Yes, Some Liver Damage Is Reversible: A Look at Alcoholic Hepatitis

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What Does Your Liver Do?

The liver plays an important role in your body’s function. Just a few of the necessary tasks performed by the liver include:²

Aids in digestion and metabolism
Produces bile, which is critical to digestion
Stores vitamins like iron and copper
Produces proteins essential to reproduction
Metabolizes bilirubin, which regulates how waste passes through the body
Helps the thyroid function
Handles cholesterol stability
Supports immunity and detoxification

Because alcohol is processed in the liver, many functions of the liver are impacted by alcohol misuse. Consuming large amounts of alcohol for extended periods can damage your liver.

What Does Liver Disease Look Like?

Alcoholic hepatitis is progressive. The liver isn’t damaged or fails overnight. Liver damage progresses through stages based on how much of your liver is damaged.³

Stage 1: Fatty Liver Disease

Fatty liver, or steatosis, refers to an enlarged liver caused by drinking too much alcohol. Alcohol misuse is not the only cause of fatty liver disease. Insulin resistance, hyperglycemia, and high levels of fats in the blood can also contribute to the disease.

Fatty liver is reversible, usually by abstaining from alcohol and making healthy lifestyle changes that may be overseen by a registered dietician or nutritionist.

Stage 2: Alcoholic Hepatitis

In the alcoholic hepatitis stage, your liver has incurred damage because of heavy alcohol misuse. Similar damage can be caused by certain types of malnutrition.

In alcoholic hepatitis, inflammation creates uncomfortable symptoms, such as:

Nausea or vomiting
Changes in appetite
Fatigue or physical weakness
Pain, including tenderness of the stomach
Low fever

Abstaining from alcohol can improve these symptoms. However, there is no guarantee that your liver will heal, even with treatment.

Stage 3: Alcoholic Cirrhosis

In about 10% of people with alcohol addiction, scar tissue replaces normal liver tissue. This process is called alcoholic cirrhosis. Cirrhosis can affect your quality of life and eventually become life-threatening. The potential risks include internal bleeding, increased risk of liver cancer, liver failure, and multi-organ failure. Cirrhosis can present with:

Fatigue or physical weakness
Weight loss, potentially related to a lack of appetite
Jaundice or skin yellowing
Gastrointestinal bleeding
Abdominal swelling
Confusion

Cirrhosis damage is irreversible, but some treatments can slow disease progression and manage the complications. To use these treatments and stop the progression of the disease, you must stop drinking alcohol.

What Is Alcoholic Hepatitis?

After consuming alcohol, your body breaks down or metabolizes the toxin in the liver. The liver can metabolize approximately one standard alcoholic drink per hour. However, when you drink faster than that, your body can’t keep up, and your level of intoxication grows. Metabolism also leaves behind toxic byproducts that contribute to liver damage.⁴

Hepatitis is the medical term that means an inflammation of the liver that occurs when liver tissues are damaged. Drinking large amounts of alcohol causes swelling and inflammation throughout the body and can hinder how the liver functions. Alcoholic hepatitis can be acute, meaning it is sudden and goes away with treatment or after a period of sobriety.

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How Is Alcohol Addiction Related to Alcoholic Hepatitis?

The diagnostic process for alcoholic hepatitis must also include an assessment to determine your level of alcohol use and whether you have an addiction. Standardized diagnostic criteria are used to determine alcohol addiction, also called alcohol use disorder (AUD).

The evaluation uses self-reporting and substance use assessments. To receive an accurate diagnosis and appropriate treatment plan to support recovery, it’s important to be as honest during the evaluation as possible.

You can expect to be asked several questions, including:⁷

How much alcohol you drink each day, week, or month.
If misusing alcohol interferes with personal, professional, or social goals and responsibilities.
If you’ve tried to stop drinking and couldn’t.
If you’ve experienced urges, cravings, or thought about drinking when you aren’t drinking.
If you experience withdrawal symptoms when you stop drinking.
If you need more alcohol than you did before to experience the same effects.

Information like this helps your doctor assess your health and treatment needs accurately to make appropriate recommendations.

Who Can Get These Conditions?

Not everyone who misuses alcohol will develop alcoholic hepatitis or another liver disease, just as not everyone who misuses alcohol becomes addicted. Certain key factors are considered to make an accurate diagnosis.

