The terminology of this disease has been updated from alcohol-related liver disease to alcohol-associated liver disease.

Alcohol-associated liver disease (ALD) is a major cause of alcohol-related morbidity and mortality through cirrhosis, liver cancer, and acute and chronic liver failure.

The amount of alcohol consumed placing an individual at risk is not known. A typical patient has consumed alcohol heavily for two or more decades, although sometimes heavy use may be for less than 10 years.

Alcohol-associated liver disease (ALD) is a spectrum of conditions, ranging from reversible fatty liver to alcoholic hepatitis (AH), cirrhosis, and hepatocellular carcinoma (HCC). AH is a distinct syndrome caused by long- term alcohol use and has poor prognosis.

ALD is caused by heavy alcohol use. The liver breaks down alcohol. If a person drinks more than the liver can process, it can become seriously damaged.

The severity of ALD depends on how much alcohol is consumed and duration of heavy drinking.

However, some are more susceptible than others and can develop ALD from lower amounts of alcohol.

ALD is most common between 40 and 50 years of age. Men are more likely than women to develop ALD. However. women can develop ALD after less exposure to alcohol than men. Also, the burden of ALD is rising in women. Some people may be genetically at higher risk of developing ALD.

Hepatic steatosis, also known as “fatty liver”, is the most common alcohol-induced liver problem.

There are three types, orhistologic stages, of alcohol-associated liver disease (ALD). Many heavy drinkers progress through these three types over time:
- Steatosis (fatty liver; alcoholic fatty liver) – Steatosis is build-up of fat inside liver cells (liver parenchyma), leading to an enlarged liver. It is the most common alcohol-induced liver problem.
- Alcohol-Induced hepatitis (AIH; alcoholic hepatitis, AH) – Alcoholic hepatitis, acute inflammation of the liver, results in death of liver cells, often with permanent scarring. It is an acute, severe problem that is often treated in the hospital. It can be treated but more severe cases lead to liver failure. AIH has poor prognosis.
- Alcoholic cirrhosis –Alcoholic cirrhosis is the irreversible destruction of normal liver tissue, leaving scar tissue in place of working tissue. Alcoholic cirrhosis leads to complications including liver failure, portal hypertension, ascites (swelling of the abdomen), infections, confusion, and bleeding in the stomach and esophagus. Alcoholic liver cirrhosis comprises the highest proportion of people in the ALD disease spectrum at 32.9%. One of the 3 main causes of liver cirrhosis is alcohol (others are hepatitis B/C & MASLD).

Alcohol use can worsen other disease states, including liver diseases but also heart disease and cancers.

Continuing alcohol consumption is a major factor decreasing the survival of patients with alcoholic hepatitis (AH).

The single best treatment for alcohol-related liver disease is abstinence from alcohol.

Participating in a treatment program while avoiding all alcohol can improve outcomes. There are effective medications that can help people decrease cravings and consumption of alcohol.

Alcohol use disorder (AUD) is a pattern of alcohol use that includes problems controlling drinking, preoccupation with alcohol or continued use of alcohol after it causes problems. This disorder also involves increasing tolerance and withdrawal symptoms. Alcohol use disorder includes alcoholism.

The National Institutes of Health defines heavy alcohol use as: Men: 5+ drinks per day or 15+ drinks per week; women: 4+ drinks per day or 8+ drinks per week. Heavy drinking increases the likelihood of ALD.

Alcohol is the most frequently misused drug in the world and in the US, where it is a leading cause of liver disease. It involves 61 % of the US population; 10 to 12 % of that 61% are heavy drinkers.

Globally, excessive alcohol use is a leading preventable risk factor for physical/social harm.

Excess alcohol consumption causes substantial medical, economic, and societal burdens.

Worldwide, approximately 5.3% of all deaths may be related to alcohol consumption.

Worldwide, alcohol associated liver disease (ALD) accounts for 5.1% of all diseases and injury.

The global estimated age-standardized death rate (ASDR) for alcohol-associated cirrhosis was highest in Africa and lowest in the Western Pacific.

The annual global incidence rates of hepatocellular carcinoma (HCC, liver cancer) among patients with alcohol-associated cirrhosis ranged from 0.9% to 5.6% (2019).

Worldwide, alcohol was associated with approximately one-fifth of HCC-related deaths (2019).

In people with AUD, alcohol-related hepatitis prevalence has been estimated at 10–35%.

In the U.S., alcohol-related liver complications result in high healthcare cost burdens.

Worldwide, alcohol-associated cirrhosis prevalence has been estimated at 23.6 million in people with compensated cirrhosis and 2.46 million with decompensated cirrhosis.

ALD’s contribution to global mortality and burden of liver-related deaths is considerable. Liver disease related to alcohol contributed to 50% of the estimated liver disease deaths for age 15+ years (2016).

Worldwide, the prevalence of ALD has been estimated at 4.8%. The prevalence in males was 2.9%, which was higher than female (0.5%).

MetALD (Met+ALD; Met-ALD; metabolic with alcohol-associated liver disease) (See also sections on MASLD and MASH)

There is a new category for people with alcohol-associated liver disease (ALD; formerly alcohol-related liver disease (ARLD)) and MASLD, called MetALD (metabolic with alcohol-associated liver disease). It is a continuum which can have elements of MASLD and/or ALD. MetALD is the result of fat in the liver from alcohol use, combined with MASLD. MetALD can result in liver inflammation, scarring, and cirrhosis.

Last updated on December 11th, 2025 at 11:34 am

Alcohol-Associated Liver Disease