How does alcohol affect the liver?

Alcoholic liver disease is liver damage caused by drinking too much alcohol over many years. Find out about its symptoms, causes and treatment. 

What is alcoholic liver disease?

Who is more likely to get alcoholic liver disease?

Alcoholic liver disease stages

Alcoholic liver disease symptoms

When to see a doctor about alcoholic liver disease

How is alcoholic liver disease diagnosed?

How stopping drinking can tackle alcoholic liver disease

What are the medical treatments for alcoholic liver disease?

If you regularly drink a lot, it can lead to alcoholic liver disease. And women are more at risk, as they absorb more alcohol than men – just 8 drinks a week counts as ‘heavy drinking’ if you’re female. Find out about the early signs of liver damage from alcohol, diagnosis and treatments, plus how to minimize your risk.

## What is alcoholic liver disease?

Also known as alcohol-related liver disease (ARLD), alcoholic liver disease is liver damage caused by drinking too much alcohol. 

Your liver’s job is to break down and remove toxins from your body, including alcohol. But having to process high levels of alcohol over time can create problems for your liver: making it fatty, and causing inflammation and scarring that stop it working properly. 

Your liver can renew itself by forming new cells when it needs to. But drinking too much alcohol over many years can stop this process, and can lead to permanent liver damage.

“Damage to your liver from alcohol goes through several stages,” explains Dr Ann Nainan, family doctor and Healthily expert. “And if you catch it early, it’s easier to treat.”

Watch this video from [Mayo clinic](https://www.youtube.com/embed/5PxuOL2pXFk) to learn more about alcoholic liver disease.

### How long does alcohol stay in your liver? 

Generally speaking, your liver breaks down alcohol at a rate of about 1 standard drink per hour.

But this can vary depending on various things, including your sex, age, weight, and how much food you’ve eaten.

Here’s what happens when you drink alcohol:

- alcohol is absorbed into your bloodstream through the lining of your stomach and small intestine
- from here, it quickly travels to every part of your body
- it reaches your brain first – after about 5 minutes – then your kidneys, lungs and liver
- after about 20 minutes, you liver starts processing the alcohol, at a rate of about 1oz an hour 
- it takes about 5 and a half hours for a blood alcohol level of 0.08% to be cleared from your body – which is the legal limit for driving in the US and most of the UK (Scotland is lower)


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## Who is more likely to get alcoholic liver disease?

“You’re more likely to get alcoholic liver disease the more alcohol you drink, and if you’ve drunk it for a long time and often above the recommended limits,” says Dr Ann. “But remember that this is a general trend – some people may get liver damage from drinking less alcohol, less often and for a shorter amount of time, or from one-off binges.” 

You’re more likely to get liver damage from alcohol if:

- you’re overweight or obese
- you already have a liver condition, such as [hepatitis C](/health-library/conditions/hepatitis-c)
- you have a family history – alcohol dependence and problems processing alcohol are often genetic
- you’re female – women are more at risk of harm from alcohol
- you’re regularly ‘binge drinking’ – having 4 or more drinks on 1 occasion (or 5 or more for men)

### Women and alcoholic liver disease 

In the past, some men were more likely to get alcoholic liver disease, because they tended to drink more heavily. 

But drinking – including binge drinking – is increasingly common among women. According to figures from the Center for Disease Control and Prevention (CDC): 

- nearly half of women say they’ve had alcohol in the past month
- more than 1 in 10 women say they binge drink – and a quarter of these women binge drink every week

### What it feels like to have alcoholic liver disease as a woman

After drinking every day for more than 10 years, Landree Sarata was 31 when she was diagnosed with alcoholic liver disease. She had no idea that as a woman she was more at risk. 

“I never expected the diagnosis,” Landree, now 37, of Quincy, Massachusetts, said in an interview with [Good Morning America](https://www.goodmorningamerica.com/wellness/story/alcohol-related-liver-disease-rise-young-women-amid-76772645). “I thought I just drank as much as everybody else did, and had fun like everybody else.” 

And because alcohol [affects women more than men](/self-care/women-and-alcohol/#effects-on-women), even small increases in drinking can lead to greater health risks – including alcoholic liver disease. 

