Alcohol

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

The incidence of hepatitis C among people who are heavy consumers of alcohol (for example men that consume 4-5 alcoholic drinks a day) is very high and well known. Eugene Schiff reported to The National Institute of Health Development Conference on Management of Hepatitis C 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 those with hepatitis C is also much higher among those who consume alcohol. This has been seen in rates of fibrosis, development of cirrhosis, incidence of liver cancer and finally in survival rates. Whether it is safe to consume any alcohol is uncertain, so physicians caring for patients infected with the hepatitis C usually advise them to abstain from alcohol entirely.

Noda and colleagues published a report in Alcohol Clinical Expert (1996). They 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, with the viral load rising 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.

Heavy consumers of alcohol are not considered eligible for interferon treatment under the guidance of the National Institute of Clinical Excellence (NICE).

For those receiving interferon combination therapy for their hepatitis C the impact that alcohol can have on both treatment experience and treatment outcome, should also be considered.

Some of the 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, some evidence exists to suggest that alcohol reduces the efficacy of interferon therapy, although why this happens is poorly understood.

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

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. Whichever you decide to do you may be able to do it alone or you may need help.
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 themselves a time target, for example, one week. Over the course of the 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 gauging how difficult it will be.

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

1. Keep temptation at bay. Dont 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 it 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. Its 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 session drinker, then perhaps you could reduce the number of drinks in each session or substitute some of them with non-alcoholic drinks, of which there is a wide range. 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 01904 644026 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

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

ARP (alcohol recovery project) aims to reduce the harm caused by problem alcohol and drug use. They provide client-focused community and accommodation-based services, supporting people to achieve positive change and freedom from the harmful effects of alcohol and other drugs. They can be reached on 020 7234 9940 or send an email to info@arp-uk.org

Drinkline is a national helpline that also provides information and advice relating to alcohol issues. They can be reached on 0800 917 8282.

Your doctor may also be able to refer you for help and support in giving up drinking.