Family History

There is a demonstrated link between a family history of substance misuse and an increased risk of developing issues with substance misuse or addiction. While there is no indication that there is an “addiction gene,” researchers believe that this connection is partly due to traits that can be inherited.

However, studies also indicate that learned behaviors—such as watching adults in one’s home of origin misuse substances—are part of an individual’s risk for developing an addiction.⁹ Treatment often includes addressing the “family disease” of addiction.

Sex

Based on a 2002 study, men were considered 3 times more likely than women to develop alcohol addiction. In a repeat study in 2013, men were considered 2 times more likely. The studies could not determine the reason for this correlation between gender and an increased risk of addiction.⁸

However, after addiction develops, data show that women experience faster progression of liver disease than men and women’s livers heal less after they abstain from alcohol than men. Experts speculate that this is linked to differences in hormonal activity, including lower gastric alcohol dehydrogenase (ADH) and higher estrogen.⁸

Drinking Patterns

The amount of alcohol you consume and how often you consume it have a significant effect on your liver. For example, someone who binge drinks multiple times a week is more likely to experience liver dysfunction than someone who has one standard serving of wine each night with dinner.⁸For the average adult, four or more drinks for a woman or five or more drinks for a man in the span of two hours qualifies as binge drinking.

Heavy or long-term alcohol use has also been shown to increase the risk of alcohol addiction.

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Medical and Mental Health Conditions

Certain medical conditions are linked to a higher rate or faster progression of liver disease. If you have hepatitis C, any alcohol use can increase your likelihood of developing alcoholic hepatitis.

While some studies show a link between a higher body mass index (BMI) and risk of alcohol-related liver disease, a link between obesity and alcoholic hepatitis has not been found. A health survey conducted between 1997 and 2001 indicated that individuals with higher BMIs tended to consume more alcohol.⁸

In a 2010 study, 44.5% of the patients with alcohol-related liver disease studied were considered obese. A 2009 study suggests that alcohol-induced liver injury may occur more easily in individuals with a higher BMI than in those with a lower BMI, because of associated changes in liver enzymes.⁸ Since these connections have been drawn between weight and alcohol use, as well as alcohol-related liver disease, many doctors consider obesity a risk factor for alcohol addiction and liver damage.

Other medical conditions, such as chronic pain, cause persistent symptoms that may be partially alleviated by substance use. These are also considered a potential contributing factor, especially if the medical condition is undiagnosed or is not adequately treated.

Mental health symptoms and conditions are also considered a risk factor for alcohol addiction. About half of people with addiction also have another mental health condition, such as depression, attention deficit hyperactivity disorder (ADHD), anxiety, or post-traumatic stress disorder (PTSD).

Substance Exposure

Early exposure to substances is a risk factor for substance misuse or addiction. One study reports that in a group of individuals over 26, those who used alcohol for the first time before age 15 were more than 5 times more likely to have a diagnosed alcohol addiction.⁹

Behavior modeling can occur in your home, your school, your friend group, your workplace, or even in the media and social media you use. Access to substances and exposure to others using substances are connected to an increased likelihood that an individual will use substances recreationally or chronically.⁹

Personal History

Sometimes, a pattern of substance misuse develops as a coping mechanism. This coping mechanism may take shape to help you deal with trauma. This trauma can include significant traumas, such as active-duty combat, natural disasters, or childhood neglect or abuse. Some individuals may also develop post-traumatic stress disorder, which has a high co-occurrence rate with alcohol addiction.⁹

A history of substance use may also increase the risk that you may use substances again.

For individuals in this situation, finding new coping mechanisms is a critical step in recovery and abstinence required to stop the progression of alcohol-related liver disease. Trauma-informed therapy, such as exposure therapy, may also be part of a relapse prevention plan.

Are Other Diseases Associated With Alcoholic Hepatitis?

Having alcoholic hepatitis symptoms makes you vulnerable to contracting other infections and diseases because your immune system is weakened by the damage. Examples of conditions commonly associated with alcoholic hepatitis include:¹⁰

Urinary tract infections (UTIs)
Bacterial peritonitis, or an infection of fluid in your abdomen
Bacterial pneumonia
Sepsis or blood poisoning caused by bacteria
Lung abscess or pockets in the lungs caused by microbial infection
Alcoholic gastritis or inflammation of the stomach lining
Alcoholic pancreatitis, or inflammation of the pancreas
Alcoholic neuropathy or nerve damage
Alcoholic cardiomyopathy or alcohol-related heart disease
Diabetes
Cancer, especially of the liver

How Do Doctors Treat Alcoholic Hepatitis?

