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Alcohol and Liver Disease: Why Women Are at Higher Risk

April 19, 2021

The expectation of local and national experts for an increase advanced liver disease, especially among women, is on the rise and expected to keep climbing.

Research published in The Lancet predicted substantial increases in cirrhosis, liver cancer and deaths. More than 44,000 Americans died of alcohol-related liver disease in 2019.

“These researchers found that women were especially at risk given changes in society’s drinking habits, the way their bodies process alcohol and increased stress, partly from the pandemic,” said Danielle Gleason, a psychologist on the Hartford HealthCare (HHC) transplant team at Hartford Hospital.

National trends show that liver disease still affects more men than women, but women are driving the current spike. At HHC, more women are being treated for liver diseases in the last three years..

“Women drinking the same amount of alcohol as men are at a much greater risk of developing alcohol use disorder (AUD) and related medical problems. We’ve only seen that ramp up through the pandemic,” said Dr. Gleason, who works with Melissa Monroe, clinical director at Rushford, to address AUD in patients coming in for liver transplant.

Calling it “an incredibly resilient organ,” she said people are often unaware of the damage drinking causes until the liver begins to fail. The early stages of alcohol-related liver disease have few, if any, symptoms.

“Another factor is denial,” Dr. Gleason added. “Denial is an important defense mechanism because addiction is often coupled with strong emotions like shame. Substance use allows them to avoid negative emotional states and denial allows them to continue drinking to cope.”

Women face more challenges against AUD than men because they are more likely to contend with such contributing factors as trauma, stressor-related disorders, depression and anxiety.

Other challenges specific to women include:

• Identifying support to help after transplant, since women are typically the family’s caregiver.
• Accessing AUD treatment that meets their unique needs. Many prefer women-only treatment models because of past trauma.

“Women are less likely to undergo a liver transplant and are more likely to die waiting for a donor organ,” Dr. Gleason noted, adding that research shows “women are at a disadvantage through all stages in the transplant process” due to body size and implicit bias when selecting donor organ recipients.

The HHC transplant team helps optimize patient health before surgery to ensure quality and longevity of life after. Patients with a history of AUD must actively participate in recovery and undergo a behavioral health evaluation to be considered for transplant, Dr. Gleason said.

“Optimal transplant patients are those who demonstrate a willingness to partner with our transplant team, engage actively in recovery, understand their substance misuse, have stable support and can manage complex, post-transplant medical care,” she said.

While transplant is an option for some, experts stressed the need to curb excessive consumption in the first place.

“We need to focus on changes on a societal level that address high-risk drinking in order to stop the increases in alcohol-related liver disease,” Monroe said.