Alcohol-related disease is on the rise in the U.S., particularly for those under 35. From 1999 to 2016, the annual deaths from cirrhosis increased by 65%, while annual deaths from hepatocellular carcinoma doubled[1]. More recent research shows that the COVID-19 pandemic has only increased alcohol consumption, and has led to many people turning to alcohol to soothe anxiety, loneliness, and stress related to the pandemic. Scientists predict that the increase in alcohol consumption during the COVID-19 pandemic will result in 100 additional deaths and 2,800 additional cases of liver failure by 2023 and up to 8,000 additional deaths by 2040[2]. Although the pandemic was a considerable source of stress, the American Psychological Association’s 2022 Stress in America report paints a picture of Americans facing a cascade of external stressors that are generally out of personal control. The survey summarized that, “a majority of adults are disheartened by government and political divisiveness, daunted by historic inflation levels, and dismayed by widespread violence.” With a sense of hopelessness, less financial stability, and growing waiting lists for mental health care, more people than before are turning to alcohol to cope with the stress of daily life. 

Alcohol and the Liver

There is a wide range of liver diseases and conditions, the most common being hepatitis viruses, autoimmune diseases, genetic conditions, nonalcoholic fatty liver disease, and cancer. Liver disease can be caused by a number of different things including heavy or long-term alcohol consumption, fat accumulation in the liver, obesity, medications, autoimmune diseases, and infections. The liver has more than 500 vital functions, including processing drugs and alcohol and removing harmful substances from the body by breaking them down into smaller byproducts to be excreted from the body as feces or urine. 

Excessive alcohol use can cause a number of problems in the liver, including hepatitis, fibrosis, and cirrhosis. When someone has liver disease, a dangerous cycle begins. Hepatitis is a form of inflammation in the liver that can be caused by alcohol. Inflammation is an essential part of healthy liver function, is important in the removal of toxic substances, and is part of repairing damaged liver cells. When liver cells are damaged, collagen is released and stiffens around the damaged cells for healing. This is a very carefully regulated process, and when the cells are repaired, the collagen disperses and the liver returns to normal. 

This cycle of inflammation and healing can become dysregulated when alcohol triggers a continual inflammatory response in the liver. Regular inflammation can cause extra collagen to be deposited in the liver. This stiffens around the damaged tissue, but no signal is released to stop the inflammation and discard the extra collagen, which means that inflammation continues and more collagen is deposited and causes even more stiffening. This causes fibroids, or scars, to develop in the liver. These scars can continue to replace healthy liver cells, if untreated, which causes severe scarring known as cirrhosis – the end result of most liver diseases.[3] The road to cirrhosis can be different for everyone and is affected by genetic factors, obesity, and underlying health problems. 

Gender Disparities in Alcoholic Liver Disease

Traditionally, rates of liver disease are higher in men than women, although the past several years have seen young women drive the increase in liver disease-related deaths.[4] While the reasons for this are yet unknown, it is assumed to be a result of increased alcohol consumption in women as well as the way that women’s bodies process alcohol. Research shows that women develop alcohol-induced liver disease faster than men and after consuming less alcohol on average[6]. Additionally, women are more likely to develop alcoholic hepatitis and die from cirrhosis than men. Emerging animal research suggests that this increased risk of developing end-stage liver disease may be connected to the physiological effects of the female reproductive hormone estrogen[6], although there is not conclusive evidence. Additionally, we are seeing increased levels of alcohol consumption in women. During the early months of the COVID-19 pandemic, women’s alcohol consumption increased more dramatically than men’s.[5] This is suggested to be a result of the increased pressure on women as a result of the pandemic. From March to September 2020, far more women left their jobs than men, and in September alone, 865,000 women left the U.S. workforce — four times more than men. Expected to fulfill traditional gender roles, many American women were unable to continue working while taking care of their children who couldn’t go to school, taking responsibility for their children’s learning, caring for elderly loved ones, and looking after the home. Many women are still exhausted, stressed, and angry and are experiencing a sense of injustice that their hard-fought strides toward equality are being unraveled. This is further illustrated by the overturning of Roe vs Wade, which gave a sense to many women that their autonomy and freedoms were being revoked. 

