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Alcohol Abuse and the Effects On the Liver

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Alcohol abuse can severely tax the liver and, as liver damage progresses, can lead to complications like brain damage or death.1 The liver is one of the most important organs in the body, playing more than 500 crucial roles, such as aiding in detoxification and assisting with nutrient creation and absorption.2 People who abuse alcohol are not only at a higher risk of incurring liver damage, they may have a higher risk of death due to liver disease. Around 2 million Americans suffer from liver disease caused by alcohol abuse.3 Alcohol detox programs can help you become clean and sober, which can prevent further injury to your liver and help you take charge of your health and overall well-being.

What Does the Liver Do?

The liver is the largest organ in your body, weighing around 3 pounds in adults. Located in the upper right part of your abdomen, the liver is important for a number of bodily processes, such as fat, carbohydrate, and protein metabolism and alcohol detoxification.3,4 Some of the crucial processes handled by the liver include:2,4

  • Making bile, which aids in waste elimination and fat break-down.
  • Production of cholesterol and certain proteins to move fats through your body.
  • Amino acid regulation.
  • Conversion of excess glucose (blood sugar) into glycogen, which is stored for energy.
  • Storage of vitamins and minerals, such as copper and iron.
  • Changing ammonia, a harmful byproduct of protein metabolism, into urea, which eventually passes out of your body in the form of urine.
  • Production of certain blood proteins which help to maintain a healthy fluid balance throughout the body.
  • Regulation of blood clotting.
  • Metabolism of harmful substances, including alcohol.

The liver is made up of 2 main lobes, which are comprised of smaller regions of liver cells known as lobules. Lobules connect to small tubes—or ducts—which combine with larger ducts to form the common hepatic duct. The hepatic duct shuttles bile made by certain live cells to the gallbladder and into the digestive system through yet another pathway known as the common bile duct. Oxygen-rich blood flows to the liver from the hepatic artery (which distributes blood to the liver, gallbladder, and pancreas), while blood containing nutrients, medications, and toxic substances (like alcohol) enters the liver from the hepatic portal vein.2,4 The liver then helps process these substances and either releases them back into your blood or sends them to your bowel to be excreted.4

Although the liver metabolizes most of the alcohol a person ingests, the very process of alcohol metabolism releases byproducts that are even more harmful to liver cells than alcohol. These toxins will, over time, lead to liver inflammation, liver tissue injury, and decreased immune system function.3 If your liver is consistently overwhelmed by excessive alcohol consumption, these effects can eventually develop into chronic, serious, and possibly fatal health problems.

Harmful Effects

Even just a few days of heavy drinking can take a serious toll on your liver, although the most severe and irreversible forms of liver damage take longer to develop.3 Prolonged alcohol abuse can compromise your liver function and eventually lead to a number of harmful effects and conditions. These conditions can occur when the liver is overwhelmed by chronic alcohol consumption, can no longer keep up with the body’s detoxification demands, and produces a buildup of fat in your liver.3

Chronic alcohol abuse can harm your liver and cause a number of negative consequences, such as:

  • Steatosis, or fatty liver: This condition results from the buildup of fat in your liver. It is the earliest and most common form of liver disease. It can occur even after just a few days of heavy alcohol consumption. Steatosis makes the liver’s job more difficult and can lead to serious inflammation if left unchecked.3 Most people do not experience symptoms from this condition and may not even be aware that there is a problem unless it progresses to alcoholic hepatitis.5
  • Alcoholic hepatitis: The term hepatitis means liver inflammation. Alcoholic hepatitis can range from mild to severe. Some people may not experience any symptoms from alcoholic hepatitis and they might only find out about the condition through tests that reveal elevated liver chemicals in the blood.5 However, some people may suffer from symptoms that include:3,5
    • Fever.
    • Nausea.
    • Loss of appetite.
    • Stomach pain.
    • Confusion.
    • Jaundice, or yellowing of skin or whites of eyes.

Alcohol hepatitis can develop into a chronic condition, which can cause serious liver damage over time. People who develop extremely severe cases of alcohol hepatitis may go on to experience liver failure.

  • Alcoholic cirrhosis: This is a progressive disease that does not often cause symptoms until the condition becomes severe, at which point you will experience symptoms similar to those that occur in alcoholic hepatitis.5 Alcoholic cirrhosis causes scarring of the liver tissue. Scar tissue starts to replace healthy liver cells, which begin to die off and cannot regrow. When scar tissue builds up significantly, the liver can no longer function normally.5 Scar tissue interferes with the transport of blood to the liver, which may mean that your liver can no longer effectively detoxify your body from alcohol, prevent infection management, or help with nutrient absorption.3 Left unchecked, alcoholic cirrhosis will progress to fatal liver disease. 1 out of 10 heavy drinkers develop alcoholic cirrhosis.5

Complications of Liver Damage

A number of different complications can develop in association with alcoholic liver disease, including:

