Yes, Some Liver Damage Is Reversible: A Look at Alcoholic Hepatitis

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In a study of nearly 160,000 hospital admissions for liver disease, more than 18% of the primary diagnosis is alcoholic hepatitis. When left untreated, alcoholic hepatitis can progress to alcohol-related cirrhosis, which is a more advanced stage of chronic liver disease. Alcohol-related cirrhosis accounts for more than 83% of hospital admissions. Cirrhosis can cause damage to the liver that may be irreversible for some people.¹

What Does Your Liver Do?

The liver plays a role in the functioning of all other organ systems. Just a few of the necessary tasks performed by the liver include that it:²

• Aids in digestion and metabolism
• Produces bile, which is critical to digestion
• Stores vitamins like iron and copper
• Produces proteins essential to reproduction
• Metabolizes bilirubin, which regulates how waste passes through the body
• Helps the thyroid function
• Handles cholesterol stability
• Supports immunity and detoxification

Because alcohol is processed in the liver, many functions of the liver can be impacted by alcohol misuse. Someone who consumes large amounts of alcohol for extended periods may damage their liver.

What Does Liver Disease Look Like?

The liver doesn’t become damaged or fail overnight. Liver damage progresses through stages based on how much liver damage exists.³

Stage 1: Fatty Liver Disease

Fatty liver, or steatosis, refers to an enlarged liver caused by consuming too much alcohol. Alcohol misuse is not the only cause of fatty liver disease. Insulin resistance, hyperglycemia, and high levels of fats in the blood can contribute.

Fatty liver is reversible, usually through abstinence from alcohol and lifestyle changes overseen by a registered dietician or nutritionist.

Stage 2: Alcoholic Hepatitis

In the alcoholic hepatitis stage, your liver has incurred damage due to heavy alcohol misuse. Similar damage can be caused by certain types of malnutrition.

In alcoholic hepatitis, inflammation is present and creates uncomfortable symptoms, such as:

• Nausea or vomiting
• Changes in appetite
• Fatigue or physical weakness
• Pain, including tenderness of the stomach
• Low fever

Abstaining from alcohol can improve symptoms. However, there is no guarantee that every patient will heal from alcoholic hepatitis symptoms even with treatment.

Stage 3: Alcoholic Cirrhosis

In about 10% of people with alcohol addiction, scar tissue begins to replace normal liver tissues. This process is called cirrhosis of the liver due to alcohol misuse. Cirrhosis can affect your quality of life and eventually may become life-threatening, including increasing the risk of liver cancer. Cirrhosis can present with:

• Fatigue or physical weakness
• Weight loss, potentially related to lack of appetite
• Jaundice, or skin yellowing
• Gastrointestinal bleeding
• Abdominal swelling
• Confusion

The damage of cirrhosis is not reversible, but can be treated. Abstinence is a requirement of stopping the progression of alcohol-related cirrhosis.

What Is Alcoholic Hepatitis?

When you consume alcohol, a physiological process breaks down alcohol in the body. The liver is the primary organ responsible for metabolizing alcohol. The liver can eliminate approximately one standard alcoholic drink per hour.

However, many people self-report drinking more than that, which may make it difficult for the liver to keep up with metabolization. Alcohol can also leave behind toxic byproducts that contribute to liver damage.⁴

Hepatitis is inflammation of the liver that occurs when liver tissues are damaged. Drinking large amounts of alcohol causes swelling and inflammation in the body and can hinder how the liver functions. Alcoholic hepatitis can be acute, meaning it is sudden and goes away with treatment or after a period of sobriety.

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However, chronic alcoholic hepatitis can occur when an individual uses alcohol heavily over time or has alcohol addiction. If chronic, alcohol hepatitis is more likely to develop into cirrhosis or liver cancer.⁵

Heavy and long-term alcohol misuse can lead to liver decompensation, a clear sign of alcoholic hepatitis. Alcoholic hepatitis symptoms can include:⁶

• Jaundice
• Infections
• Esophageal bleeding, or bleeding of the throat
• Ascites, or fluid collecting in the abdomen
• Elevated bilirubin or other toxins that may affect how waste is eliminated in the body
• Nausea or vomiting
• Malaise
• Fever
• Abdominal pain
• Malnutrition related to decreased appetite
• Hepatic encephalopathy, or a brain condition related to poor liver function
• Systemic inflammatory response syndrome
• Liver failure

Individuals with alcoholic hepatitis are also at increased risk of developing an eating disorder due to the decrease in appetite the condition can cause. Individuals with alcoholic hepatitis may eat less food, fewer meals, or eliminate certain types of food. This may develop into disordered eating patterns or meet the clinical criteria for an eating disorder with restrictive behaviors, such as anorexia nervosa, bulimia nervosa, or other specified feeding or eating disorder (OSFED).

