Hard-drinking young adults suffer surge in deadly liver disease

A little over a year ago, Eric Dunham had the operation that saved his life: a double transplant to give him a new liver and a new kidney. Chronic, heavy drinking had destroyed his own organs. It also led to a condition called hepatic encephalopathy, which made him feel as if he were losing his mind, as well as weakened blood vessels that caused life-threatening stomach bleeding.

A priest once was called to Dunham’s hospital bedside to give him last rites as his family wept. Over nearly three years, dialysis multiple times a week and blood transfusions every couple of days kept him alive long enough to get a donor match.

What to many people is a celebratory elixir or ubiquitous social lubricant, alcohol can ravage the human body. And it doesn’t take decades for this powerful toxic to do its damage.

Dunham had just turned 33.

“I would have never thought it — not ever,” the Keansburg, N.J., man said. “You think you’re taking the safe road with alcohol because it’s not a drug. It’s legal. When you’re young, you don’t realize what it could do to you.”

As deaths from alcohol-related liver diseases like cirrhosis and cancer have skyrocketed in recent years, one of the most disturbing parts of that trend is the staggering rise in its youngest victims.

People ages 25 to 34 represent the greatest increase in deaths driven by alcohol-related liver cirrhosis — a nearly 11% increase per year from 2009 to 2017, according to research published last year in The BMJ and updated in August.

“Every day on rounds, all of America’s liver specialists are seeing multiple young people in various states of liver failure. In clinics, we experience more and more young people being referred,” said liver specialist Elliot B. Tapper, an assistant professor with the University of Michigan Medical School and coauthor of the research. “We’re doing more transplants than we’ve ever done for this reason. More and more people are dying.”

Local experts are seeing this too, like Keira Chism, a psychiatrist with Thomas Jefferson University Hospital’s Transplant Institute.

“It seems like we’re seeing more and more young people with end-stage liver disease or severe alcoholic hepatitis with underlying cirrhosis,” Chism said. “It feels shocking.”

At the Caron Treatment Center in Wernersville, Berks County, chief medical officer Joseph Garbely said just within the last two years, more young adult alcohol patients are coming in sicker, with more complex physical problems. They require more extensive stabilization care and longer stays on Caron’s medical unit.

“They never used to have to do that,” Garbely said. “They’re experiencing significant withdrawal, and they have medical complications that are concerning. We’re seeing an uptick in bone marrow suppression, which is indicative of the increased frequency and amount that young people are drinking when they start drinking. We see a decrease in platelets, white blood cells, and red blood cells because that’s what alcohol does to your bone marrow.”

Experts in liver disease and alcohol use disorder blame extreme drinking patterns for these disquieting health trajectories.

“There is clearly a cultural change where there are more binge drinkers than there were previously,” said Tapper, who studied the increase in young adult cirrhosis deaths.

Overall, fewer young people are drinking than in previous generations, other research has found. But those who do drink more often are going to extremes.

Tapper noted that higher alcohol-content beverages — like hard seltzers such as Four Loko and White Claw — appear to be more popular among young drinkers.

Excessive body weight among many of America’s young people may also be a factor in rising liver disease.

“It is known that obesity compounds the toxicity of alcohol,” said Tapper, noting that obesity and alcohol both contribute to the development of fatty liver disease. “It is also known that obesity-related liver disease has increased particularly over the same time frame in which we are observing increased mortality from alcohol-related liver disease.”

Another disturbing trend: For some, extremely heavy drinking starts earlier than ever. Studies have found a 33% increase from 2006 to 2014 in alcohol-related emergency department visits by people ages 18 to 24. From 2001 to 2015, there was a 68% jump in alcohol-related hospitalizations in the 21-to-24 age group, according to Aaron White, a senior expert with the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“Despite declines in drinking [overall], there have been increases in ED visits and hospitalizations involving alcohol among young adults," White said. “It is possible that the percentage of young adults who drink at extremely high levels has increased.”

That’s not all. The female body is more susceptible to some forms of alcohol damage, and research suggests significant increases in drinking and bingeing among young women, White said.

And some emerging findings from surveys about adolescent drinkers, boys and girls, suggests many are imbibing alone, White said, trying to self-medicate against feelings of despair.

“There might be fewer of them drinking, but among those who are drinking, there might be more unhealthy relationships with alcohol forming — drinking alone, drinking to cope with anxiety and depression,” he said. “Those things don’t bode well for the future.”

At the peak of his drinking, Dunham was up to a fifth of Jagermeister a night, plus beer. Without it, he couldn’t sleep, wouldn’t eat.

His mother, Carol, pleaded with him to stop. When he was younger, he had been into pills, opioids. He lost his best friend to an overdose and never quite got over the loss.

He left the pills alone, but stuck with the alcohol. A safer choice, he thought. More and more, he drank alone; less and less, the alcohol filled the sadness he felt inside.

Not long before he turned 33, Dunham went to a doctor who told him he had a fatty liver, a condition that can be caused by heavy drinking, and makes it harder for the liver to do its job filtering out toxins. Knock off the booze and come back in six months, the doctor said.

At least it wasn’t cirrhosis, Dunham thought. He kept drinking.

The day after his birthday, he started throwing up blood. His mother insisted they go to a hospital. He ended up in a coma for three weeks. When he came to, his mother told him his liver and kidneys were shot. He had to relearn to walk after lying in a hospital bed for weeks.

For the next three years, his mother stuck by him, taking him for dialysis and transfusion, praying for an organ-donor match. In March 2018, her prayers were answered; Dunham got a new liver and kidney at Jefferson. The next month, she was gone. Cancer.

A year has passed. In a few days, Dunham will turn 38. He’s been sober since waking up from a coma five years ago. He’ll be on anti-organ-rejection drugs for the rest of his life, but his body is healing. He wishes his mother were here to see it.

“She fought so, so hard for me,” he said.

Dunham hasn’t gone back to his old job with an online book seller. He thinks he might like to help people who are going through similar experiences to his own.

“I think my mom’s watching me,” he said. “Plus, everyone fought so hard for me. I fought so hard, too.”

He isn’t sure what lies ahead. But for now, he is trying to focus on the gift he has been given.

“My goal in life right now is to be happy,” he said. “That’s all I’m shooting for right now — to live and be happy.”