  • Portal hypertension and varices: Portal hypertension is a sever complication that can occur due to alcoholic cirrhosis or, in some cases, alcoholic hepatitis. Liver scarring can make it more difficult for blood to circulate through your liver, leading to increased blood pressure (hypertension) in your intestines. Because the blood must find a way to recirculate to your heart, it creates varices, which are new blood vessels located in your stomach or esophagus. If your blood pressure continues to elevate, the varices may be unable to cope and can bleed, causing anemia or blood in your stool.6
  • Ascites: People who have cirrhosis, portal hypertension, and decreased serum albumin levels may develop this condition, which causes fluid accumulation in the abdomen. This can cause swelling of your abdominal area, appetite loss, and shortness of breath.7
  • Liver cancer: Cirrhosis is one of the most common causes of liver cancer. People do not often experience symptoms of liver cancer until it has progressed to a very severe state. Symptoms can include:8
    • Weight loss.
    • Appetite loss.
    • Feeling full after eating, even if you have not eaten a lot.
    • Vomiting.
    • Abdominal pain and swelling.
    • Jaundice—yellowing of the whites of your eyes and skin.
    • Itchy skin.
    • Feeling fatigued and weak.
  • Hepatic encephalopathy: This is a very serious and, in some cases, deadly brain disorder that can result from cirrhosis and other forms of liver damage. It causes a number of symptoms, such as:1
    • Abnormalities in personality, mood, and sleep patterns.
    • Asterixis, which is a telltale sign of advanced liver disease that manifests as a flapping or beating movement of the hands when palms are extended outward.
    • Cognitive changes, like decreased attention span.
    • Problems with coordination.
    • Anxiety and depression.
    • Coma, which may be fatal.

Alcohol Detox Symptoms & Treatment

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “alcohol withdrawal is underrecognized and undertreated.”9 Detox and treatment are crucial to help manage withdrawal symptoms and to help overcome alcohol addiction. People who abuse alcohol can suffer from a range of mild to severe withdrawal symptoms when they stop drinking. They may require professional detox to help them through this difficult and potentially fatal period and to ensure that they do not relapse.

Symptoms of alcohol withdrawal can include:9

  • Poor appetite, nausea, and/or vomiting.
  • Autonomic hyperactivity, which can result in tremor, increased heart rate, and/or heightened blood pressure.
  • Elevated body temperature.
  • Impaired concentration, judgment, and memory.
  • Restlessness or anxiety.
  • Insomnia, nightmares, or intense dreams.
  • Delusions.
  • Visual, tactile, or auditory hallucinations.
  • Delirium.
  • Grand mal seizures.

Detox is a process in which toxins are eliminated from your body after you stop drinking. In a professional detox program, you receive assistance and support to help you stay as comfortable and safe as possible during the withdrawal process. A medical detox program provides supportive medications and care from qualified medical staff to help minimize and alleviate withdrawal symptoms and manage complications, should they arise. Detox can also occur in non-medical settings, where it is also referred to as social detox, although this is not recommended for alcohol withdrawal due to the risk of potential seizures.9 A hospital or some other form of 24-hour medical detox treatment is the recommended standard of care for the management of alcohol withdrawal.9

Medical detox programs may use the following medications:9

  • Benzodiazepines, to minimize withdrawal symptoms, and decrease the risk of dangerous complications, such as severe agitation and seizures.
  • Carbamazepine, which is an anticonvulsant that has been proven effective in managing wild to moderate alcohol withdrawal.
  • Clonidine, which is an alpha adrenergic agonist that can treat autonomic hyperactivity symptoms, such as rapid heartbeat and high blood pressure.
  • Antipsychotics, which can manage delusions, delirium, hallucinations, and agitation.

It’s important to note that relapse is very common. If you want the best possible treatment outcome, detox alone will not suffice in rectifying maladaptive drinking patterns. Many detox treatment teams create follow-up plans for patients, in which they enter an alcohol abuse treatment program. Addiction treatment programs equip you with the coping skills you need to maintain sobriety.

Sources

  1. National Institute on Alcoholism and Alcohol Abuse. (2004). Alcohol Alert: Alcohol’s Damaging Effects on the Brain.
  2. Johns Hopkins Medicine. (N.D.). Liver: Anatomy and Functions.
  3. National Institute on Alcoholism and Alcohol Abuse. (2010). Beyond Hangovers: Effects on the Liver.
  4. U.S. National Library of Medicine. (2016). How Does the Liver Work?
  5. Tidy, C., Patient.info. (2017). Alcohol and Liver Disease.
  6. NHS Choices. (2015). Alcohol-Related Liver Disease.
  7. Herrine, S.K. & Kimmel, S., MSD Manual. (N.D.). Ascites.
  8. NHS Choices. (2016). Liver Cancer.
  9. Center for Substance Abuse Treatment. (2006). Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment.
  10. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  11. U.S. National Library of Medicine. (2017). Alcohol Withdrawal.

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