What is alcohol-related liver disease (ARLD)?

Alcohol-related liver disease (ARLD) is liver damage caused by drinking too much, and it is the biggest reason people in the UK develop serious liver problems. Alcohol is responsible for six out of every ten cases of liver disease in this country, and around one in five adults drink at levels that put their liver at risk. You do not need to be addicted to alcohol for this to happen. Regularly finishing a bottle of wine with dinner or having several pints most nights of the week is enough.

ARLD is not one condition. It is a spectrum that goes from something your liver can fix on its own, all the way through to damage that can kill you. Most people on that spectrum have no idea they are on it until it has reached a dangerous and wholly avoidable emergency.

How ARLD develops

Your liver processes alcohol every time you drink. It breaks alcohol down and removes it from your body, but every time it does this, some liver cells die. Normally, that isn’t a huge problem because the liver is one of the few organs that can grow new cells to replace the ones it loses. But if you drink often enough and heavily enough, your liver stops being able to keep up. It then falls behind on repairs, and the damage starts to accumulate.

Factors that contribute to liver damage from alcohol

The severity and speed of the damage can really vary a lot from person to person. Only about one in three people who drink heavily over a long period will develop cirrhosis, which is the most advanced stage of ARLD. Genetics, body weight, sex, and other health conditions all play a role in how vulnerable your liver actually is.

Women are at higher risk than men because they produce less of an enzyme called alcohol dehydrogenase, which helps break alcohol down. This means that more alcohol reaches the liver in a concentrated form. Diabetes, hepatitis, and carrying excess weight also increase the risk of liver damage from alcohol.

The stages of ARLD

ARLD moves through four main stages, but there can be an overlap, and not everyone progresses through all four.

Why many people find out about ARLD too late

In many cases, alcohol liver disease symptoms do not become obvious until the damage is already advanced. In the early and middle stages, you can feel completely fine while your liver is quietly deteriorating. This is why it is so often picked up by accident during blood tests or scans ordered for something else entirely.

A UK study of people who died from ARLD found that more than half had either never been diagnosed or were only diagnosed within six months of their death. But these weren’t usually people who had been hiding from doctors. Many of them had been in and out of hospitals and GP surgeries for years, with multiple admissions, appointments, and emergency visits, but nobody had connected their symptoms to alcohol-related liver damage until it was too late.

The symptoms of ARLD

When alcohol liver disease symptoms do appear, they often include:

• Persistent tiredness
• Unexplained weight loss
• Loss of appetite
• Nausea
• Tenderness or pain on the right side of your abdomen

In more advanced cases, you may notice:

• Yellowing of the skin and eyes
• Swelling in the legs or abdomen
• Confusion
• Vomiting blood

By the time these signs are visible, the liver is usually in serious trouble.

How ARLD is detected and treated

If your GP suspects liver problems, they will usually start with blood tests to check your liver enzymes and how well the organ is functioning. A FibroScan, which is a painless scan that measures liver stiffness, can give a clearer picture of whether scarring has developed. In some cases, an ultrasound or biopsy may be needed to assess how far things have progressed.

There is no drug that reverses ARLD. The most effective treatment at every stage is to stop drinking. For fatty liver, this alone is often enough for a full recovery. For hepatitis and early fibrosis, stopping can halt the progression and allow some degree of healing. For cirrhosis, stopping won’t undo the scarring, but it can prevent further deterioration and significantly extend your life.

Beyond stopping alcohol, treatment focuses on managing complications. This can include medication for fluid retention, dietary changes to address malnutrition, and, in the most severe cases, a liver transplant. To be considered for transplant, you typically need to have been abstinent from alcohol for a sustained period and demonstrate that you have support in place to stay that way.

What you can do right now to reduce the risk

If you drink regularly and have never had your liver checked, asking your GP for a blood test is a reasonable first step. This is especially worth doing if you drink more than 14 units a week, if you have been drinking at that level for several years, or if you carry excess weight. You do not need to wait for symptoms. The whole point of early detection is catching damage before it announces itself.

If your drinking has reached a level where cutting down feels difficult, or where you have tried and not managed it, the issue is no longer just about your liver. Alcohol addiction changes the way your brain works, and willpower alone is often not enough. It is a condition that needs proper treatment, the same as any other.

Getting support through EATA

Whether you are worried about your drinking and want to get ahead of the problem, or you already know your liver has been affected and need help stopping, we can help you. Contact EATA for free, confidential advice. You do not need a diagnosis or a referral to get in touch. We can help you figure out where you stand and what to do about it.