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Alcoholic Liver Disease

Alcoholic liver disease, a common and fatal result of alcohol use disorder and binge drinking, progresses through three stages, each more life-threatening. Ceasing alcohol intake is crucial to treating or reversing liver damage. However, once irreversible damage occurs, individuals face the risk of losing their lives to the disease.

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Alcohol & Liver Health

Alcoholic liver disease is one of the most common and fatal outcomes of alcohol use disorder and binge drinking behavior. Alcohol addicts typically move through the three stages of alcohol-related liver disease, with each stage more life-threatening than the last.

Stopping alcohol intake is always the first step to treating or reversing liver disease, as the liver will struggle to process alcohol the more it’s damaged. However, alcoholics will reach a tipping point where the damage is no longer reversible, and they risk losing their lives to the disease.

What Is Alcohol Liver Disease?

Alcohol liver disease is a condition caused by years of heavy drinking and includes three types:

  1. Steatotic (fatty) liver
  2. Acute alcoholic hepatitis
  3. Cirrhosis

Many heavy drinkers will make their way through these stages if they continue abusing large amounts of alcohol.

Steatotic liver or fatty liver disease occurs when the liver is enlarged due to the build-up of fat inside the liver cells. Acute alcoholic hepatitis describes the acute inflammation of the liver, leading to cell death and permanent scarring.

Liver cirrhosis is the final stage of liver disease and refers to scarring on the liver, which causes irreversible poor liver function.

Although not all heavy alcohol users will develop alcoholic liver disease, the chances of developing it increase the longer you drink and the more alcohol you consume.

How Does Alcohol Affect the Liver?

Alcohol is toxic to the liver, regardless of the amount. The liver is responsible for breaking down most of the alcohol consumed. Through the process of breaking alcohol down, chemicals that are even more harmful than alcohol are created.

Drinking more alcohol than your liver can process can cause damage that slowly gets worse over years of heavy drinking.

Without treatment and lifestyle changes, alcohol can damage the liver so badly that liver failure is possible. In extreme cases, a liver transplant may be necessary to avoid death.

Statistics About Alcoholic Liver Disease

Alcoholic liver disease is a serious risk to people who abuse alcohol, especially in large quantities over many years. Alcohol causes 4 out of 5 Americans to die from liver disease.

According to research from the University of Central Florida (UCF):

  • About 20% of alcoholics and heavy drinkers will reach stage 1 of liver disease (steatotic or fatty liver disease) from alcohol.
  • Half of the severe cases of alcoholic hepatitis are fatal, and 40% will progress into the next alcoholic liver disease stage, which is cirrhosis (scarring of the liver) unless they stop drinking immediately.
  • In the later stages of cirrhosis, the survival rate is about 60% for those who quit drinking but only 35% for those who don’t.
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Symptoms and Stages of Alcohol-Related Liver Disease

Not all individuals with alcohol-related liver disease experience noticeable symptoms, depending on the liver’s current level of functioning. Many people discover they have early-stage alcoholic liver failure by chance through testing like blood tests or X-rays.

Stage 1: Steatotic (Fatty) Liver Disease

Drinking a large amount of alcohol can lead to a build-up of fats in the liver and can stop it from functioning properly, even from drinking for just a few days. At this stage, the liver is inflamed and tender.

Unlike nonalcoholic fatty liver disease, liver cells degenerate faster with alcoholic fatty liver disease. People with stage 1 alcohol liver disease or alcoholic steatosis may not experience any symptoms. It’s not until the next stage that problems often begin for individuals who engage in binge drinking.

Common symptoms of stage 1 alcoholic liver disease or steatotic (fatty) liver disease include:

  • Often has no symptoms
  • Tiredness and weakness
  • Unexplained weight loss
  • Enlarged liver due to build-up of fat inside liver cells
  • Upper abdomen discomfort on the right side

Stage 2: Acute Alcoholic Hepatitis

Alcoholic hepatitis is the acute inflammation of the liver, leading to the death of liver cells and permanent scarring if left untreated. At this stage, symptoms will be noticeable and may be worse if the individual has pre-existing liver conditions such as hepatitis C or hepatitis B.

Severe alcoholic hepatitis can be life-threatening without treatment. If scarring builds up, the liver’s blood flow is disrupted and forces the healthy parts that remain to work harder. The risk of liver failure only worsens at this stage.

