Heavy Drinking and Its Effects on the Liver

Alcohol consumption: part of our history and culture

Today it is not uncommon to see heads of state, respected professionals, and key social figures drinking alcohol. However, alcohol has not always been as socially accepted in American society as it is today. From 1920 to 1933, the United States legally forbade the sale of alcohol anywhere in the country. In the infamous Prohibition era, alcohol was not only illegal, but socially stigmatized in certain circles and fantasized in others, leading to the era known as the Roaring 20s. Although prices for alcohol increased during prohibition, and demand dropped in most circles, demand increased among certain demographics. Part of this was due to the “forbidden fruit” effect, and the appeal of acquiring something that is illegal. However, cirrhosis or liver disease rates did not drop proportionally to falling demand, and the major reason for this was due to the populations that continued to drink.1 The drinkers at highest risk for cirrhosis are those who drink heavily most days of the week. For these drinkers demand is very inelastic, meaning that the quantity demanded does not change much when price changes. Therefore, they continued to drink in the same quantities they did pre-prohibition, despite the higher price point. Thus, cirrhosis numbers did not change significantly.

Alcohol consumption continues to impact the health of Americans today. In the United States, excessive alcohol consumption causes approximately 75,000 deaths per year and is the third leading preventable cause of death.2 Binge drinking, defined as drinking 5 or more alcoholic drinks on one occasion, contributes to drinking culture in the United States and has become a pervasive public health issue. Binge drinking is highest among young adults aged 18 to 25 years old, with about 40% of college students reporting that they binge drink.3 Alcohol is heavily marketed towards these age groups especially through social media, and heavy drinking is central to many students’ expectations of college life.2,4 Drinking cultures also exist globally. In the United Kingdom, efforts to curb binge drinking have turned toward court-ordered ankle monitor technology which detect if habitual alcohol abusers have consumed alcohol.5 In South Korea, alcohol is considered a daily part of life and heavy drinking is often a must if one wants to get ahead in the workplace.6

Heavy alcohol consumption and drinking culture in the United States and globally contributes to rates of cirrhosis.

Public health challenges of alcohol consumption

How does heavy drinking behavior affect the liver? Heavy drinking over time causes the body to start to replace the liver’s healthy tissue with scar tissue. The hepatic stellate cells (HSCs) of the liver play a key role in the development of fibrosis, which is the first stage of liver scarring.7 HSCs are inactive, fat-storing cells and are located in the space of Disse in the liver.7 Long-term alcohol consumption can lead to a process that activates these HSCs. These activated HSCs then secrete large amounts of scar-forming proteins. When scar tissue builds up and takes up most of the liver, there may be changes to the structure and function of the liver. This is known of cirrhosis. Symptoms of alcoholic liver cirrhosis include jaundice, portal hypertension, and skin itching. As cirrhosis worsens and scar tissue replaces more of the healthy tissue, the liver will began to fail.

Part of the public health crisis that has arisen from alcohol abuse can be seen with the rising prevalence of alcoholic cirrhosis. In the United States, from 2008 to 2015, cases of alcoholic cirrhosis increased 43%. Diagnosis of cirrhosis is often made well after significant liver damage has occurred, and about half of cirrhosis deaths are caused by alcohol.8,9 The mortality rate of this disease is greater than many common cancers, including breast, prostate, and colon.9 In 2011 there were around 1,900 liver transplants performed because of alcoholic cirrhosis.  At an estimated cost of $577,000 each, this created a financial burden worth over $1 billion.10 This price tag is only for the surgery and does not include follow-up care or medications. In 2015 the total cost of alcoholic cirrhosis was at least $5 billion.8

References
  1. Dills A, Miron J. Alcohol Prohibition and Cirrhosis. 2003. doi:10.3386/w9681.
  2. Sudhinaraset, May, et al. “Social and Cultural Contexts of Alcohol Use.” Alcohol Research : Current Reviews, vol. 38, no. 1, 2016, pp. 35–45.
  3.  Naimi, Timothy S., et al. “Binge Drinking Among US Adults.” JAMA, vol. 289, no. 1, Jan. 2003, pp. 70–75. jamanetwork.com, doi:10.1001/jama.289.1.70.
  4. Mcmurtrie, Beth. “Why Colleges Haven’t Stopped Binge Drinking.” The New York Times, 14 Dec. 2014, https://www.nytimes.com/2014/12/15/us/why-colleges-havent-stopped-binge-drinking.html.
  5.  Nevin, Charles. “Britain’s Drinking Problem.” The New York Times, 8 Aug. 2014, https://www.nytimes.com/2014/08/09/opinion/sunday/britains-drinking-problem.html.
  6.  Chao, Steve, and Liz Gooch. “The Country with the World’s Worst Drink Problem.” Al Jazeera, 7 Feb. 2016, http://www.aljazeera.com/indepth/features/2016/02/country-world-worst-drink-problem-160202120308308.html.
  7. Osna, Natalia A., Terrence M. Donohue Jr, and Kusum K. Kharbanda. “Alcoholic liver disease: Pathogenesis and current management.” Alcohol research: current reviews 38.2 (2017): 147.
  8. Gruneisen, N. (2017). The Increasing Cost of Alcohol Abuse. Retrieved from https://www.aasld.org/about-aasld/press-room/increasing-cost-alcohol-abuse
  9. Frazier, T. H., A. M. Stocker, N. A. Kershner, L. S. Marsano and C. J. McClain (2011). “Treatment of alcoholic liver disease.” Therap Adv Gastroenterol 4(1): 63-81.
  10. (2018). “Financial Matters: Liver Transplant Costs.” from http://www.cpmc.org/advanced/liver/patients/topics/finance.html

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