Alcohol —By Alan Franciscus
Did You Know…
- Drinking moderate to heavy amounts of alcohol is linked to seven types of cancer: mouth, esophagus, larynx, liver, colon, rectum, and breast.
- A survey in 2015 reported that 15.7 million people in the United States had an alcohol use disorder in the prior year.
- Alcoholic liver disease (without hepatitis C is a leading cause of cirrhosis, liver cancer, and death.
- Drinking alcohol increases the level of fat in the liver that can lead to steatosis (fatty liver). Fatty liver can cause severe disease progression including cirrhosis, liver cancer, liver transplantation, and death. Fatty liver will soon surpass Hep C as the leading cause of cirrhosis, liver cancer, and liver transplantation.
If you have chronic hepatitis C (HCV), a healthy approach to keep the liver and the body healthy is to abstain from drinking alcohol. However, the safe level of alcohol consumption for someone with hepatitis C is unknown. It is worth knowing that drinking too much alcohol can increase the risk of HCV disease progression to cirrhosis, liver cancer, and death. Many physicians and state Medicaid systems will refuse to provide HCV treatment to people who drink alcohol. Additionally, people who drink alcohol will not be able to receive a liver transplant.
Not Just the Liver
Drinking too much alcohol can cause:
- High blood pressure
- Central nervous system injury, such as to the brain and nerves (peripheral neuropathy – numbness and pain in the extremities)
- Sexual impotence in males and females
- Depression, anxiety, and other psychosocial problems
- Lowered immune system response, so people may not be able to fight off infections as effectively
It’s safe to say that everyone with HCV should abstain from alcohol. In a perfect world, everyone should abstain from drinking alcohol. But we do not live in a perfect world, and few of us are perfect. Alcohol is a very addictive substance. It is not practical to expect someone to stop drinking cold turkey. This approach does not work for most people and could be dangerous for people who have a serious addiction to alcohol.
There are many approaches to becoming sober. Alcohol, like any addiction, requires many approaches to achieve success. The recovery process may include medications, therapy, self-help groups. It should include family, loved ones, and friends.
Heavy drinkers over a period of months, years or even a short period, may experience severe alcohol withdrawal. The symptoms can range from mild to severe to life-threatening. If someone starts to experience alcohol withdrawal symptoms or if they believe they may experience these symptoms, they should talk to a medical provider before they stop drinking or as soon as they experience the symptoms. People who have previously experienced severe withdrawal symptoms should seek professional medical advice before they stop drinking. Some medications can help with the withdrawal symptoms.
Alcoholic Anonymous (AA)
A well-known abstinence program is Alcoholic Anonymous (AA). AA is a 12-step program that includes open meetings. The meetings are free; people share their stories, members work the program by following and working 12 steps with the aid of a sponsor who is in the program. The identities of the people and the stories shared within the meetings are kept anonymous.
Some medications can help reduce the craving for alcohol:
- Disulfiram (Antabuse) is an older drug that makes people sick if they drink alcohol.
- Naltrexone and nalmefene are opioid antagonists -the drugs block a neural transmitter to help reduce the cravings for alcohol.
- Various antidepressants such as SSRIs and tricyclics are drugs used specifically to replace a chemical in the brain depleted by alcohol. These drugs work better for people who are depressed after abstaining from alcohol.
- Gabapentin – anticonvulsant drug that helps with the effects from alcohol withdrawal.
- Campral – acamprosate – is thought to offset some of the negative effects of alcohol withdrawal.
The drugs above help to reduce the alcohol craving but work better when combined with self-help programs and therapy.
Harm reduction techniques are another way to reduce or stop drinking alcohol. The first step is to make a plan. For instance, if you drink six beers a day every week, reduce it to five beers a day the following week. The following week reduce drinking beer even more. Get to a point where there is a day in between where there is no alcohol. Another approach is to switch from higher alcohol content such as whiskey to a lower alcohol content such as beer. Be careful not to drink more of the lower alcohol content to make up the for the higher alcohol content.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) has a questionnaire called CAGE. Answering the following four CAGE questions can help you find out if you or a loved one has a drinking problem:
- Have you ever felt you should Cut down on your drinking? Y / N
- Have people Annoyed you by criticizing your drinking? Y / N
- Have you ever felt bad or Guilty about your drinking? Y/ N
- Have you ever taken a morning Eye-opener (drink first thing in the morning?) Y/ N
Answering yes to one question suggests that you may have an alcohol problem. Answer yes to two or more questions means that you likely have a problem with alcohol and should seek professional help or a peer-led group like AA.
Alcoholism is an insidious disease that affects everyone in the alcoholic’s orbit. The most important person in the process of becoming sober is the alcoholic. It’s a monumental task to take on the job to become sober. It may not happen the first or second time. But every time someone takes on the task, they will learn something valuable about themselves and the process. Eventually, perseverance pays off. Use every resource available, and enlist everyone in the process of being sober.
National Institute on Alcoholism and Alcohol Abuse. https://pubs.niaaa.nih.gov/publications/treatment/treatment.htm
NIAAA has recently launched the Navigator—a website that can help people with alcoholism. The website has no commercial ties or corporate sponsors. The information contained on the Navigator is based on scientific research. The goal is to educate and provide a wide variety information to help people with alcoholism. The Navigator also provide links to non-profit organizations and other resources for people to learn about alcoholism. https://alcoholtreatment.niaaa.nih.gov/
Alcoholic Anonymous https://www.aa.org/
Check out our Harm Reduction Glossary for more information about medications to reduce alcohol cravings.
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Alan Franciscus is the Executive Director of the Hepatitis C Support Project and the Editor-in-Chief of the HCV Advocate Website.
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