Common symptoms of stage 2 alcoholic liver disease or acute alcoholic hepatitis include:

  • Nausea and vomiting
  • Loss of appetite
  • Malnutrition
  • Steatohepatitis lesions
  • Stomach pain
  • Confusion
  • Yellowing of the skin and eyes (jaundice)
  • Risk of viral hepatitis
  • Alcoholic cirrhosis
  • Liver failure

Stage 3: Cirrhosis

Cirrhosis refers to permanent scar tissue on the liver, causing poor liver function and eventual failure if not treated. At this stage, there is less healthy liver tissue available to filter toxins from the blood, and the liver won’t work well or work at all.

If the patient reaches end-stage liver failure, a liver transplant is the only treatment available to avoid likely death.

Common symptoms of stage 2 alcoholic liver disease or acute alcoholic hepatitis include:

  • Extreme weight loss
  • High blood pressure
  • Increased infections
  • Reduced blood flow through the liver (portal hypertension)
  • Spleen enlargement
  • Lung problems
  • Bleeding in the gastrointestinal tract
  • Hepatic fibrosis (excessive connective tissue due to liver injury)
  • Enlarged veins in the esophagus (esophageal varices)
  • Fluid build-up in the belly (ascites)
  • Hepatic encephalopathy (loss of brain function from the liver’s inability to filter toxins from blood)
  • Liver cancer (hepatocellular carcinoma)
  • End-stage liver disease and failure
  • Kidney failure

Causes and Risk Factors of Alcoholic Liver Disease

Aside from heavy and prolonged alcohol abuse, there are a few notable risk factors for developing alcoholic liver disease. The condition tends to be most common in individuals between 40 and 50 years old.

In addition, alcoholic liver disease is more likely in men. However, women may be more vulnerable to the effects of alcohol use and can develop the disease with less alcohol consumption than men.

Other risk factors for developing alcoholic liver disease include:

  • Obesity
  • Pre-existing liver conditions, such as hepatitis C
  • Family history of liver disease and/or alcohol addiction

Diagnosis and Treatment for Alcoholic Liver Disease

Diagnosing liver disease is fairly straightforward. Although many don’t notice the symptoms of the first stage of alcoholic liver disease, standard testing can detect issues with the liver.

Treating liver disease, however, can be more complicated and will depend on the severity of your liver’s condition. Other health conditions can also add complications to your symptoms and treatment plan.

How Is Alcoholic Liver Disease Diagnosed?

While early stages of liver disease are often detected by accident through testing for other reasons, there are several test methods to diagnose liver disease. Testing methods range from as simple as blood tests to as invasive as a liver biopsy.

Other methods of testing for alcoholic liver disease include:

  • Complete health history and physical exam
  • Liver function tests (measures enzyme and protein levels in blood)
  • Ultrasound
  • CT scan
  • MRI
  • Liver biopsy

What Treatment Options Are Available for Alcoholic Liver Disease?

Earlier stages of alcoholic liver disease are treatable if caught before severe damage occurs. However, treatment can vary depending on what stage the individual is in.

Regardless of the stage of liver disease, stopping alcohol intake is the first step in treatment. For individuals with alcohol addiction, this may also include an addiction treatment program as well.

Common treatments for alcoholic liver disease include:

  • Avoiding salty foods
  • Addiction treatment, including medical detoxification if needed
  • Anti-inflammatory medicines
  • Antibiotics and probiotics
  • Corticosteroid therapy
  • Experimental treatments through clinical trials
  • Liver transplant
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You Aren’t Alone—Find Help for Alcoholic Liver Disease

When seeking help for liver disease due to drinking alcohol, you or a loved one must be honest with your healthcare provider about how often you abuse alcoholic beverages.

While addressing your liver condition, your doctor may also refer you to addiction treatment to ensure you’re able to stop drinking and avoid further damage to your liver. Withdrawal symptoms can be severe, especially for heavy drinkers, so medical detox may be necessary to keep you safe.

Talk to your doctor about your drinking issues and see what treatment option is best for your situation. You can also try SAMHSA’s online treatment locator or call 1-800-662-4357 (HELP) to learn what treatment options are available where you live.

