Alcoholism and Liver Disease
27 March 2006
Doctors at the University of Southampton have found that most patients with severe alcohol-induced liver disease do not have a dependence on alcohol, as generally previously believed. These findings are at odds with current strategies to combat the increase in alcohol related deaths which are targeted at those with alcohol dependency.
In a study of thirty four patients with severe ALD (Alcohol-Induced Liver Disease), the team found that only 9 per cent showed evidence of severe alcohol dependence. They were more likely to be employed, married or in a stable relationship, and to drink with family, friends or work colleagues - a pattern which often escalated into heavy drinking.
This compared with the control group of thirty four patients known to have alcohol dependence, who were more likely to drink alone, to be unemployed and unattached. The trigger for heavy drinking was likely to be a traumatic event and/or depression.
'The majority of patients presenting with alcoholic liver disease appear to be heavy controlled or social drinkers, leading relatively controlled lives, perhaps not feeling that their drinking is a major health issue until they are diagnosed with end-stage liver disease, at which point the liver has been damaged to the extent that only 30 per cent will be long term survivors. Alternatively, if drinking spirals out of control as a result of dependence, subjects are more likely to seek treatment at an earlier stage, and therefore survive for longer.' said Dr Nick Sheron, consultant hepatologist and senior lecturer at the University of Southampton.
'The high mortality from severe ALD at first presentation means that there are limited options for reducing deaths. The current government focus on binge drinking and on alcohol dependency will miss many patients who will later die from ALD. The documented rise in liver deaths so far is very worrying but does not include the impact of more recent changes in drinking patterns, particularly in women. Unless something is done fairly urgently, we predict a continued rise in deaths from ALD over the next 10 years, most particularly in young and middle aged women,' concludes Dr Sheron.
Professor Ian Gilmore, Chairman of the Royal College of Physicians' Alcohol Committee said: 'The Royal College of Physicians welcomes this important piece of research which dispels the myth that all patients with alcoholic liver disease are alcoholics or dependent drinkers. Because alcoholic cirrhosis is such a silent killer, the first signs may come when it is already too late. This emphasises the importance of early detection of problem drinkers in the NHS and the availability of advice and support to help people cut down on their drinking.'
Notes for editors
The results were based on a completed questionnaire on basic demographic characteristics and the Severity of Alcohol Dependence Questionnaire (SADQ) which was devised according to guidelines issued by a World Health Organisation committee and is considered a valid and reliable method for rating alcohol dependence. The full paper is published by Oxford University Press and can be accessed via www.alcalc.oxfordjournals.org.
A new website which helps calculate the damage done to an individual's liver and other organs by drinking unsafe amounts of alcohol was launched in January this year. The 'Drinkulator' traffic light drink calculator (www.drinkulator.org) is the brainchild of students and staff at the University of Southampton's School of Medicine.
Total recorded alcohol consumption in the UK is estimated to have doubled between 1960 and 2002 and deaths from liver disease have increased eight-fold since the 1970s in England.
Established in 1971, the University of Southampton's School of Medicine is at the forefront of medical and basic science research. It is one of the top ten UK medical schools for research income and high quality outputs, and its innovative educational programme has been rated excellent (the highest possible rating) by the government-backed Quality Assurance Agency.
The School is committed to academic excellence in all aspects of research and medical education. It operates a highly focused research strategy with large interdisciplinary Research Divisions that bridge traditional subject boundaries. These divisions provide a critical mass of research resources and explore areas of common intellectual interests around important clinical problems. There are six Research Divisions and an Education Division reflecting the School's major strengths: Human Genetics; Community Clinical Sciences; Infection, Inflammation and Repair; Cancer Sciences; Developmental Origins of Health and Disease; and Clinical Neurosciences.
The University of Southampton is one of the UK's top 10 research universities, with a global reputation for excellence in both teaching and research. With first-rate opportunities and facilities across a wide range of subjects in science and engineering, health, arts and humanities, the University has around 20,000 students and 5,000 staff at its campuses in Southampton and Winchester. Its annual turnover is in the region of £274 million.
Southampton is recognized internationally for its leading-edge research in engineering, science, computer science and medicine, and for its strong enterprise agenda. It is home to world-leading research centres, including the National Oceanography Centre, Southampton; the Institute of Sound and Vibration Research; the Optoelectronics Research Centre; the Textile Conservation Centre; the Centre for the Developmental Origins of Health and Disease; and the Mountbatten Centre for International Studies.