If you have these alcoholic hepatitis symptoms, your doctor may perform several diagnostic tests to confirm the cause of your symptoms. These tests may include chest X-rays, blood cultures, urinalysis, and abdominal imaging. Liver biopsy and doppler ultrasounds may be used for further assessment.

Once diagnosed, the severity of the damage to your liver will be evaluated using multiple scoring systems. Your results help with the develop a treatment plan and help your doctor determine your prognosis.⁶

How Is Alcohol Addiction Related to Alcoholic Hepatitis?

The diagnosis process for alcoholic hepatitis must also include an assessment to determine your level of alcohol use or misuse and whether you have alcohol addiction. A mental health professional assesses you for the official mental health diagnosis for addiction to alcohol: alcohol use disorder (AUD).

The evaluation uses self-reporting and substance use assessments. Be as accurate as you can.

You can expect to be asked how much alcohol you consume in a day, week, or month. You will also be asked if misusing alcohol interferes with personal, professional, or social goals and responsibilities. ⁷

Information like this helps your doctor assess your health accurately. The goal is to see if you also need alcohol addiction treatment alongside treatment for alcoholic hepatitis.

Who Can Get These Conditions?

Not everyone who misuses alcohol will develop alcoholic hepatitis or any liver disease, just as not everyone who misuses alcohol becomes addicted. Certain key factors are considered to come into play.

Family History

There is a demonstrated link between a family history of substance misuse and an increase in an individual’s relative risk of developing issues with substance misuse or addiction. While there is no indication that there is an “addiction gene,” researchers believe that this connection is partly due to traits that can be inherited.

However, studies also indicate that learned behaviors—such as watching adults in one’s home of origin misuse substances—are part of an individual’s risk for developing an addiction.⁹  Treatment often includes addressing the “family disease” of addiction.

Sex

Based on a 2002 study, men were considered 3 times more likely than women to develop alcohol addiction. In a repeat study in 2013, men were considered 2 times more likely. The studies could not determine the reason for this correlation between gender and an increased risk of addiction.⁸

On the other hand, research points to women being at risk for faster liver disease progression than men. Additionally, less liver healing has been observed in women after they begin abstaining from alcohol. This is speculated to be linked to differences in hormone activity, including lower gastric alcohol dehydrogenase (ADH) and higher estrogen.⁸

Drinking Patterns

The amount of alcohol you consume and how often you consume it has a significant effect on your liver. For example, someone who binge drinks multiple times a week is more likely to experience liver dysfunction than someone who has one standard serving of wine each night with dinner.⁸ For the average adult, four or more drinks for a woman or five or more drinks for a man in the span of two hours qualifies as binge drinking.

Heavy or long-term alcohol use has also been shown to increase the risk of alcohol addiction.

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Medical and Mental Health Conditions

Certain medical conditions are linked to a higher rate or faster progression of liver disease. If you have hepatitis C, any alcohol use can increase your likelihood of developing alcoholic hepatitis.

Research does not indicate that obesity causes alcoholic hepatitis. However, some studies show a link between a higher body mass index (BMI) and risk of alcohol-related liver disease. A health survey conducted between 1997 and 2001 indicated that individuals with higher BMIs tended overall to consume more alcohol.⁸

In a 2010 study, 44.5% of the patients with alcohol-related liver disease studied were considered obese. A 2009 study also suggests that alcohol-induced liver injury may occur more easily in individuals with a higher BMI than in those with a lower BMI, due to associated changes in liver enzymes. ⁸ Because these connections have been drawn between weight and alcohol use, as well as alcohol-related liver disease, many doctors consider obesity a risk factor for alcohol addiction and liver damage.

Other medical conditions, such as chronic pain, that cause persistent symptoms that may be partially alleviated through substance use are also considered a potential contributing factor, especially if the condition is undiagnosed or is not adequately treated.

Mental health symptoms and conditions—including undiagnosed mental health conditions—are also considered a risk factor for alcohol addiction. About half of people with addiction also have another mental health condition, such as depression, attention deficit hyperactivity disorder (ADHD), anxiety, or post-traumatic stress disorder (PTSD).