Initial alcoholic hepatitis treatment may include diuretics or water pills to eliminate excess fluid from your body. Your doctor may also prescribe antibiotics. Other treatments include:¹¹

Corticosteroids to reduce inflammation
Vitamins and minerals to replenish lost nutrients
Treatment for alcohol use disorder

There are several types of medication commonly used to manage alcohol withdrawal symptoms and help maintain abstinence. Examples include:¹¹

Acamprosate
Naltrexone
Disulfiram
Baclofen

Medications like these work in varying ways to reduce cravings for alcohol or make you sick if you drink while taking medicine.¹²

Your doctor may also recommend lifestyle changes, such as smoking cessation, moderate exercise, and good nutrition. Researchers have created dietary guidelines to prevent further liver damage and, for some, reverse damage caused by alcohol misuse. A few examples of these guidelines include:¹³

Eat smaller meals throughout the day rather than three big meals.
Eat approximately 60% carbohydrates—such as cereals, fruits, and vegetables—to maintain your energy levels.
Eat approximately 15% proteins for energy, including lean meats, skim milk, and eggs.
Eat lower levels of fat and salt.
Avoid alcohol and other substance use.

You can begin alcoholic hepatitis treatment as soon as you receive a diagnosis. Whether you need medical help for detoxing from alcohol, nutrition therapy, or education on beneficial lifestyle changes to heal your liver and recover from addiction, speak to your doctor.

Contact our treatment specialists at 800-948-8417 Sponsored to learn about your alcohol addiction treatment options.

Resources

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Kalra, A., Yetiskul, E., Wehrle, C.J., Werhle, C.J. & Tuma, F. (2021). Physiology, Liver. Treasure Island (FL): StatPearls Publishing.
Streba, L. A., Vere, C. C., Streba, C. T., & Ciurea, M. E. (2014, July 07). Focus on Alcoholic Liver Disease: From Nosography to Treatment. World Journal of Gastroenterology, 20(25), 8040-8047.
National Institutes of Health. (2007). Information about Alcohol. Biological Sciences Curriculum Study. Bethesda (MD): National Institutes of Health (US).
S. National Library of Medicine. (2021). Hepatitis. MedlinePlus.
Singal, A. K., Kodali, S., Vucovich, L. A., Darley-Usmar, V., & Schiano, T. D. (2016). Diagnosis and Treatment of Alcoholic Hepatitis: A Systematic Review. Alcoholism, Clinical and Experimental Research, 40(7), 1390-1402.
Torruellas, C., French, S. W. & Medici, V. (2014, September 07). Diagnosis of Alcoholic Liver Disease. World Journal of Gastroenterology, 20(33), 11684-11699.
Ohashi, K., Pimienta, M. & Seki, E. (2018). Alcoholic Liver Disease: A Current Molecular and Clinical Perspective. Liver Research, 2(4), 161-172.
National Institute on Alcohol Abuse and Alcoholism. (2020). Understanding Alcohol Use Disorder.
Basra, G., Basra, S. & Parupudi, S. (2011, May 27). Symptoms and signs of acute alcoholic hepatitis. World Journal of Hepatology, 3(5), 118-120.
Chayanupatkul, M. & Liangpunsakul, S. (2014). Alcoholic Hepatitis: A comprehensive review of pathogenesis and treatment. World Journal of Gastroenterology, 20(20), 6279–6286.
Vuittonet, C. L., Halse, M., Leggio, L., Fricchione, S. B., Brickley, M., Haass-Koffler, C. L., Tavares, T., Swift, R. M. & Kenna, G. A. (2014). Pharmacotherapy for alcoholic patients with alcoholic liver disease. American Journal of Health-System Pharmacy, 71(15), 1265–1276.
Hajdarevic, B., Vehabovic, I., Catic, T. & Masic, I. (2020). The Role of Diet Therapy in the Treatment of Liver Disease. Material Socio-Medica, 32(3), 200–206.