Alcohol-related liver disease

Drinking alcohol increases your risk of developing liver disease and causing irreparable damage to this important organ

Chronic liver failure caused by drinking alcohol causes severe symptoms and may be fatal in up to a half of all cases within two to three years. There are no life-saving or prolonging medical treatments available. Liver transplantation can be effective, but you have to commit to stopping drinking completely as it will not work if you continue to drink heavily. Prevention is better than cure.^1,2

Alcohol-related liver disease is caused by drinking alcohol, usually over a sustained period of time. Nearly a fifth (19%) of UK drinkers drink above the low risk drinking guidelines (more than 14 units a week) and could be drinking in a way that is causing harm to their liver.³

Regularly drinking more than the UK Chief Medical Officers' (CMOs') low risk drinking guidelines (no more than 14 units a week) can harm your liver. Even drinking below the CMOs' low risk drinking guidelines over a sustained period of time can cause harm to the liver.⁴

Are there other forms of liver disease?

Alcohol-related liver disease is distinguished from other forms of long-term liver disease such as non-alcohol related fatty liver disease and chronic viral hepatitis. However, drinking alcohol will make these conditions worse. Anyone who has any form of liver disease is advised not to drink alcohol or to seek advice from their specialist about their drinking.^5,6

Who does alcohol-related liver disease affect?

Although around seven in 10 people with alcohol-related liver disease have an alcohol dependence problem,⁷ it is not only daily drinkers who develop liver disease. Binge drinking is also associated with alcohol-related liver disease.⁸

Worried about how much you drink? Take our confidential online Drinking Check

By understanding the impact drinking alcohol can have on your liver and reducing the amount you drink each week, some alcohol-related liver disease may be prevented, reversed, or further disease progression prevented^.9

Increased alcohol intake can also give rise to obesity and diabetes. Alcoholic drinks contain a high number of calories. Research from the Alcohol Health Alliance revealed just two glasses of wine can contain almost an entire day’s recommended sugar intake.¹⁰

How does alcohol affect the liver?

Any time we drink alcohol, the liver must break it down before it can be removed from the body and some liver cells die during this process. This is thought to be why the liver is the organ that sustains the greatest degree of tissue damage through heavy drinking, which leads to alcohol-related liver disease.¹¹

Having a break from alcohol is important to allow the liver to recover and make new cells. Sustained heavy drinking doesn’t allow the liver time to do this.

Find out if your drinking could be causing you harm

The stages of alcohol-related liver disease

Alcohol-related liver disease is a spectrum of disease that broadly consists of three stages, each increasing in severity. It also increases the risk of developing liver cancer.

Alcoholic fatty liver disease
‘Fatty liver’ develops because of a build-up of fat in the cells in the liver.¹² And drinking a large amount of alcohol, even for a short period of time, can lead to a build-up of fat in the liver.¹³

It is estimated that alcohol-related fatty liver disease develops in 90% of people who drink more than 40g of alcohol (or four units) per day.¹⁴ That’s roughly the equivalent of two medium (175ml) glasses of 12.5% ABV wine, or two pints of typical strength (4% ABV) beer.

This stage of alcohol-related liver disease does not usually cause any symptoms and may only be identified through a blood test. It’s also reversible by reducing your long-term alcohol consumption below the UK Chief Medical Officers’ (CMOs’) low risk drinking guidelines.

Your liver will start shedding excess fat if you stop drinking for a sustained period of time¹⁵and - after that - ensure you do not exceed the CMOs’ low risk drinking guidelines. But if you don’t reduce your drinking at this stage, in up to a third of people with this condition, it will progress to the much more serious stages outlined below.

Find out more about the UK low risk drinking guidelines

Alcohol-related hepatitis
Alcohol-related hepatitis is a potentially serious condition caused by heavy alcohol consumption over a longer period. Between 10–35% of individuals with alcohol-related fatty liver disease who continue drinking heavily will develop alcohol-related hepatitis.¹⁶

While alcohol-related hepatitis usually occurs after years of harmful drinking, it can also occur if you drink a large amount of alcohol in a shorter period of time.¹⁷

As with fatty liver disease, alcohol-related hepatitis may be reversed if you stop drinking. However, continuing to drink any amount of alcohol when you have alcohol-related hepatitis will increase the risk of developing cirrhosis.

Cirrhosis
The third stage of alcohol-related liver disease is cirrhosis – where healthy liver tissue has been replaced permanently by scar tissue. This is the result of long-term, continuous damage to the liver.¹⁸

Up to one in every five long-term heavy drinkers will develop alcohol-related liver cirrhosis.¹⁹ While cirrhosis is not reversible, there is good evidence that stopping drinking completely improves the outcome for some people.²⁰

If you have cirrhosis and do not stop drinking, then you are likely to die from liver failure. In 2022, 7,635 people in the UK died of alcohol-related liver disease – up from 5,840 in 2019.²¹ There is always a shortage of donor organs and people who do not stop drinking cannot usually access liver transplants in the UK. There are only 750 adult liver transplants a year for people with liver diseases.²²

Liver cancer

Alcohol-related cirrhosis increases the risk of developing liver cancer.^23,24 Every year almost three out of every 100 (2.9%) people who have liver cirrhosis go on to develop alcohol-related liver cancer.²⁵

Find out more about liver cancer and alcohol

How to identify the symptoms of alcohol-related liver disease

The early stages of alcohol-related liver disease can be difficult to identify as there are not usually any symptoms. Even some people with cirrhosis can have no symptoms. Often this means alcohol-related liver disease is diagnosed during tests for other conditions, or at a stage of advanced liver damage.

