By Adam Koh. In consultation with Dr Kenneth Koo, Director & Senior Consultant, Gastroenterology & Hepatology and Dr Irene Tirtajana, Associate Consultant, Psychiatry.

A little wine or beer can be a good thing. Alcohol helps people relax, so it’s no wonder it is often used as a social lubricant to liven up the mood. Moderate drinking – one standard drink a day for women and up to two standard drinks a day for men – is generally harmless for most healthy people and may impart some health benefits. Red wine, for instance, is good for heart health. However, frequently drinking large amounts of alcohol, or binge drinking, can cause significant damage to the liver.

Related: Alcohol — More than Meets the Eye

Toxic Overload Due to Excessive Alcohol Intake

Excessive alcohol intake can lead to toxic overload.

In most people, a little alcohol consumption poses no problem. This is because the liver, the body’s ‘chemical plant’, contains special enzymes to break down and neutralise alcohol.

Dr Kenneth Koo, Director and Senior Consultant, Gastroenterology & Hepatology, Ng Teng Fong General Hospital, explained, “The liver processes alcohol and breaks it down to acetaldehyde.” Excessive alcohol intake means more acetaldehyde is formed. This potentially toxic compound is responsible for many of the side effects of alcohol such as nausea, headaches and flushing.

“Prolonged exposure to acetaldehyde is thought to play a role in the development of alcoholic liver disease, among various other mechanisms,” he added.

Long-Term Alcohol Abuse

This is why long-term alcohol abuse can result in alcoholic liver disease, a spectrum of liver injuries that can range from a relatively mild disease such as fatty liver, to more severe forms of liver inflammation such as alcoholic hepatitis. Alcohol abuse can also lead to the formation of permanent scar tissue in the liver or liver cirrhosis.

Fatty liver occurs when fat accumulates within the liver cells, enlarging and damaging them. If left untreated, fatty liver disease progresses to cirrhosis. This is where liver cells are replaced with fibrous scar tissue.

The build-up of scar tissue impairs the functioning of the liver, causing bodily processes to deteriorate. When the liver fails, the body loses its ability to produce essential biochemicals, store nutrients, detoxify metabolic waste, clot blood and regulate glucose.

Cirrhosis can cause bleeding, retention of fluids, mental confusion, and in some cases, progress to cancer. Apart from liver disease, alcohol abuse can also lead to a myriad of other health problems such as damage to the pancreas, numbness in the hands and feet and heart problems.

Related: Alcohol and Health—Setting Your Drink Limits

One Standard Drink Too Many

Excessive alcohol intake may increase the chances of liver disease.

While not everyone who drinks alcohol will develop liver disease, alcohol abuse is the most significant risk factor, Dr Koo said. “The risk of cirrhosis increases for men who drink more than 60g to 80g of alcohol a day for more than 10 years.

For women, the risk increases for those who consume more than 20g a day.” The type of alcohol may also influence the risk of developing alcoholic liver disease, he added. He pointed to a study in Denmark that revealed that drinking beer or spirits was more likely to be associated with liver disease than wine drinking.

Having five or more drinks at one sitting for men, or four or more drinks for women – has been shown to increase the risk of alcoholic liver disease. Women are also at higher risk of alcoholic liver disease than men. Other risk factors are smoking, obesity and the existence of liver disease such as chronic viral hepatitis.

Medical Help and Management

Seek help if you or your loved ones are experiencing symptoms of alcohol abuse.

Seek help early if you suspect that you or a loved one have a drinking problem and are at risk of alcoholic liver disease. The condition can be diagnosed through a combination of a thorough patient history, physical examination, blood investigations and an ultrasound scan of the liver.

“Once diagnosed, treatment requires a holistic approach involving many healthcare professionals,” said Dr Koo.

“The mainstay of treatment is complete alcohol abstinence. Often this involves healthcare professionals trained in addiction medicine. Nutritional support is also important as many patients with drinking problems are malnourished, and this is associated with a poorer outcome.”

The good news is that for people in the early stages of fatty liver disease, abstaining from alcohol for four to six weeks can reverse the condition. Late-stage disease may require more sustained management such as lifestyle changes, total abstinence and medication. Advanced liver cirrhosis may require a liver transplant for long-term survival.

Related: How Much Is Too Much?

Quit for Good!

Alcohol abuse can lead to various health problems.

Regular alcohol consumption may result in dependence. Some signs include craving; the need to drink increasing amounts in order to achieve the same effect; and anxiety, sweating, nausea or shaking when abstaining from alcohol. If there are signs of a physical dependence on alcohol, it is safer to quit under medical supervision. If you wish to quit, these are some important steps to take.

  1. Determine your goals: Ask yourself if you wish to stop drinking altogether or just cut back. For instance, decide your drinks limit per day and commit to two or more ‘dry’ days per week. Cutting down on your alcohol intake can set the stage for abstinence.
  2. Set your milestones: Decide when your plan to stop or limit drinking starts. If you’re trying to stop drinking, set a specific quit date.
  3. Celebrate your victories: For every goal reached (e.g. a period of total abstinence reached), give yourself a pat on the back for staying on your journey of recovery.

Related: Life is Better When You're Sober

Tips for Staying on The Wagon

Prevent excessive alcohol intake and keep to 1 standard drink.

Get Rid of Temptation to Stop Drinking or Avoid Excessive Alcohol Intake

  • Remove all alcohol and related paraphernalia from your home and office
  • Tell your friends, family members and co-workers
  • Inform others you’re trying to stop drinking. If they drink, ask them to support your recovery by not doing so in front of you
  • Be honest and upfront about your new limits. For example, let guests know that drinking is not allowed in your home and that you may not be able to attend social events where alcohol is served

Find Social Support to Prevent Alcohol Abuse

  • Join a support group or talk to people who have successfully quit or cut back on drinking.
  • Seek Help! If you experience noticeable withdrawal symptoms in the process of cutting down on alcohol, seek medical advice/supervision. Consult a doctor or seek emergency treatment if you experience severe tremors, vomiting, fever, seizures, confusion, visual/auditory hallucinations or paranoia.

Putting Down the Glass

  • The point at which social drinking becomes a prelude to alcohol abuse can be a fine one; not many people readily accept they have a problem. Answering ‘yes’ to two or more of these questions indicates a possible alcohol problem and professional help is recommended.
    1. Have you ever felt you should cut down on your drinking?
    2. Have you ever been annoyed when people criticise your drinking?
    3. Have you ever felt guilty about your drinking?
    4. Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

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This article was first published in ONEHealth Magazine, 2016 Issue 8