Yesterday's post discussed a new study assessing the impact of different levels of drinking on hepatitis C disease progression. The results indicated that heavy drinking, particularly in men, was associated with greater fibrosis. Beyond that, there was a trend towards increased fibrosis associated with greater amounts of alcohol consumption, but that for light or moderate drinkers the association with fibrosis progression was not statistically significant.
Here are some ways to think about this research from a harm reduction perspective:
1. Research can't always give you clear, unambiguous answers: One of the lessons of this study is that alcohol's effects may be subtle and highly variable. The study could not demonstrate a safe level of drinking, nor could it unequivocably show that even light drinking is harmful for people with hepatitis C. While more research would be helpful, it's unlikely to result in a clear formula for how much it's safe to drink, and for whom. As with many other aspects of hepatitis C, we listen to the research and learn to live with the ambiguities. Clear answers can be comforting, but they're often in short supply, and it's dishonest to impose false certainties and absolutes on the messy realities of hepatitis C.
2. Everyone's body is different: Just as people respond differently to alcohol in their mood and behavior, people with hepatitis C will likely have a range of possibilities in how drinking affects their liver. As the study authors note, some people may be more susceptible to the effects of alcohol on the liver. Even heavy drinkers in this study did not invariably progress to cirrhosis.
3. There's no way of knowing how susceptible someone is to liver damage from alcohol consumption: If you have hepatitis C, you can't predict what level of drinking is "safe" or "dangerous" for your liver. Some people with advanced liver disease can feel the effects of alcohol -- their body's telling them through symptoms that alcohol is hard on the liver. But most people won't know what effect alcohol is having on their liver from symptoms.
4. Other information about liver health can help put the risk of drinking in context: In the study described yesterday, elevated ALT levels were strongly associated with risk of greater fibrosis, as was age and liver inflammation. In other studies, obesity or a high body mass index has been associated with greater fibrosis, while female sex may somewhat protect from fibrosis progression. There's no formula for predicting your risk of fibrosis, but a biopsy can tell you where things stand with your liver. People who have been infected with hepatitis C for 20 years and have little or no fibrosis may not have to change the way they drink; people who have cirrhosis may need to take the risks of alcohol more seriously.
5. Drinking may be a risk, but it's not just a risk: People have a range of reasons for drinking -- pleasure, companionship, relief from stress, etc. Even people who aren't dependent on alcohol may be reluctant to give it up. Some drug users have worked hard to quit other drugs, like heroin, cocaine, and crack, trading them for alcohol -- drinking helps them stay away from the drugs that were creating more immediate and severe problems in their lives. If you only think and talk about alcohol as a risk for liver disease, you're missing a big part of the picture -- the reasons why people drink, and the real and perceived benefits they get from continuing to drink.
In a future post, I'll talk about how educators and people with hepatitis C are grappling with these issues. In the meantime, feel free to add a comment (click at the bottom of this post) about your take on alcohol and hepatitis C.