During COVID: More alcohol consumption, more hospital patients with liver disease

Written by Amy Ta, produced by Bennett Purser

With the loneliness of quarantine and lockdowns, alcohol consumption has been going up. Liquor consumption last year increased by 19% for adults ages 30-59, according to a study from the National Institute of Alcohol Abuse and Alcoholism. The pandemic-driven economic crisis is also making life tougher for people struggling with sobriety. That means an increase in severe liver disease. 

KCRW talks about this with Dr. Brian Lee, a hepatologist and liver transplant specialist with Keck Medicine at the University of Southern California.

KCRW: Are you seeing a rise in patients having problems with their livers and alcohol addiction?

Dr. Brian Lee: “That's right. It's really been a trend that we've been seeing even before COVID. But it's been particularly pronounced with COVID. That is, people who are drinking more and come in with severe liver disease in the hospital.”

What is severe liver disease? What are the symptoms?

“Liver disease, people think about somebody who is yellow and with a big belly and early cirrhosis, which is end stage liver disease. But the reality is that most people with cirrhosis don't have any symptoms at all. 

So one, I think it's important to recognize heavy alcohol use, and to speak to that with your doctors to be able to screen the screen for liver disease. 

But in the hospital, when somebody is very sick, what we see is that people come in with alcoholic hepatitis, which is severe inflammation from alcohol use, or they have decompensated cirrhosis, meaning that they've developed, a fluid in the belly or an infection or bleeding from their liver disease.”

If most people don't have symptoms, how do you know if you have liver disease?

“It's important to be screened for it. So we have blood tests, imaging, or biopsies to be able to tell if you have liver disease.”

What’s the definition of heavy drinking?

“The actual definition is four drinks per day for women, and then five drinks per day for men. … What people don't know is that you can develop liver disease at much lower amounts. So they've been shown that women who drink more than one drink per day on average, and two drinks per day for men, can cause significant liver disease over time.”

Is there any safe level of alcohol consumption?

“We used to think that if you were below the threshold, meaning one drink per day for women and two drinks per day for men, but there's a recent very large global study that showed that any amount of alcohol actually reduced overall survival and life expectancy. So many people would say that there isn't any safe level of alcohol consumption.”

Can the liver repair itself if it's been damaged by alcohol consumption?

“Yeah, exactly. So the liver is an incredible organ. And that after damage, it's able to grow back and regenerate. People who have had heavy drinking and they develop hepatitis, if they're able to stop drinking, the liver is able to recover. 

Now there comes a point, particularly when you have cirrhosis, that it might be too late. So it's really important to recognize liver disease early, especially when it's from alcohol.”

What are you hearing from your patients who struggle with alcohol during this pandemic? 

“I think that COVID has caused a lot of stress in many different ways. And we know now that stress is heavily linked to alcohol use, whether you start drinking, or your drinking habits become worse. 

I've heard all sorts of stories, whether it's from the stress of the virus itself, or being lonely or bored at home, or being divorced … or losing your job.”

What are you advising people? Should they not drink at all or drink in moderation? 

“People with liver disease, especially those who come into the hospital with liver disease due to alcohol … I always say not even a drop of alcohol ever again. Now that's easier said than done. And alcohol use disorder is a disease. But really, somebody with liver disease really shouldn't be having a drop of alcohol.

… I'd say that for somebody who's healthy, from a liver perspective, one drink per day for women, two drinks per day for men shouldn't really cause significant liver disease. But those who already have liver disease, not even a drop.” 



  • Dr. Brian Lee - hepatologist and liver transplant specialist with Keck Medicine at the University of Southern California