Treating alcohol-related liver disease  

Successful treatment for alcohol-related liver disease (ARLD) often depends on whether someone is willing to stop drinking alcohol, and make changes to their lifestyle.

Stopping drinking alcohol

Treatment for alcohol-related liver disease involves stopping drinking alcohol. This is known as abstinence. Abstinence can be vital depending on what stage the condition is at.

If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for at least two weeks. After this point, it is usually safe to start drinking again if you stick to the NHS guidelines on alcohol consumption.

If you have a more serious form of ARLD - alcoholic hepatitis or cirrhosis - life-long abstinence is recommended. This is because stopping drinking is the only way to prevent  damage to your liver getting worse and potentially stop you dying of liver disease.

Stopping drinking is not easy, especially as an estimated 70% of people with alcohol-related liver disease have an alcohol dependency problem. Nevertheless, if you have alcohol-related cirrhosis or alcoholic hepatitis and do not stop drinking, no medical or surgical treatment can prevent liver failure occurring.

Withdrawal symptoms

If you are abstaining from alcohol you may suffer withdrawal symptoms. These will be at their worst for the first 48 hours, but should start to improve as your body adjusts to being without alcohol. This usually takes between three and seven days from the time of your last drink.

Many people initially experience disturbed sleep when abstaining from alcohol, but in most cases their sleep pattern returns to normal within a month.

In some cases, you may be advised to reduce your alcohol intake in a gradual and planned way to help avoid withdrawal problems. You may also be offered a medication called a benzodiazepine and psychological therapy, such as cognitive behavioural therapy (CBT), to help you through the withdrawal process.

Some people need to stay in hospital or a specialist rehabilitation clinic during the initial withdrawal phases so their progress can be closely monitored.

If you are staying at home, you will regularly see a nurse or other health professional. You might see them at home, at your GP surgery or at a specialist NHS service.

Preventing relapses

Once you have stopped drinking, you may need further treatment to help ensure you don't start drinking again.

The first treatment usually offered is psychological therapy. This involves seeing a therapist to talk about your feelings and thoughts and how these affect your behaviour and wellbeing.

If psychological therapy alone is ineffective, you may also need medication to help you abstain from alcohol, such as acamprosate, naltrexone or disulfiram.

See treating alcohol misuse for more information about treatments offered.

Self-help groups

Many people with a dependence on alcohol find it useful to attend self-help groups to help them stop drinking. One of the most well-known is Alcoholics Anonymous, but there are many other groups that can help.

See alcohol support for more information about the help available.

Diet and nutrition

Malnutrition is common in people with ARLD, so it's important to eat a balanced diet to help ensure you get all the nutrients you need.

Avoiding salty foods and not adding salt to foods you eat can help reduce your risk of developing swelling in your legs, feet and abdomen (tummy) caused by a build-up of fluid. See tips for a lower salt diet for more information.

The damage to your liver can also mean it is unable to store glycogen, a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals, which leads to muscle wasting and weakness. Therefore, you may need extra energy and protein in your diet.

Healthy snacking between meals can top up your calories and protein. It may also be helpful to eat three or four small meals a day, rather than one or two large meals.

Your GP can advise you on a suitable diet or, in some cases, refer you to a dietitian.

In the most serious cases of malnutrition, nutrients may need to be provided through a feeding tube inserted through the nose and into the stomach.

Medication for symptoms

The use of medication to directly treat ARLD is controversial. Many experts have argued there is limited evidence for its effectiveness.

For people with severe alcoholic hepatitis, treatment in hospital may be necessary. Specific treatment with corticosteroids or pentoxifylline medication may be used to reduce inflammation of the liver in some people with this condition. Nutritional support (see above) is also an important part of treatment in these cases.

Other medications that have been used to treat liver damage include anabolic steroids (a more powerful type of steroid medication) and propylthiouracil (a type of medicine originally designed to treat overactive thyroid glands), but there is a lack of good evidence these help and they are no longer used for severe alcoholic hepatitis.

Liver transplants

In the most serious cases of alcohol-related liver disease, the liver loses its ability to function, leading to liver failure. A liver transplant is currently the only way to cure irreversible liver failure.

If you develop progressive liver failure despite abstinence from alcohol, you are otherwise well enough to survive such an operation, and you commit to not drinking alcohol for the rest of your life, liver transplantation can be considered.

Alcohol misuse: David's story

David talks about the effects that his former alcohol addiction had on his health and relationships.

Media last reviewed: 06/09/2013

Next review due: 06/09/2015

Taking medications with alcohol-related liver disease

If you have alcohol-related liver disease, it is important to talk to your GP or pharmacist before taking over-the-counter or prescription medications, as the condition can affect the way the body processes some medications.

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Alcohol support

Realising you have a problem with alcohol is the first step to getting better, but it is often the hardest one

Page last reviewed: 06/09/2013

Next review due: 06/09/2015