A US study that looked at ARLD from 2009-2015 found that rates of alcohol-related liver injury in women increased by 50% during this period (compared with a 30% increase in men).

So it’s important to be aware of the risks. “Lots of people think a heavy drinker is someone who drinks until they black out every night – but this isn’t the case,” says Dr Ann. In fact, the CDC defines heavy drinking as 8 or more drinks a week if you’re a woman – that’s just over 1 a day. (It’s 15 a week if you’re a man.)

Read more about [women and alcohol](/self-care/women-and-alcohol), including reducing your health risks, and [alcohol and the menopause](/self-care/alcohol-menopause).

## Alcoholic liver disease stages

Alcohol can cause 3 types of [liver disease](/health-library/conditions/liver-disease), which happen in stages:

### Stage 1: alcoholic fatty liver disease

In this first and least serious stage, fat builds up in your liver, but it usually doesn’t cause any symptoms. It can be an important warning sign that you’re drinking too much. It’s usually reversible if you stop drinking alcohol.

### Stage 2: alcoholic hepatitis

If you continue drinking alcohol, your liver can become inflamed – this is known as [hepatitis](/health-library/conditions/hepatitis). At an early stage, the inflammation is mild, and may not cause any symptoms. It can often be reversed if you stop drinking at this stage. 

But if you carry on drinking and the inflammation progresses, it can cause serious liver damage and symptoms.

### Stage 3: cirrhosis 

The final stage of alcoholic liver disease is [cirrhosis](/health-library/conditions/cirrhosis). This is when a lot of your normal liver tissue is permanently replaced with a tough scar tissue – known as ‘[liver fibrosis](/health-library)’ – that stops your liver working properly. 

Your liver may shrink over time, leading to end-stage liver failure, where your liver stops working completely. 

Cirrhosis of the liver can’t be reversed. But if you stop drinking before it turns into end-stage liver failure, you may help avoid more damage to your liver.


## Alcoholic liver disease symptoms

The symptoms of alcoholic liver disease can vary according to the stage. If you have stage 1 (alcoholic fatty liver disease), you may get no symptoms. 

Early in stage 2 (mild alcoholic hepatitis), you may also have no symptoms. You might only find out you have it if blood tests show you have high levels of liver chemicals called ‘enzymes’ in your blood.

But as the condition progresses, symptoms tend to become more common. They can include:

- tummy swelling (ascites)
- swelling of your legs, ankles and feet ([edema](/health-library/conditions/oedema))
- yellowing of your skin and the whites of your eyes ([jaundice](/health-library/conditions/jaundice))
- itchy skin
- dark coloured pee
- light coloured and/or foul-smelling poop
- vomiting
- vomiting blood, or blood in your poop (this can look like black tar)
- losing a lot of weight without meaning to
- muscle weakness and wasting


## When to see a doctor about alcoholic liver disease

See a doctor as soon as possible if:

- you have any of the symptoms of alcoholic liver disease
- you think you’re drinking too much, or you’re having trouble cutting down
- other people have commented on your drinking habits 
- your mood and lifestyle is being affected by your drinking

Your doctor can do tests if necessary, and help you find ways to safely cut down on your drinking. If you drink a lot of alcohol, it’s important to not cut down suddenly without speaking to a doctor, because this can cause serious side effects.

In serious cases, liver disease can cause complications that are a medical emergency. Call an ambulance or go to the emergency department if:

- you feel confused or drowsy
- you have bad tummy pain and feel unwell, faint or dizzy
- you’re [vomiting blood](/health-library/symptoms/vomiting-blood) or something that looks like coffee grounds
- your poop looks bloody, or dark like tar 
- you’re bleeding from any part of your body and can’t stop the bleeding


## How is alcoholic liver disease diagnosed?

Because alcoholic liver disease doesn’t tend to cause symptoms early on, you may only discover you have it while having tests for something else.

But if you have symptoms, a doctor may suspect it based on your symptoms, a physical exam and your drinking habits. 

You may also need some tests, including:

- [blood tests](/health-library/medical-exams/blood-tests) – to check your liver function, and check other substances your liver normally makes, including those that help your blood clot
- scans such as [MRI](/health-library/medical-exams/mri-scan), [CT](/health-library/medical-exams/ct-scan) or [ultrasound](/health-library/medical-exams/ultrasound-scan) – to take a closer look at your liver
- a liver [biopsy](/health-library/treatments/biopsy) – to confirm the cause, type and severity of any liver damage

Your doctor may also want to check if your drinking habits could be a problem. They may give you a questionnaire to fill in.


