The following is a message from Clinical Associate Professor of General Internal Medicine Jeydith Gutierrez, MD, MPH; Clinical Associate Professor of General Internal Medicine and Psychiatry Andrea Weber, MD; and Clinical Professor of Gastroenterology and Hepatology Antonio Sanchez; MD.

Alcohol consumption can have serious health effects, yet this is often under-discussed. April is Alcohol Awareness Month, which reminds us to consider how alcohol affects a person’s life.

Alcohol consumption has been associated with many health problems and it is one of the leading causes of death in the United States. In 2021, more than 170,000 people died due to alcohol-related causes, a number that has more than doubled in the last decade. This isn’t just a statistic; it’s a call for action.

In the last few years, we have seen an increase in the number of patients that are admitted to the hospital due to severe illnesses related to alcohol use. Often these patients are severely ill, dealing with life-threatening and devastating effects of excessive alcohol use. Unfortunately, several of them end up losing their lives way too early.

Acute intoxication can lead to unintentional injuries, and alcohol poisoning, which can be life-threatening. In the long run, alcohol use can lead to many chronic diseases such as high blood pressure, heart disease, stroke, mental health problems, liver disease, and a rising number of cancers, which the University of Iowa College of Public Health recently reported as a growing concern for Iowans in particular.

So, how can we define risky drinking?

Moderate drinking is defined, for adults of legal drinking age, as limiting the intake to two drinks or fewer in a day for men, and no more than one drink in a day for women.

The liver is a vital organ that processes everything we eat and drink, including alcohol.

When you drink alcohol, it’s absorbed into your bloodstream and eventually makes its way to your liver, where it’s broken down. However, your liver can only process a small amount of alcohol at a time. Consuming more alcohol than your liver can handle can lead to serious health problems. Initially, this might cause fat to build up in your liver, a condition known as hepatic steatosis or fatty liver, which can be reversible if you stop drinking. However, continued excessive drinking can lead to more severe liver related conditions.

Over time, persistent alcohol consumption can cause inflammation, known as alcoholic hepatitis, which can be severe and life-threatening. Chronic liver inflammation from alcohol use may also lead to the development of liver fibrosis, or scarring of the liver tissue. If the drinking continues, this can lead to cirrhosis, a late-stage liver disease where the liver is severely scarred and can become permanently damaged. Cirrhosis significantly hampers the liver’s ability to function and can have life-threatening consequences. Unfortunately, this process is largely asymptomatic, until it is too late, when the liver is severely damaged. At this point the treatment options are limited. Liver transplant can be an option for carefully selected patients, but many patients may not qualify for a liver transplant, either because they are too ill, or they have other contraindications. Therefore, unfortunately, often patients at these late stages die before they can receive a liver transplant.

The good news is that liver damage from alcohol can be prevented. Awareness is key. Understanding the impact of alcohol on your liver and making informed choices about drinking can make all the difference.

It is easy to start drinking more without even realizing it. Here are some tips from the Substance Abuse and Mental Health Services Administration (SAMHSA) to be more mindful about how much someone is choosing to drink:

Additionally, we suggest these options for consideration if you or you are advising someone who will choose to drink at or host events where alcohol is available:

1. Accommodations for Safety: Provide options like a spare bedroom, contact for taxi/ride services, or a designated sober driver.
2. Offer Alternatives at Gatherings: Always have non-alcoholic beverages and food available during social gatherings.
3. Separate Drink Containers: Keep alcoholic and non-alcoholic beverages in separate containers; make non-alcoholic options more accessible.
4. Non-Alcoholic Options: Include non-alcoholic beer and provide pre-mixed cocktails with the option to add alcohol separately.
5. Choose Appropriate Venues: Plan social events at places that don’t focus on alcohol, like parks or coffee shops.
6. Alcohol-Free Events: Consider hosting events without alcohol or offer a BYOB option for those who wish to drink.
7. Promote Alcohol-Free Activities: Organize social activities that do not involve alcohol, like group sports, hiking, or board games.
8. Games Without Alcohol Incentives: Create fun, engaging games that don’t involve drinking as part of the gameplay.

It is important to remember that alcohol use disorder (AUD) is an illness. As health professionals, we should be aware of what we can do to reduce the stigma and barriers that people face in either asking for help or accessing treatment.

Treatment for AUD frequently consists of cognitive and behavioral therapy and pharmacological interventions, often in combination. There are several FDA- approved medications to treat AUD that can provide significant benefits in both helping people abstain from alcohol or reducing heavy alcohol use, yet these medications are underutilized. Fewer than 10% of patients with a diagnosis of AUD receive prescriptions for a medication therapy.

Furthermore, most people with AUD present to their general practitioners, but there is a scarcity of specialists in Addiction Medicine. The Division of General Internal Medicine is working on enhancing the workforce to improve access for patients to clinicians with expertise in addiction treatment through the Addiction Medicine fellowship, and by having internal medicine and psychiatry residents rotate through Addiction Medicine clinics.

Talk to your doctor about how you can keep your liver healthy and consider joining community support groups if you’re struggling with alcohol use. Remember, it’s never too late to start making healthier choices for your liver and your life.