Excessive drinking during the pandemic increased rates of liver disease, transplants

Excessive drinking during the COVID-19 pandemic has led to skyrocketing rates of alcohol-associated liver disease to the point of needing transplants, according to doctors.

Transplant centers across the United States are reporting more patients in need of a new liver than ever before, sometimes seeing double the number of patients needing transplants compared to pre-pandemic levels.

In fact, alcohol-related liver disease has surpassed other conditions such as hepatitis C and fatty liver disease as the number one reason for liver transplants.

The demographics have also changed. Historically, patients needing liver transplants were older men in their 60s. Now, patients needing transplants are often in their 20s and 30s and there has been an increase in the number of women needing transplants.

Doctors told ABC News this is yet another unintended consequence of the COVID pandemic and that they hope to reduce the stigma so patients can feel supported in getting the help they need.

'A nationwide phenomenon'

"It's a nationwide phenomenon where, since the pandemic, there has been a notable increase in alcohol use, including harmful alcohol use where there is associated liver disease, and it has led to increased hospitalization of patients with liver injury due to alcohol," Dr. Maarouf Hoteit, medical director of liver transplants at the Hospital of the University of Pennsylvania, said.

"And a subgroup of these patients, indeed, has advanced liver injury where we're not able to improve the liver function with medical therapy alone," he continued. "So that has resulted in, indeed, increased referral for liver transplantation for patients with alcohol [associated] liver disease, and especially since the pandemic."

At UCHealth University of Colorado Hospital, about 40% of patients with liver disease due to alcohol who were screened every week needed a transplant before the pandemic. Currently, between 80% and 90% of patients with alcohol-assisted liver disease screened every week need a transplant.

Dr. Elizabeth Pomfret, chief of surgery at the hospital, said this is the highest number of patients with alcohol-associated liver disease who need transplants she's seen during the course of her career.

She added that, traditionally, patients with liver disease from alcohol must have a period of abstinence and undergo professional counseling before being considered a suitable candidate for the liver transplant list. However, patients are often seeking help when they're already quite sick.

"What we've seen during COVID, and subsequently, is that often these patients are presenting so sick that there's no time for them to go through a counseling period, abstinence," she said. "They're presenting really with life-threatening illness that they will not survive without the transplant and so we've had to completely change the way we approach things."

This means quickly putting a patient on the transplant list and working in tandem with specialists in addiction medication, inpatient rehab, outpatient rehab, psychiatry, and social work to address their severe alcohol use.

"Centers, including ourselves, have been a lot more accepting of willing to transplant patients with a sort of more recent history of drinking than we used to be," Dr. Robert Cannon, surgical director for liver transplant at the University of Alabama at Birmingham, told ABC News. "Ten years ago, no one would transplant a patient if they've had a drink in the last six months. Now, more recently, over 85% of centers will transplant patients with recent drinking."

Why drinking is on the rise

Doctors said there are many reasons why the pandemic may have led to an increase in alcohol use among Americans.

Hoteit said the stress that many people were experiencing related to COVID -- including fear of contracting the virus and financial stress -- as well as being isolated likely led to an increase in drinking.

Pomfret said another reason was that the culture of drinking changed during the pandemic, making it normal to drink outside of the evenings or weekends.

"There was also a culture of coping with things through having Zoom cocktail hours and Zoom cooking lessons…and so I think people in general often found that they were drinking a lot more alcohol than they typically did," she said. "They might be drinking during the week, when that wasn't something they normally did."

Stigma around alcohol-associated liver disease

A woman in her 30s who underwent a transplant at UCHealth, and asked to remain anonymous, told ABC News she had already been drinking months prior to the pandemic but it felt more acceptable when lockdowns occurred.

"Drinking was more acceptable, and it was more a socially acceptable thing to do at the point," she said. "Drinking was…it would be a distraction. It would be something fun to do…And I was sad, and I would only drink when I was sad. I was self-medicating."

She said she stopped drinking at the beginning of 2021 and began seeking help from a therapist.

However, she started getting sick after she quit drinking and remained that way for months until she was directed to UCHealth in November 2021 and was diagnosed with liver cancer about a month later. She received her liver transplant in December 2022.

"It was intimidating. It was having to admit to mistakes, it was having to own things that you were embarrassed and ashamed of," she said. "But I never felt judged when I was there, which was important, and it was that non-judgmental attitude…that helped me stay on the right path that helped me realize that other people believed in me and I cannot tell you how much that has helped in my recovery."

Doctors say there is a stigma when it comes to patients with liver disease due to drinking and it might be preventing some people from seeking help over fears of being shamed.

"I think what we've learned and have realized is alcohol use disorder is a disease, just like cancer or any other and it's one that's treatable and trying to shift away from it being sort of focused on morality," Cannon said. "And trying to reduce that stigma has been a big help for getting patients into treatment, getting them to help."

Hoteit added that another challenge is the scarcity of mental health resources and substance abuse assistance resources to get patients the help they need.

"Everybody deserves a second chance," he said. "And there's a potential to help a lot more patients if we focus away from the stigma and focus on truly addressing this issue as a health care problem."