Alcohol-associated liver disease (ALD) is a common form of liver disease in the United States. People get ALD by drinking moderate to large amounts of alcohol for months to years. It doesn't matter whether the alcohol is hard liquor, beer, or wine. Any type of alcohol can cause liver damage, leading to cirrhosis of the liver, and even liver cancer.

So how much alcohol is too much? It depends on whether you're a man or a woman. Studies have shown that women experience liver disease at lower levels of alcohol intake than men.

Many liver specialists would agree that liver disease is likely at these levels:

• For women: 2 or more units of alcohol on a regular basis
• For men: 3 or more units of alcohol on a regular basis

• One unit of an alcoholic beverage contains 10 grams of alcohol. A unit is roughly equivalent to: one 12-ounce bottle of beer (5% alcohol); one 4-ounce glass of wine (12% alcohol); or one 1-ounce shot of hard liquor (40% alcohol).

Some people will experience liver damage even if they drink much less.

In a person with chronic liver disease (such as hepatitis B or C or fatty liver disease), alcohol causes even more damage than it would in people without those liver diseases. At present, no one knows if there is a safe level of alcohol for people with are already living with liver disease.

The good news is that the livers of heavy drinkers can improve if they stop drinking entirely. This may be a very difficult thing for you to do.

To keep track of how much you drink, use a drinking diary. Record the number of drinks you have every day. At the end of the month, add up the total number of drinks you had during each week.

One way to make any kind of change in your behavior is to come up with a "change plan." This exercise has you list the specific goals you would like to achieve, outline the steps and challenges you will meet in reaching those goals, and figure out ways to overcome those challenges. (A Drinking Diary and Change Plan are included in the resources section.)

Tips for Cutting Back on Drinking

The National Institutes of Health offers the following tips to help people cut back on drinking:

Watch it at home.

Keep only a small amount or no alcohol at home. Don't keep temptations around.

Drink slowly.

When you drink, sip your drink slowly. Take a break of 1 hour between drinks. Drink water or non-alcoholic drinks after a drink with alcohol. Do not drink on an empty stomach! Eat food when you are drinking.

Take a break from alcohol.

Pick a day or two each week when you will not drink at all. Then, try to stop drinking for 1 week. Think about how you feel physically and emotionally on these days. When you succeed and feel better, you may find it easier to cut down for good.

Learn how to say NO.

You do not have to drink when other people drink. You do not have to take a drink that is given to you. Practice ways to say no politely. For example, you can tell people you feel better when you drink less. Stay away from people who give you a hard time about not drinking.

Stay active.

What would you like to do instead of drinking? Use the time and money spent on drinking to do something fun with your family or friends. Go out to eat, see a movie, or go for a walk.

Get support.

Cutting down on your drinking may be difficult at times. Ask your family and friends for support to help you reach your goal. Talk to your doctor if you are having trouble cutting down. Get the help you need to reach your goal.

Watch out for temptations.

Watch out for people, places, or times that make you want to drink, even if you do not want to. Stay away from people who drink a lot and avoid bars where you used to go. Plan ahead of time what you will do to avoid drinking when you are tempted.

Do not drink when you are angry or upset or have a bad day. These are habits you need to break if you want to drink less.

Do not give up!

Most people do not cut down or give up drinking all at once. Just like going on a diet, it is not easy to change. That is OK. If you do not reach your goal the first time, try again. Remember, get support from people who care about you and want to help. Do not give up!

Fibrosis is the medical term for scar tissue in the liver. Fibrosis is caused by infection, inflammation, or injury. It prevents the liver from working well.

Alcohol causes inflammation in the liver, causing more fibrosis. In a person with a chronic liver disease (such as hepatitis B or C), alcohol causes even more damage than it would in patients without those other liver diseases. Fibrosis eventually can lead to severe scarring (cirrhosis), especially when a person drinks heavily.

Cirrhosis is severe scarring of the liver and is the end result of damage to liver cells. Cirrhosis can be caused by many things, including viral hepatitis or alcohol, or both.

How does alcohol affect cirrhosis?

Alcohol increases the damage done to the liver and speeds up the development of cirrhosis. For example, after about 25 years of hepatitis C infection, heavy drinkers show more than twice the scarring of light drinkers or non-drinkers. After 40 years of infection and heavy drinking, most heavy drinkers have developed cirrhosis.

Hepatitis C and cirrhosis

In general, someone with hepatitis C has around a 20% chance of the fibrosis progressing all the way to development of cirrhosis. Alcohol use increases this chance severely. A heavy drinker with hepatitis C has 16 times the risk of cirrhosis compared with a non-drinker with hepatitis C. Alcohol and hepatitis C both damage the liver, so together, the risk of serious liver damage (cirrhosis) is much higher than with either alone. Learn more about how alcohol affects people living with hepatitis C.

Can I be treated for HCV if I drink alcohol?

People who drink alcohol are eligible for hepatitis C treatment, although drinking is not recommended. Drinking can interfere with your ability to take medications properly or make all of your lab or medical appointments. With hepatitis C treatment, taking your medication as prescribed, getting lab tests done, and making medical visits are all critical.