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Alcohol

Without doubt, the most effective measure anyone infected with hepatitis C can take to slow down disease progression is to avoid drinking alcohol.

The incidence of HCV among people who are heavy consumers of alcohol (e.g. men that consume 4-5 alcoholic drinks a day) is very high. A recent report indicated that the incidence of hepatitis C is seven times higher among alcoholics than in the general population.

Research has clearly shown that the severity of liver disease in HCV sufferers is much higher among those who consume alcohol. This has been seen in rates of fibrosis, the development of cirrhosis, the incidence of liver cancer and finally in survival rates. Whether it is safe to consume any alcohol is uncertain. Physicians caring for patients infected with hepatitis C usually advise them to abstain from alcohol entirely.

A report appearing in Alcohol Clinical Expert observed a more rapid development of cirrhosis and hepatocellular carcinoma in alcoholic patients with chronic hepatitis C. The risk of development of hepatocellular carcinoma in alcoholics with cirrhosis was 8.3 times higher than non-alcoholic patients.

There also appears to be a relationship between alcohol consumption and hepatitis C viral loads. The viral load tends to rise in proportion to alcohol consumption, suggesting that alcohol has some effect on hepatitis C replication.

Response to antiviral treatment is also affected by alcohol consumption. Several studies have shown a decreased rate of sustained viral response in people who drink alcohol compared to those who do not.

Alcohol and interferon therapy

Under the guidance of the National Institute for Health and Care Excellence (NICE) heavy consumers of alcohol are not considered eligible for interferon treatment.

For those receiving interferon combination therapy the impact alcohol can have on both treatment experience and treatment outcome should also be considered.

Some of the negative side effects of treatment are significantly enhanced if alcohol is consumed. Depression, a common side effect of interferon treatment, is associated with alcohol consumption. In addition, evidence exists to suggest that alcohol reduces the efficacy of interferon therapy, although why this happens is not yet understood.

As a consequence many specialists view treatment for alcohol misuse as part of their patients' care and treatment plan.

What to do about alcohol consumption

The best thing you can do for your liver is to give up drinking alcohol completely. The next best thing is to reduce your intake. Some people can quit alcohol quite easily whilst others will inevitably find this an extremely difficult thing to do. Some people find it useful to have a trial run at abstaining from alcohol. By setting a time target (e.g. one week), over the course of that week they keep a note of how difficult or easy it was and how long they were able to last without alcohol. This exercise is useful in working out how difficult it will be.

If you decide to stop completely here are some practical things that might help:

  1. Keep temptation at bay. Don’t keep any alcohol at home.
  2. Identify your triggers. These could be people, places or circumstances. Try to avoid them or develop a plan so that you are prepared and able to deal with the situation without alcohol.
  3. Remind yourself regularly about why you are giving up alcohol and the benefits giving up will bring.
  4. Try and keep your mind off alcohol by involving yourself in other things, particularly at times you associate with having a drink.
  5. Get support. This could be from your family and friends, your doctor or a support group.

If you decide to cut down - here are some practical things that might help:

  1. Monitor how much alcohol you consume. Be honest, even if the total seems unreasonable. Once you know where you are starting from it will be easier to measure or monitor improvements.
  2. If you are drinking alcohol, drink slowly and drink plenty of water or juice as well.
  3. Drink with or after food as this slows down the absorption rate.
  4. It’s better to spread your weekly units over the whole week rather than have them in one session.
  5. Consider how you could reduce this amount. If for example you are a daily drinker perhaps you could have one less drink a day, or you could decide to have non-drinking days. If you are a session drinker, then perhaps you could reduce the number of drinks in each session or substitute some of them with non-alcoholic drinks. Devise a drinking goal for yourself and write this down too.
  6. Get support. This could be from your family and friends, your doctor or a support group.

It can help if you have someone who also wants to reduce or eliminate their alcohol consumption. If you are lucky enough to belong to a hepatitis C support group, others there may be interested in stopping or cutting down with you. In addition some support groups may run their own alcohol abstinence programmes or be able to refer you to one.

Alcoholics Anonymous is an international organisation devoted to supporting people who wish to stop drinking. In the UK there are over 3,000 regional meeting places where anyone wishing to stop drinking can receive information, advice and support.

More information can be obtained by calling 0845 769 7555 where a trained volunteer will answer your call, listen to your concerns and perhaps direct you to a local meeting. Alternatively you can visit their website at www.alcoholics-anonymous.org.uk

Finding local alcohol services

There are a number of resources available to help you find local alcohol services:

Drinkline is the national drink helpline and can provide local service information. Call 0300 123 1110

NHS Choices has a database of support and treatment services

Rehab Online is a directory of residential rehabilitation services for adult drug and/or alcohol misusers in England and Wales

Alcohol Concern is the national charity for alcohol abuse and can provide information and advice on a range of alcohol issues. They can be reached on 0207 928 7377 or www.alcoholconcern.org.uk

Your GP or local Community Alcohol Team should also be able to provide you with details of services available in your area

The London Drug and Alcohol Network (LDAN) has an online directory of services across London: www.ldan.org.uk and use 'Find a service'

In Wales, contact the Wales drug and alcohol helpline DAN on 0808 808 2234.