking or cut back. Alcohol withdrawal symptoms can cause tremors, seizures, confusion, anxiety, and insomnia.
If you’re diagnosed with alcohol use disorder, your risk for consequences like alcoholic liver disease is increased. If you start to experience liver problems, it’s important to seek treatment for the disorder so that your liver can begin to heal. However, quitting alcohol “cold turkey” or suddenly can also be dangerous, and treatment often requires medical care.
Treating Alcohol Use Disorder with Alcoholic Liver Disease
When you decide to seek treatment for alcohol use disorder, you will begin by going through an assessment process that’s designed to determine your needs in treatment. You may go through something called a biopsychosocial assessment, an in-depth questionnaire that you go through with a clinician. This is designed to assess your biological, psychological, and social needs. You may also go through a medical assessment with a doctor to address any medical needs that are occurring alongside your substance use disorder.
If you have been diagnosed with alcoholic liver disease, it’s important for you to let your addiction treatment team know as soon as possible. Alcohol dependence can cause potentially dangerous symptoms when you quit cold turkey. Abrupt withdrawal can cause seizures, heart palpitations, high blood pressure, confusion, panic attacks, and potentially fatal heart complications. To avoid this, you may go through a tapering schedule with medications that cause similar effects to alcohol, like benzodiazepines. However, some benzodiazepines can be hard on your liver, which can worsen liver disease.
If your treatment care team is aware of your liver problems, it may opt for a benzodiazepine like lorazepam, which is believed to be the least harmful benzo option for liver disease.
Since alcohol withdrawal can be dangerous and liver disease is a significant medical condition, you may start treatment in medical detox. Intensive inpatient treatment involves 24-hour medically managed care from medical professionals that are experienced in treating addiction. Detox is specifically designed for people who are likely to go through severe withdrawal symptoms. However, other medical conditions may also be treated and addressed, including liver disease.
After detox, you may continue in a medically monitored inpatient treatment program, where your liver health may continue to be monitored. You will also go through a personalized treatment program that’s specifically designed to meet your needs. You may go through group therapies, and you’ll meet with a therapist one-on-one regularly. As long as your liver causes medical instability or needs to be monitored, you may remain in inpatient care. However, when you become medically stable, and you can live at home without risk to your safety or sobriety, you may move on to an outpatient program.
Through treatment, the goal of your recovery plan will be to facilitate long-term sobriety. You may receive behavioral therapies that address your substance use problems and underlying issues like mental health. You will learn to cope with stress and cravings without using alcohol. You will also create a relapse prevention plan designed to help you avoid relapse in the future. Because your liver and overall health may be significantly impacted by continued alcohol use and relapse, it’s important for you to achieve lasting sobriety.
