Reality Show Death Spotlights Cirrhosis Risk

March 19, 2008— -- Drunken driving accidents. Alcohol poisoning. Blackouts. Hangovers.

Such drawbacks of heavy alcohol consumption are familiar to young drinkers who overconsume. But a recent episode of a popular reality show may add one more potential risk to the list. And it is one that many alcoholics in their 20s and 30s may not expect: cirrhosis.

On Monday, A&E's "Intervention" showcased the story of Lawrence Ryan, a 34-year-old entrepreneur with severe alcoholism.

According to the show, Ryan — who was also a cancer survivor — would often drink a liter of vodka a day. And along with his heavy dependence came the usual set of problems associated with alcohol addiction.

But in the end, it was cirrhosis — a gradual encroachment of scar tissue within the liver, blocking blood flow through the organ — that cost Ryan his life. He died Feb. 22.

While the risks of cirrhosis are usually far from the minds of alcoholics who are Ryan's age, alcoholism experts say the disease is not unheard of among younger patients.

"It is not unusual to see an alcoholic in the last stages of alcoholism develop cirrhosis, and Lawrence died the way most cirrhotic patients die, from ruptured esophageal varices," says Dr. Nicholas Pace, clinical associate professor of medicine at NYU Medical Center who is on the board of directors of the National Council on Alcoholism and Drug Dependence.

"This is not very common, but it does occur," agrees Dr. Fred Berger, Medical Director of the Scripps McDonald Center and clinical professor of psychiatry at the University of California, San Diego School of Medicine. Berger says he has treated many patients whose alcohol addiction has led to cirrhosis. And not all of them have been in their 50s and 60s.

"Major life problems from alcohol often start showing up in patients' 30s," he says. "Fatty infiltration of the liver from obesity also can lead to cirrhosis in young people."

A Silent Problem?

Though some of the more dramatic impacts of alcohol abuse may get more attention, cirrhosis is actually the 12th leading cause of death by disease, responsible for killing about 26,000 Americans each year, according to the National Institutes of Health (NIH).

The symptoms of the illness can often fly under the radar — though in Ryan's case, the ugly bruises that had formed on the sides of his torso testified to his sickness. Those with cirrhosis are known to bruise and bleed easily, as the liver begins to stop production of the proteins needed for proper blood clotting.

And the disease takes hold deceptively slowly, taking years to develop. But for those who begin drinking early, the risk of cirrhosis is very real by the time they are in their 30s.

"If Lawrence started drinking at the age of 16, he had a sufficiently long enough duration to induce chronic liver damage and cirrhosis," says Hide Tsukamoto, director of the Research Center for ALPD and Cirrhosis at the University of Southern California's Keck School of Medicine.

And cirrhosis may be one condition in which time is not on the side of younger alcoholics.

"Youth are vulnerable to liver damage because their nutrition and metabolism can be more easily and profoundly perturbed by alcohol due to their high demand for nutrition and energy to support growth and activity," Tsukamoto notes.

The good news is that cirrhosis as a cause of death has declined steadily in the United States in most age groups for at least the past three decades, according to statistics from the NIH. And deaths among the youngest age group studied — from 25 to 34 years — are the lowest among any age group. In 2004, for example, fewer than 1 out of every 100,000 people in this age group died from cirrhosis.

But current research suggests a lingering danger. According to statistics from the NIH's National Institute on Alcoholism and Alcohol Abuse, as many as 10 percent of eighth graders, 20 percent of 10th graders and 30 percent of 12th graders binge drink — a behavior that could put them at future risk of the illness.

And in the U.K., at least, health experts are seeing a resurgence of this problem. In March 2006, the British Society of Gastroenterology issued a statement suggesting that the drinking habits of the young could be bringing about a wave of new cirrhosis cases.

"Already, we have seen a 350 percent increase in cirrhosis between 1970 and 1998, and this figure is 900 percent for those under 45 years of age," the statement reads.

When Intervention Comes Too Late

Of course, cirrhosis isn't the only major risk of alcoholism that should have younger drinkers concerned.

"Young people do not worry enough about this or any of the other major health problems that alcohol causes," Berger says. "Heavy drinking reduces the life span, on the average, by about 15 years through heart attacks, strokes, various cancers, gastrointestinal problems, brain, heart muscle, and peripheral nerve damage."

To avoid this downward spiral, professional intervention should come as soon as possible. And Pace says that the best intervention leaves no room for falling off the wagon.

"It is important that a patient like Lawrence be told that they have a medical disease that their liver no longer can metabolize alcohol in a normal manner," he says, "that their liver has become allergic to alcohol, that they have to stop drinking completely under medical supervision and get into an extensive counseling program which would include [Alcoholics Anonymous] — if they want to survive."

Dr. Teré Dickson contributed to this article.