## How stopping drinking can tackle alcoholic liver disease

Too much alcohol can damage your liver, but if you stop drinking alcohol, this allows your liver cells to regenerate and heal the liver. “However, drinking too much alcohol over many years affects the liver’s ability to heal itself, which may lead to permanent damage,” says Dr Ann.

If you have alcoholic liver disease, stopping drinking – with advice from a doctor – is the best treatment to slow down or even reverse liver damage.

You may find support groups helpful if you’re giving up alcohol. Speak to your doctor for advice about how to find and join these groups. 

Read more about [alcohol support](/health-library).

### Can you reverse liver damage? 

Reversing liver damage depends on the stage you’re at. If you have alcoholic fatty liver or early-stage alcoholic hepatitis, stopping drinking can help reverse the damage. 

But if you have later-stage alcoholic hepatitis or cirrhosis, some damage can’t be reversed. Not drinking alcohol can help to prevent more damage, but you may have ongoing symptoms or complications, and need medical support.

You’re more likely to recover if alcoholic liver disease is caught and treated at an early stage. So see a doctor if you think you have it, or you’re worried about how your drinking habits are affecting your body.

### How long do you need to abstain from alcohol for the liver to repair itself? 

If you’re at an early stage, you may not need to stop drinking forever. Research shows that not drinking for 2 to 3 weeks can be enough to reverse alcoholic fatty liver disease (stage 1). But this can vary depending on your individual circumstances, and you may need to stop drinking for months or years.

Once you’ve got alcoholic hepatitis (stage 2), you’ll need to stop drinking forever to help stop the liver damage from getting worse.

### What are the signs your liver is healing from alcohol?

It’s not always easy to tell if your liver is healing because alcoholic liver disease doesn’t usually cause symptoms in its early stages.

But blood tests that measure how well your liver is working (liver function tests) can be useful in showing if your liver is healing. 

An ultrasound or CT scan may also show when signs of liver disease, such as alcoholic fatty liver, are improving.


## What are the medical treatments for alcoholic liver disease?

Aside from not drinking alcohol, you may also need treatment for the symptoms and complications caused by liver damage. 

This treatment may involve:

- __nutrition advice from your doctor or a nutritionist__ – it’s common to be low in key nutrients when you have alcoholic liver disease. Eating a healthy, [balanced diet](/nutrition/healthy-eating-and-balanced-diet)__ can help you get the vitamins and minerals your body needs to function well. Your doctor may also recommend supplements, such as [B vitamins](/self-care/vitamins-and-minerals-vitamin-b) 
- __medications to ease alcohol withdrawal symptoms__ – when you stop drinking, you may get some symptoms during the first few days. These usually improve after a week, but medications (such as sedatives) can help to ease these symptoms if they’re serious. Read more about [managing alcohol withdrawal](/self-care/alcohol-misuse/#treatment)
__- medication to help with liver inflammation 
__- medication to help you stop drinking alcohol__

### When is the treatment a liver transplant?

When alcoholic liver disease reaches its most serious stage and your liver can’t function anymore, a doctor (usually a liver specialist called a hepatologist) may recommend a liver transplant.

Your specialist will be able to tell you all you need to know about the surgery and help guide you through the process of making the decision to have (or not have) a transplant.

Read more about a [liver transplant](/health-library/treatments/liver-transplant).


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References

Jo Wheatley

Susie Parker

Dr Ann Nainan

Dr Adiele Hoffman

Article information

All of Healthily's articles undergo medical safety checks to verify that the information is medically safe. View more details in our <a href="/safety" target="_blank" rel="noopener noreferrer">safety page</a>, or read our <a href="/legal/editorial-policy-principles" target="_blank" rel="noopener noreferrer">editorial policy</a>.

Drinking too much alcohol can damage your liver and cause alcoholic liver disease. Find out how alcohol affects your liver, and how to minimize your risk.

Wondering how alcohol affects the liver? Learn how to look after yours with our lowdown on alcoholic liver disease.
