The British Society of Gastroenterology along with the British Association for the Study of them Liver support those medical teams who care for patients with liver disease. These healthcare workers see the destructive effects and distress caused by alcohol-related liver disease first hand.
In this blog, Dr Ewan Forrest, Consultant Hepatologist at Glasgow Royal infirmary and Alcohol Lead for the British Society of Gastroenterology, shares his personal reflections from the frontline — highlighting the human cost of alcohol harm, the urgent need for action, and how we can prevent more lives from being lost to this entirely avoidable disease.
Seeing patients with severe alcohol-related liver disease is an almost daily occurrence for most doctors specialising in gastroenterology and liver disease. Whilst every patient suffering from this condition is an individual tragedy, inevitably the memory of caring for some patients remains longer than others. This is not because anyone patient’s suffering is more or less significant than another’s. It is perhaps because the consequence of their illness is in such stark contrast to what could have been if this preventable disease had been avoided.
For my own part I often reflect upon a patient in their 30s with severe alcohol-related hepatitis, a severe form of alcohol-related liver disease characterised by the rapid onset of jaundice and development of liver failure. I met this patient after they had been admitted to hospital for the very first time. I recall sitting at their bedside hearing about their young family and their determination to get better to return home to see them. They knew they had been drinking too much alcohol and that this had increased during the pandemic lockdown, but they had not appreciated how harmful this could be. Tears were shed, and it is the tears I remember with sharp vividness. The jaundice was so severe that the tears themselves were tinged yellow, and they left bright stains on the paper tissues used to stem their flow. Despite all the best supportive medical care we could provide, this patient died 2 weeks later.
Alcohol related liver disease is rising
I wish I could say this was unique: a one-off experience. However along with my colleagues in gastroenterology and liver disease, this is a situation we see recurring with heart-breaking regularity. The individual tragedy is reflected in population statistics. The latest figures from the Office for National Statistics on alcohol-specific deaths highlight the grim reality of alcohol harm throughout the United Kingdom. Between 2013 and 2023, the number of those dying from an alcohol-specific cause has risen by 54%. Those from more deprived sections of our society bear a disproportionate burden of alcohol-related harm and suffering. The rise in alcohol-specific deaths has been particularly steep over the last 5 years, perhaps reflecting detrimental changes in drinking patterns since the COVID related lockdowns.
In England, the overall increase in alcohol-specific deaths between 2018 and 2023 was 45%. The increased number of deaths was especially noticeable in the North East (68%) and East England (55%). In Scotland, where minimum unit pricing for alcohol has been in place since 2018, the rise in deaths was lower at 12%, suggesting that the minimum unit price for alcohol may have blunted the impact of lockdown drinking. However, any increase in alcohol-related deaths is a tragedy, and there is certainly no room for complacency as Public Health Scotland has just produced a report which estimates a 54% increase in liver deaths in Scotland by 2044.
Over three quarters of alcohol-specific deaths are due to alcohol-related liver disease. However, many patients are unaware they have liver disease until they have to come to hospital as an emergency. Alcohol-related liver disease certainly earns its moniker as a ‘silent killer’: although it screams loudly when it chooses to reveal itself. Over a quarter of patients admitted to hospital on account of alcohol-related liver disease are attending for the first time. Of these, around 15% will not survive to be discharged and around one third will be dead within a year. If this was any other medical condition, there would be major public health campaigns with politicians clamouring to be seen to address the issue.
But society’s relationship with alcohol is complex. The call to ‘Drink Responsibly’ pushed by the alcohol industry places the responsibility for any harm on the drinker, not the products, drinks industry or society. To develop an alcohol problem of any kind, is therefore framed as a failure of the individual. This amplifies the stigma which those suffering from alcohol difficulties already experience. With stigma comes isolation; with isolation comes further difficulty in addressing the underlying alcohol use disorder. No one has their first drink intending to be harmed or even die from an alcohol-related illness. Yet for many in our society that is their ultimate destination, encouraged on their way with persistent advertising, pervasive marketing and positive imagery publicised by the drinks industry.
So, what can be done?
This is a multifaceted problem which needs a multifaceted approach. Public health and legislative measures play an important role and have been shown to be effective in minimising alcohol harms. We also need to prioritise screening and early intervention as we know that action taken earlier on can prevent hospital admissions and suffering. It is important for us to work with colleagues in addiction services, as an integrated approach to both the liver disease and the alcohol use disorder is in the best interest of our patients: either one approach is of little long-term benefit without the other.
Thankfully, this isn’t a hopeless situation. Alcohol-related liver disease is preventable — and we already have the tools to turn the tide. Policies such as minimum unit pricing, restrictions on alcohol marketing, and reduced availability have proven impact. Investment in alcohol care teams within hospitals and improved access to treatment services in the community can support people to reduce their drinking before irreversible harm is done. We must also challenge stigma, ensuring that those experiencing alcohol problems are treated with compassion, not blame.
As clinicians, policymakers, and members of society, we all have a role to play in building a future where fewer lives are lost to alcohol, and more people are empowered to lead healthy, fulfilling lives. We can — and must — change the story. Most of all, I do not wish to see bright yellow tear stains on paper tissues ever again.
Written by Dr Ewan Forrest, Consultant Hepatologist at Glasgow Royal infirmary and Alcohol Lead for the British Society of Gastroenterology,
This blog was published with the permission of the author. The views expressed are solely the author’s own and do not necessarily represent the views of the Alcohol Health Alliance or its members.
