Mental Health

Harm Reduction for Alcoholic Liver Disease Can be Challenging | by Gillian May | Nov, 2021

Ever since I lost my dad five years ago to alcoholic liver disease, I’ve researched and wrote about the condition hoping to help others. I often write about the confusing aspects of the condition and physical clues about the disease to help people get the treatment they need. My goal is to help prevent the sudden death and disability that alcoholic liver disease can create.

The number one way to prevent or reduce harm from this condition is to cut back or quit drinking. However, this is much easier said than done. Addiction is one of the most complex conditions out there. People often say, “why don’t you just quit then,” but they don’t understand how deep addiction goes and how hard it is to stop. For those without any support, resources, or meaning in their life, quitting an addiction may be close to impossible.

For this reason, I often target my education towards understanding the disease and learning what to look for when the disease starts to harm the liver. My thought is, if people at least understand how this condition creeps up on them, they may seek help sooner before real danger arrives.

Of course, this still requires a person to actually quit drinking or reduce their drinking enough to stay out of harm’s way. So why is harm reduction so challenging with alcoholic liver disease? There are a few factors I will point out below.

People don’t seek help.

Alcoholism, like many addictions, is highly stigmatized in society. That’s nothing new, yet most of us haven’t clued in that stigma actually harms people. We inappropriately paint alcoholics as bad people who have no self-control. This causes alcoholics to stay quiet about their drinking, which means they don’t seek help.

The other issue is that help is so limited right now. Services and treatment centers are so full, and there’s not enough funding to create more space. Even accessing therapy is becoming very difficult, which means most people would prefer to drink than try to access help and be frustrated.

People can’t quit drinking.

We can say alcoholics should quit drinking, and really, that’s the only way to prevent alcoholic liver disease. However, the nature of alcoholism is to protect the addiction. People use alcohol to cover emotional and physical pain, and thus they don’t want to be without it. Also, the chemical dependency of alcoholism makes it difficult for people to quit without going into withdrawal.

The brains of alcoholics become hard-wired for alcohol use over time. Not only is their system primed for severe withdrawal should alcoholics quit drinking, but their nervous system has changed to favor the chronic use of alcohol. These changes highlight the neuroplasticity of our brains — neuroplasticity is how the brain adapts to habitual activities, including addiction. Over time, our brains get so used to drinking that trying to change this becomes extremely hard. The more people understand this, the less they can label people with addictions as inherently flawed somehow.

Most alcoholics find reducing drinking to be impossible.

The other way to reduce harm is also to reduce the amount of alcohol consumed. Logic says that if an alcoholic can’t quit drinking, they can perhaps cut down to reduce the possibility of damage to the liver. However, again, this is easier said than done.

The nervous system of people who abuse alcohol is used to operating with a certain level of alcohol in the blood. Over time, alcoholics build a tolerance for alcohol, which means they have to consume more to get “high.”

Firstly, reducing the amount of alcohol would cause an increase in withdrawal symptoms. Secondly, the brains of people with addiction depend on the substance to get a reward and thus to feel a sense of pleasure. Reducing alcohol use would disrupt this adaptation making life feel more uncomfortable. While many people with addictions can get past this to save their health, others can not. Within this problem lies the mystery of why addiction is so hard on some people.

Other health conditions complicate the overall picture.

There are indeed many people out there who drink heavily and do not have liver disease. Or they may have a mild case but can live a generally healthy life. There are many factors for why certain people get problematic liver disease compared to others, but co-morbid conditions could also help explain a bit. Research shows that people with liver disease fair worse if they have other co-morbid conditions like diabetes, depression, pain conditions, or metabolic issues.

According to research, people who abuse alcohol and have other co-morbid conditions may be more likely to get alcoholic liver disease. There’s many reasons for this but it can be boiled down to more wear and tear on the liver from medicines and the general pathophysiology of these conditions. However, other health conditions complicate the picture because it may be difficult to control how these conditions affect the body over time. When you add in heavy alcohol use, it’s hard to know the origin of liver problems should they arise.

The liver is a forgiving organ, but it makes things more confusing.

Lastly, harm reduction for alcoholic liver disease can be complicated by the fact that the liver is such a forgiving organ. What this means is that the liver can withstand a lot of abuse before it becomes too damaged to function properly. And each person is so different as to how forgiving their livers actually are.

While its a good thing that the liver is so forgiving, it can also mean that people don’t know there’s a problem until the problem has become bad enough to cause symptoms. By the time liver disease causes symptoms, the damage has reached a high level. This is why prevention and harm reduction is so important. This is also why education matters — people need to understand those earlier signs and start consulting with their doctors more.

This article covered some reasons why harm reduction for alcoholic liver disease can be challenging. While it’s hard to diagnose and treat alcoholic liver disease, it’s not impossible if the condition is caught early enough. The best way to prevent this condition is to quit drinking or drastically reduce the amount of alcohol ingested. However, this discussion highlighted why this can be easier said than done at times.

Hopefully educational articles like this can help the general public understand alcoholism and alcoholic liver disease better. Knowing more may be a big step in preventing and reducing harm.


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