Why prevention is better than cure for alcohol-related problems

As a hepatologist (liver doctor), many people I look after have alcohol-related liver cirrhosis. Unfortunately, once the liver is severely scarred, we have no effective medication that can improve or reverse it. Liver disease remains the only common cause of death that is increasing in the UK, often because problems aren't detected until the disease is advanced. With a 50% mortality rate over two to three years for those with the most advanced forms, the old adage "prevention is better than cure" could not be more appropriate. 

However, this approach isn't just attributable to liver disease. Many alcohol-related problems, including various cancers and heart disease, can be prevented by reducing your risk. While the majority of drinkers may not develop these conditions, the risk is cumulative: the more you drink, the higher the chance of developing alcohol-related health problems.  

Sticking to (or staying as near as possible to) the Chief Medical Officer’s (CMO) low-risk guidelines of 14 units a week is the most effective way to prevent serious problems down the road. 

The missed middle ground of increasing-risk drinking 

Recent data from the Drinkaware Monitor describes UK drinking practices and demonstrates why we must help risky drinkers change their relationship with alcohol. 

The data suggests that a preventative approach would be highly effective to reduce alcohol harm in the UK. While 18% of UK drinkers (equivalent to 8.2 million people) drink above the CMO’s guidelines, the majority of these individuals (15%) are drinking at increasing-risk levels, rather than high-risk levels (3%). 

These increasing-risk levels are defined by the CMO guidelines as: 

• Between 15 and 34 units per week for women 
• Between 15 and 49 units per week for men 

This insight highlights that while around seven million people are drinking in ways that could increase their risk of harm over time, they still have time to make positive changes. Early intervention and prevention strategies could help this group reduce their consumption to lower-risk levels before high-risk patterns or serious health problems occur. 

Additionally, with 60% of UK drinkers reporting binge drinking within the past year and 12% doing so at least weekly, there is clear evidence of risky drinking patterns that could be reduced through targeted education and awareness campaigns. 

Many risky drinkers do not believe they need to cut back 

Perhaps more worryingly, the research found that many at-risk drinkers do not believe they need to consider cutting back. Despite the increased health risks, 43% of risky drinkers did not attempt to reduce their consumption in the last year. Although there are many reasons why people may not cut back, misperceptions about what constitutes "problem" drinking are a major barrier to health:

• Over half (58%) of risky drinkers believe there is “nothing seriously wrong” with their drinking 
• 57% consider themselves “fairly normal” drinkers 
• 43% believe it is a waste of time to reflect on their drinking because they do not see it as a problem 

As a liver doctor, my role is to support people in maintaining a healthy liver. Seeing up to 58% of people at drinking at risky levels not acknowledging their consumption is of great concern. Alcohol-related problems, especially liver problems, are preventable through moderation, but they are incredibly difficult to manage once severe damage occurs. 

Unlike many other health care conditions, a person who is drinking too much alcohol has more power to improve their health than any consultant does. You can reduce the risk of alcohol-related problems far more effectively through lifestyle changes than I can through medical intervention. 

For those in those "increasing-risk" drinkers, the first step is simple: acceptance. By acknowledging these patterns and seeking support to cut down, you are taking the single most important step in protecting your long-term health.