Symptoms may include:²⁶

abdominal (stomach) pain
loss of appetite
diarrhoea
fatigue
nausea
feeling generally unwell

Later stage liver damage symptoms, which are more serious and easier to identify, include:²⁷

bruising easily
confusion and memory problems
fatigue
jaundice (yellow skin)
increased sensitivity to alcohol and drugs, both medical and recreational (because the liver cannot process them)
itchy skin
significant weight loss
swelling of the legs, ankles, or abdomen
vomiting blood
weakness, or loss of appetite

Stopping or reducing your drinking

Drinking within the UK Chief Medical Officers' (CMO’) low risk drinking guidelines (drinking no more than 14 units a week) will help keep your risk of developing alcohol-related liver disease low and benefit your overall health.

Reducing the amount you drink, ideally to zero, can help reverse damage, and reduce the risk of disease progression, for those with early-stage alcohol-related liver disease. There are no effective treatments available to stop the progression of the disease, therefore alcohol abstinence is the most effective measure.²⁸

How to stop drinking alcohol completely

If you have established alcohol-related liver disease, it is essential that you stop drinking completely and permanently, to help prevent progression to even more serious disease. You will probably need professional help to stop drinking – find out how to access support here:

Further information

Your GP or a member of their team can help you figure out if you should make any changes in your drinking, and offer help and advice along the way.

If you’re concerned about someone’s drinking, or your own, Drinkline runs a free, confidential helpline. Call 0300 123 1110 (weekdays 9am – 8pm, weekends 11am – 4pm).

The British Liver Trust provides support and information on liver disease. Call their free helpline Monday to Friday from 10am to 3pm on 0800 652 7330 or visit the British Liver Trust website.

Further advice and information

Arming yourself with strategies and tips can help you or a loved one take small steps towards big results.

How to create lasting resolutions How to cut down on alcohol at home How to stop drinking alcohol completely Low alcohol drinks

References

[1] D'Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol 2006; 44(1): 217-31.

[2] Ratib S, Fleming KM, Crooks CJ, Aithal GP, West J. 1 and 5 year survival estimates for people with cirrhosis of the liver in England, 1998-2009: a large population study. J Hepatol 2014; 60(2): 282-9.

[3] Drinkaware 2024 Monitor. All figures, unless otherwise stated, are from YouGov Plc. Total sample size was 5,143 adults. Fieldwork was undertaken between 29th May - 11th June 2024. The survey was carried out online. The figures have been weighted by age, gender, social grade, region, and devolved nation and are representative of all UK adults (aged 18 to 85). Available at: https://www.drinkaware.co.uk/research/drinkaware-monitors/drinkaware-monitor-2024

[4] Department of Health (2016) Alcohol Guidelines Review – Report from the Guidelines development group to the UK Chief Medical Officers.

[5] Toshikuni, N., Tsutsumi, M., & Arisawa, T. (2014). Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease. World Journal of Gastroenterology : WJG, 20(26), 8393–8406. https://doi.org/10.3748/wjg.v20.i26.8393.

[6] Ikejima, K., Kon, K., & Yamashina, S. (2020). Nonalcoholic fatty liver disease and alcohol-related liver disease: From clinical aspects to pathophysiological insights. Clinical and Molecular Hepatology, 26(4), 728–735. https://doi.org/10.3350/cmh.2020.0202

[7] NHS website. Alcohol-related liver disease - treatment (20 September 2022). [Accessed 19 April 2025]. Available at: https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/treatment

[8] Åberg, F., Helenius‐Hietala, J., Puukka, P., & Jula, A. (2017). Binge drinking and the risk of liver events: a population‐based cohort study. Liver International, 37(9), 1373-1381.

[9] Ohashi, K., Pimienta, M., & Seki, E. (2018). Alcoholic liver disease: A current molecular and clinical perspective. Liver research, 2(4), 161-172.

[10] Sugar content in wine revealed: Health experts deem alcohol labelling ‘woefully inadequate’. Alcohol Health Alliance, 16 February 2022. [Accessed 19 April 2025]. Available at: https://ahauk.org/news/sugar-content-in-wine-revealed-health-experts-deem-alcohol-labelling-woefully-inadequate

[11] Teschke, R. (2019). Alcoholic liver disease: current mechanistic aspects with focus on their clinical relevance. Biomedicines, 7(3).

[12] Malnick, S. D. H., Alin, P., Somin, M., & Neuman, M. G. (2022). Fatty Liver Disease-Alcoholic and Non-Alcoholic: Similar but Different. International journal of molecular sciences, 23(24), 16226. https://doi.org/10.3390/ijms232416226

[13] NHS website. Alcohol-related liver disease. (20 September 2022). [Accessed 19 April 2025]. Available at: https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld

[14] Seitz, H.K., Bataller, R., Cortez-Pinto, H., Gao, B., Gual, A., Lackner, C., Mathurin, P., Mueller, S., Szabo, G. and Tsukamoto, H. (2018). Alcoholic liver disease. Nature Reviews Disease Primers, 4(1), 1-22.