Alcohol and Stress in Young Americans 

Alcoholic liver disease has traditionally been a problem that affects people over 35. However, the number of 25 to 34-year-olds who died annually from alcohol-related liver disease almost tripled between 1999 and 2016, with this age group experiencing the greatest relative increase in mortality.[7] The study did not identify the cause of this spike in alcohol-related mortality, but the years coincide with the economic recession of 2008. 

As the global economy struggles to recover from the COVID-19 pandemic and is faced with other geopolitical challenges, climate change presents a rapidly increasing threat to human life, and social media is contributing to an ever-more divided America, it is no surprise that young Americans are struggling.

According to a poll by the American Psychological Association[8], over a quarter of Americans state that most days they are “so stressed they cannot function.” College debt, rising house prices, the racial climate, inflation, violence, and crime are all causes of extreme stress in young Americans. Young adult women aged 18 to 34 were more likely to report that their stress is completely overwhelming most days as compared to older women and men, which correlates with the sharp increase in alcohol consumption and alcohol-related deaths in this group.

The American Psychological Association suggests that we should disrupt negative thinking patterns and take control where we can to mitigate the effects of external stressors. Giving yourself time to rest and recharge, asking friends and family for help where you can, and refraining from comparing yourself to others are all ways to reduce the weight of stress you are carrying. If stress becomes overwhelming or you have started consuming alcohol or other substances as a result of stress, reach out for support. Dealing with alcohol-related issues immediately offers the best chance of full recovery. 

If you or a loved one is struggling with anything you have read in this blog, please get in touch with Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.

References 

[1] Deutsch-Link, S., Jiang, Y., Peery, A. F., Barritt, A. S., Bataller, R., & Moon, A. M. (2022). Alcohol-Associated Liver Disease Mortality Increased From 2017 to 2020 and Accelerated During the COVID-19 Pandemic. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(9), 2142–2144.e2. https://doi.org/10.1016/j.cgh.2022.03.017

[2] Hampton, T. (2022, January 5). Study holds warning on pandemic drinking. Harvard Gazette. Retrieved January 23, 2023, from https://news.harvard.edu/gazette/story/2022/01/covid-related-drinking-linked-to-rise-in-liver-disease/ 

[3]Hepatitis (inflammation). American Liver Foundation. (2022, July 22). Retrieved January 23, 2023, from https://liverfoundation.org/about-your-liver/how-liver-diseases-progress/hepatitis-inflammation/ 

[4] Deutsch-Link, S., Jiang, Y., Peery, A. F., Barritt, A. S., Bataller, R., & Moon, A. M. (2022). Alcohol-Associated Liver Disease Mortality Increased From 2017 to 2020 and Accelerated During the COVID-19 Pandemic. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 20(9), 2142–2144.e2. https://doi.org/10.1016/j.cgh.2022.03.017

[5] Barbosa, C., Dowd, W. N., Barnosky, A., & Karriker-Jaffe, K. J. (2022). Alcohol Consumption During the First Year of the COVID-19 Pandemic in the United States: Results From a Nationally Representative Longitudinal Survey. Journal of addiction medicine, 10.1097/ADM.0000000000001018. Advance online publication. https://doi.org/10.1097/ADM.0000000000001018

[6] Eagon P. K. (2010). Alcoholic liver injury: influence of gender and hormones. World journal of gastroenterology, 16(11), 1377–1384. https://doi.org/10.3748/wjg.v16.i11.1377

[7] Tapper, E. B., & Parikh, N. D. (2018). Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: Observational study. BMJ. https://doi.org/10.1136/bmj.k2817 

[8] American Psychological Association. (n.d.). Stress in america 2022: Concerned for the future, beset by inflation. American Psychological Association. Retrieved January 23, 2023, from https://www.apa.org/news/press/releases/stress/2022/concerned-future-inflation