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FAQs About Alcoholic Liver Disease

How long can you live with alcoholic liver disease?

It depends on how severe your liver disease is. For individuals with fatty liver disease, they may not experience symptoms and, as long as their liver doesn’t worsen, can live a relatively normal life. However, as scarring on the liver worsens, the liver will struggle to function normally.

In severe cases of liver disease like cirrhosis or end-stage liver failure, extreme treatment might be necessary to stay alive. A liver transplant is often the last resort, and many patients die waiting for a suitable organ donor.

What are the first signs of liver damage from alcohol?

Common first signs of liver damage from alcohol include:

  • Weight loss
  • Fatigue and weakness
  • Discomfort on the right side of the upper abdomen
  • Enlarged liver due to build-up of fat inside liver cells

Who is at risk for fatty liver disease?

In general, anyone who abuses alcohol regularly and engages in binge drinking is at risk for developing alcoholic fatty liver disease. However, not all who abuse alcohol will develop the condition.

Other risk factors for developing alcoholic liver disease include:

  • Family history of liver disease and/or alcohol abuse problems
  • Obesity
  • Pre-existing liver conditions

Can your liver heal from alcohol damage?

In some cases, yes. Stage 1 liver disease or fatty liver disease is usually reversible by cessation of alcohol consumption, diet changes, and medication. For acute alcoholic hepatitis, some of the damage can be reversed through treatment.

Upon reaching stage 3 or cirrhosis (scarring of the liver), the damage is much harder to reverse. While some patients with cirrhosis can partially recover damaged tissue, many will have to live with the damage.

For individuals with liver failure, there is no reversing the damage. These individuals will deal with liver dysfunction for the rest of their lives depending on whether they commit to the necessary changes and treatments to improve the liver function that remains.

Is alcoholic liver disease fatal?

It can be. For people with severe cirrhosis, the damage to the liver tissue prevents the liver from properly removing toxins from the blood. End-stage liver failure is typically fatal without a liver transplant, but some patients cannot live long enough to receive a new organ.

Kent S. Hoffman, D.O. is a founder of Addiction HelpReviewed by:Kent S. Hoffman, D.O.

Chief Medical Officer & Co-Founder

  • Fact-Checked
  • Editor

Kent S. Hoffman, D.O. has been an expert in addiction medicine for more than 15 years. In addition to managing a successful family medical practice, Dr. Hoffman is board certified in addiction medicine by the American Osteopathic Academy of Addiction Medicine (AOAAM). Dr. Hoffman has successfully treated hundreds of patients battling addiction. Dr. Hoffman is the Co-Founder and Chief Medical Officer of AddictionHelp.com and ensures the website’s medical content and messaging quality.

Jessica Miller is the Content Manager of Addiction HelpWritten by:

Editorial Director

Jessica Miller is the Editorial Director of Addiction Help. Jessica graduated from the University of South Florida (USF) with an English degree and combines her writing expertise and passion for helping others to deliver reliable information to those impacted by addiction. Informed by her personal journey to recovery and support of loved ones in sobriety, Jessica's empathetic and authentic approach resonates deeply with the Addiction Help community.

  1. Alcohol-Associated Liver Disease. Johns Hopkins Medicine. (2023, November 21). https://www.hopkinsmedicine.org/health/conditions-and-diseases/alcoholinduced-liver-disease
  2. Cabezas, J. (2022, April 25). Management of Alcohol-Related Liver Disease and Its Complications. SpringerLink. https://link.springer.com/article/10.1007/s40261-022-01143-9
  3. Liver Disease Diets: Fatty Liver Diet and More. American Liver Foundation. (2024, January 18). https://liverfoundation.org/health-and-wellness/healthy-lifestyle/liver-disease-diets/
  4. Osna, N. A., Donohue, T. M., & Kharbanda, K. K. (2017). Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Research: Current Reviews. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513682/
  5. Patel, R., & Mueller, M. (2023, July 13). Alcoholic Liver Disease. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK546632/
  6. Phillips, M. M. (2023, August 7). Alcoholic Liver Disease. MedlinePlus. https://medlineplus.gov/ency/article/000281.htm
  7. The Stages of Liver Disease. American Liver Foundation. (2023, August 4). https://liverfoundation.org/about-your-liver/how-liver-diseases-progress/

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