The liver is a manufacturing powerhouse.

• It makes and distributes proteins that do vital things like fight off illness, prevent infection and make sure your blood clots correctly.
• It directs cholesterol and hormones to the rest of your body.
• It stores glycogen (energy), vitamins and minerals.

The liver, which is made up of two lobes, can also regenerate. For example, if someone donates a portion, or lobe, of their liver to someone else, the donated liver can grow to up to 85% of its original size in the recipient.

“The liver is an amazing organ with a tremendous ability to recover,” says Northwestern Medicine Hepatologist Justin R. Boike, MD. “However, you can’t live without a liver and you can’t live with liver failure. There is not a machine like the dialysis machine for people with kidney failure that can replace the function of the liver.”

Alcohol and the Liver

No matter how much alcohol you consume, your liver can only process so much of it. That amount varies from individual to individual.

Alcohol is directly toxic to the liver, but so are the byproducts of alcohol metabolism. When your liver metabolizes, or breaks down, alcohol, it creates a chemical called acetaldehyde.

Acetaldehyde:

• Makes your face feel flushed while drinking alcohol
• Is part of what makes you feel unwell or hungover after drinking alcohol
• Damages your DNA and doesn’t allow your body to repair the damage, which is why at least six cancers are linked to alcohol consumption

Short-Term Damage to the Liver From Excess Alcohol Consumption

The liver can handle only so much alcohol consumption while still functioning properly, but after a short period of excessive alcohol consumption, your liver can reach what Dr. Boike calls “the tipping point.”

At this “tipping point,” your liver can develop acute alcohol-related hepatitis. This condition:

• Typically arises after a period of heavy binge drinking (about more than 12 drinks per day for a few weeks or months)
• Causes your liver to swell and become tender
• Starts to kill your liver cells
• Has a very high mortality rate of greater than 50%, according to Dr. Boike
• Is common in people in their 30s or 40s

Symptoms of acute alcohol-related hepatitis include:

• Jaundice (yellow skin and eyes)
• Ascites (buildup of fluid in the abdomen)
• Confusion due to the buildup of toxins in your body
• When not processed by your liver, chemicals like ammonia can cause reduced cognitive function
• Fever as your body tries to fight what it thinks is an infection in your liver

Dr. Boike says that he’s seen a huge spike of patients with acute alcohol-related hepatitis during the COVID-19 pandemic, as alcohol consumption increased by nearly 40% during the pandemic.

“Patients with acute alcohol-related hepatitis have a 100% chance of death if they continue drinking alcohol,” says Dr. Boike. “However, if patients abstain from alcohol use, some livers can recover to normal function after several months of sobriety.”

Long-Term Damage to the Liver From Excess Alcohol Consumption

Over years of regular and excessive drinking, sustained damage to the liver from alcohol can cause liver cancer, alcohol-associated liver disease and cirrhosis.

Liver cancer often has no signs or symptoms until it reaches an advanced stage.

Alcohol-associated liver disease is the progressive decline of liver function due to inflammation and destruction of the liver cells because of alcohol use. Alcohol-associated liver disease can lead to cirrhosis or scarring of the liver, which occurs when the liver cells are injured repeatedly and try to regenerate.

Alcohol-associated liver disease:

• Is more typical in someone who has slowly and repetitively damaged their liver by drinking frequently over the course of decades. 
• Has similar symptoms to acute alcohol-related hepatitis, including:
• Jaundice
• Ascites (buildup of fluid in the abdomen)
• Long-term cognitive decline due to high levels of ammonia in their body over the course of many years

“For people with alcohol-associated liver disease and cirrhosis, it’s paramount that they do not consume any alcohol,” says Dr. Boike. “There is no safe amount of alcohol for them to consume.”

Adding Addictions Medicine Into the Mix

Treating the liver for diseases caused by alcohol is often inseparable from treating an underlying addiction to alcohol. People who require treatment for alcohol-related liver diseases may be referred to an addiction medicine specialist to be assessed for an alcohol use disorder. Mental health counseling is also important because increased alcohol intake may often be in response to underlying mental health issues like increased stress, depression or anxiety.

Many people with alcohol-related liver diseases may benefit from a liver transplant, but to be considered, they need to recover from their alcohol use disorder and abstain from drinking alcohol.

“Even though they may have just had a near-death experience, with alcohol use, many people are quick to forget the pain and remember the pleasure of drinking,” says Northwestern Medicine Addiction Medicine Specialist Anthony March, DO. “That’s why our addictions medicine team partners so closely with the liver care team to make sure people with liver disease get connected to formalized treatment for alcohol use disorders.”

There are many options for treatment for alcohol use disorders, but there is no one-size-fits-all approach.

Treatment may include:

• Medication-assisted therapy to curb cravings or urges to drink alcohol
• Joining a support group like Alcoholics Anonymous (AA)
• Counseling and cognitive behavioral therapy
• In-patient therapy programs
• Out-patient therapy programs

“Dr. March and I have done research showing that people who have insight into their alcohol use disorder — people who acknowledge that they have a drinking problem — have better post-liver transplant success than those who remain sober, but never completely recognized that their drinking was a problem,” says Dr. Boike.

“It can take many years to formally address and treat an alcohol use disorder, and often times we have to continue to plant seeds in the patient’s head and hope that they grow into the patient wanting to get healthy someday,” says Dr. March.  

Drink in Moderation

The Centers for Disease Control and Prevention (CDC) recommends drinking in moderation to reduce the short- and long-term health risks associated with alcohol.

Recommendations for Moderate Drinking Habits

For women: one drink or less per day, totaling no more than 7 drinks per week.

For men: two drinks per day, totaling no more than 14 drinks per week.