Substance Exposure

Early exposure to substances is a risk factor for substance misuse or addiction. One study reports that in a group of individuals over 26, those who used alcohol for the first time before age 15 were more than 5 times more likely to have a diagnosed alcohol addiction.⁹

Behavior modeling can occur in your home, your school, your friend group, your workplace, or even in the media and social media you use. Access to substances and exposure to others using substances is connected to an increased likelihood that an individual will use substances recreationally or chronically. ⁹

Personal History

In many cases, a pattern of substance misuse develops as a coping mechanism. For many individuals, this coping mechanism may take shape to help them deal with a trauma. This trauma can include “Big T” traumas, such as active-duty combat or natural disasters, as well as “little t” traumas, such as repeated instances of childhood neglect. Some individuals may also develop post-traumatic stress disorder (PTSD), which has a high co-occurrence rate with alcohol addiction. ⁹

A history of substance use may also increase the risk that you may use substances again.

For individuals in this situation, finding new coping mechanisms is often a critical step in recovering and empowering the abstinence required to stop and recover from alcohol-related liver disease. Therapy for trauma, such as exposure therapy, may also be part of a relapse prevention plan.

Are Other Diseases Associated With Alcoholic Hepatitis?

Having alcoholic hepatitis symptoms makes you vulnerable to contracting other infections and diseases because your immune system is weakened by the damage. Examples of conditions commonly associated with alcoholic hepatitis include:¹⁰

• Urinary tract infections (UTIs)
• Bacterial peritonitis, or an infection of fluid in your abdomen
• Bacterial pneumonia
• Sepsis, or blood poisoning caused by bacteria
• Lung abscess, or pockets in the lungs caused by microbial infection
• Alcoholic gastritis, or inflammation of the stomach lining
• Alcoholic pancreatitis, or inflammation of the pancreas
• Alcoholic neuropathy, or nerve damage
• Alcoholic cardiomyopathy, or alcohol-related heart disease
• Diabetes
• Cancer, especially of the liver

How Do Doctors Treat Alcoholic Hepatitis?

Initial alcoholic hepatitis treatment may include diuretics or water pills to eliminate excess fluid from your body. Your doctor may also prescribe antibiotics. Other treatments include:¹¹

• Corticosteroids to reduce inflammation
• Vitamins and minerals to replenish lost nutrients
• Treatment for alcohol use disorder

There are several types of medication commonly used to manage alcohol withdrawal symptoms and assist with maintaining abstinence. Examples include:¹¹

• Acamprosate
• Naltrexone
• Disulfiram
• Baclofen

Medications like these work in varying ways to reduce cravings for alcohol or make you sick if you drink while taking medicine.¹²

Your doctor may also recommend lifestyle changes, such as smoking cessation, moderate exercise, and dietary changes. Researchers have created dietary guidelines to prevent further liver damage and, for some, reverse damages caused by misusing alcohol. A few examples of the guidelines you can start implementing include:¹³

• Eat smaller meals throughout the day rather than three big meals.
• Eat around 60% carbohydrates—such as cereals, fruits, and vegetables—to maintain your energy levels.
• Eat around 15% proteins for energy, including lean meats, skim milk, and eggs.
• Eat lower levels of fat and salt.
• Avoid alcohol.

You can begin alcoholic hepatitis treatment as soon as you receive a diagnosis. Whether you need medical help for detoxing from alcohol, nutrition therapy, or education on beneficial lifestyle changes to heal your liver and recover from addiction, speak to your doctor.

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Resources

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2. Kalra, A., Yetiskul, E., Wehrle, C.J., Werhle, C.J. & Tuma, F. (2021). Physiology, Liver. Treasure Island (FL): StatPearls Publishing.
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4. National Institutes of Health. (2007). Information about Alcohol. Biological Sciences Curriculum Study. Bethesda (MD): National Institutes of Health (US).
5. S. National Library of Medicine. (2021). Hepatitis. MedlinePlus.
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9. National Institute on Alcohol Abuse and Alcoholism. (2020). Understanding Alcohol Use Disorder.
10. Basra, G., Basra, S. & Parupudi, S. (2011, May 27). Symptoms and signs of acute alcoholic hepatitis. World Journal of Hepatology, 3(5), 118-120.
11. Chayanupatkul, M. & Liangpunsakul, S. (2014). Alcoholic Hepatitis: A comprehensive review of pathogenesis and treatment. World Journal of Gastroenterology, 20(20), 6279–6286.
12. Vuittonet, C. L., Halse, M., Leggio, L., Fricchione, S. B., Brickley, M., Haass-Koffler, C. L., Tavares, T., Swift, R. M. & Kenna, G. A. (2014). Pharmacotherapy for alcoholic patients with alcoholic liver disease. American Journal of Health-System Pharmacy, 71(15), 1265–1276.
13. Hajdarevic, B., Vehabovic, I., Catic, T. & Masic, I. (2020). The Role of Diet Therapy in the Treatment of Liver Disease. Material Socio-Medica, 32(3), 200–206.