Treating Alcoholic Liver Cirrhosis & AUD
The Centers for Disease Control and Prevention (CDC) publishes that almost 4 million American adults suffer from liver disease. The liver helps to metabolize and filter out substances that may be harmful to the body.
Alcohol is a substance that the liver helps the body to safely break down. When someone drinks a lot of alcohol, like via binge or heavy drinking, it can build up in the liver and lead to the possible onset of alcohol-related liver disease (ALD), a preventable disease. ALD occurs in people who drink excessively on a regular basis, typically over a long period of time, such as people battling chronic alcoholism. ALD is a progressive disease, with the most severe form being liver cirrhosis.
The American Liver Foundation reports that around 10-20 percent of people who drink heavily for 10 years or more will develop cirrhosis of the liver. According to the National Survey on Drug Use and Health (NSDUH), just over 15 million American adults struggled with alcohol addiction in 2016.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that almost 10 percent of all alcoholics in the United States fall into the “chronic severe” subtype. Chronic severe alcoholics are likely middle-aged individuals who started drinking at a young age; they typically have a family history of alcoholism and regularly drink to excess, increasing the possible risk factors for developing liver cirrhosis.
Chronic alcoholism and liver cirrhosis are complex diseases that benefit best from integrated and specialized treatment methods.
Side Effects of Cirrhosis of the Liver
Not everyone who drinks or battles alcoholism will developing cirrhosis of the liver; however, the more frequently someone drinks, and more alcohol a person drinks on a regular basis, the more the odds go up. Genetics, malnutrition, obesity, gender, ethnicity, and other factors may make a person more vulnerable to developing alcohol-related liver disease than someone else.
Cirrhosis is essentially what happens when the liver is damaged, and scar tissue builds up and replaces healthy liver tissue. When a person drinks to excess, fat tissue builds up in the liver. Fatty liver, or steatosis, is the earliest stage of ALD, and also the most common form of alcohol-related liver disease. If a person stops drinking at this point, the damage can generally be reversed.
When heavy drinking continues, ALD can progress into alcoholic hepatitis, which involves inflammation of the liver and destruction of healthy liver cells. NIAAA warns that about 40 percent of the time, if a person suffering from alcoholic hepatitis continues to drink to excess, they will develop cirrhosis. The Global Health Observatory (GHO) states that between 20-50 percent of the time, cirrhosis of the liver is caused by alcohol consumption.
The first stage of scarring in the liver is fibrosis. When the scar tissue continues to accumulate and overtakes most of the liver, this is cirrhosis. The US National Library of Medicine (NLM) publishes that symptoms of cirrhosis include:
- Appetite disruption and weight loss
- Low energy and fatigue
- The appearance of small, red blood vessels on the skin that have a spider-like appearance
- Abdominal pain and nausea
- Jaundice (yellowish tinge to skin, eyes, and mucous membranes)
- Edema (fluid buildup in legs) and ascites (fluid collection in abdomen)
- Bruising easily and abnormal bleeding
- Shrinking testicles in men as well as impotence and swelling of breasts
- Clay-colored and/or pale stool
- Mental confusion and difficulties thinking clearly
- Red palms
Left untreated, liver cirrhosis can lead to several potentially life-threatening complications, including enlarged spleen, bleeding from veins in stomach or esophagus, buildup of fluid in the abdomen, liver cancer, kidney failure, brain disorders, and coma. Mayo Clinic reports that in 2009, cirrhosis and chronic liver disease were the 12th leading cause of death for adults in the United States. Continuing to drink while suffering from cirrhosis worsens the prognosis of the disease and creates more possible side effects. NIAAA publishes that when people battling cirrhosis stop drinking, however, the five-year survival rate is as high as 90 percent. Treatment for alcoholism and cirrhosis greatly increases a person’s overall health and wellness, and can improve quality of life in general.
Medical Detox Is the First Stage of Recovery
One of the typical side effects of chronic alcoholism is significant physical dependence on alcohol. When a person is dependent on alcohol, they should not stop drinking “cold turkey” as the brain and body can have an intense rebound effect, which can be potentially life-threatening.
When a person drinks alcohol on a regular basis, the brain and body become accustomed to the chemical interference it causes. Alcohol is a central nervous system depressant that acts on some of the brain’s chemical messengers, called neurotransmitters, which serve to slow some life-sustaining functions, such as respiration and heart rate, blood pressure, and body temperature. Levels of GABA (gamma-aminobutyric acid) are increased with the presence of alcohol. GABA is a kind of natural sedative produced by the brain that lowers anxiety and minimizes the “fight-or-flight” stress response. Dopamine, a neurotransmitter involved in mood regulation and movement capabilities, is also increased by the presence of alcohol.
If alcohol levels suddenly drop after a person has been drinking regularly for a long period of time, the brain may try to regain balance, which can cause a spike in some of these brain chemicals. Alcohol withdrawal symptoms can be difficult and even severe. The New England Journal of Medicine (NEJM) warns that around 3-5 percent of the time, alcohol withdrawal can lead to the development of potentially fatal delirium tremens (DTs). DTs is the most significant form of alcohol withdrawal, and can include extreme confusion, fever, hallucinations and delirium, and seizures, which can be fatal.
Additional alcohol withdrawal symptoms include gastrointestinal upset, agitation, anxiety, depression, insomnia, headaches, dizziness, cognitive difficulties, and mood swings. Because of the possibility of DTs and significant alcohol withdrawal symptoms in someone who suffers from chronic alcoholism, medical detox is considered the optimal method to allow alcohol to process safely out of the brain and body.
During a medical detox program, alcohol may be replaced with other tranquilizing medications, such as benzodiazepines, to help a person become physically stable. Medical detox programs provide a high level of care and continual medical monitoring of vital signs, which is also important for a person struggling with a medical complication, such as liver cirrhosis.
Alcohol Rehab Programs That Offer Comprehensive Care
Medical detox is generally the first stage of a complete treatment program for co-occurring disorders, such as alcoholism and cirrhosis. Treatment for co-occurring disorders is optimally integrated, meaning that all treatment providers are on the same page and working together.
Medical complications of liver cirrhosis will need to be managed simultaneously with the side effects of alcohol withdrawal and cessation of drinking. Complete abstinence is necessary to treat and possibly even reverse some of the damage done to the liver from alcohol consumption.
A residential alcohol rehab program can provide comprehensive care for both diseases, help to achieve abstinence, and work to minimize relapse. Behavioral therapies and counseling sessions during rehab can provide tools for reducing relapse, managing stress, and coping with potential triggers that may come up. During a residential rehab program, medical providers can treat the side effects of cirrhosis while mental health and substance abuse treatment providers address the emotional and behavioral concerns of alcohol abuse and alcoholism at the same time.
Alcoholism and cirrhosis can both contribute to poor nutrition and even malnutrition, so nutrition therapy is often introduced during rehab as well. Someone who struggles with cirrhosis and alcoholism will likely need to go on a special diet to replace nutrients and vitamins that may be depleted due to the diseases.
Medications, often steroids, may help to reduce swelling in the liver during treatment for cirrhosis. In severe cases of cirrhosis, a liver transplant may be necessary. Often, to be eligible for such a procedure, an individual will need to sustain abstinence from alcohol for at least six months, and also provide assurances that they will continue to remain abstinent after undergoing the surgery.
Support groups, such as 12-Step meetings, are often introduced during rehab. They can be great outlets for people to receive encouragement and develop connections with peers who can help in sustaining long-term abstinence. A comprehensive alcohol rehab program can provide clients with the time and space to heal, and also with tools to reduce episodes of relapse.