Q&A: Dry January trend ‘could be a wake-up call’ on risk for alcohol-related liver disease
Key takeaways:
- Dry January may offer ‘a wake-up call’ for patients with alcohol-related liver disease to rethink alcohol use.
- Early education and repetitive messaging on alcohol dangers may reduce its impact.
Dry January has become an increasingly popular trend in which people abstain from alcohol use for 1 month to reset their health after the holiday season. But, for some, it could be a wake-up call about their struggles with alcohol.
In 2024, 35% of Americans aged 21 to 24 years reported completing Dry January, which was markedly higher than the 14% of Americans aged 55 years or older, according to data from the Civic Science analytics platform.
“If you are curious about Dry January, go for it,” Stephen Silva-Brave, an alumnus of the Global Liver Institute Advanced Advocacy Academy, told Healio. “Evaluate what is happening in your body and mind and, if it is a challenge, then you should question your relationship with alcohol.”
For Silva-Brave, his wake-up call was when his primary care physician diagnosed him with fatty liver disease, which then progressed to cirrhosis. He was told to lose weight and cut back on his drinking. Although Silva-Brave was able to get his health back on track, he said his PCP did not convey “an urgency that I was at risk of destroying my liver” and was given the impression that a fatty liver was “not a big deal.”
One challenge in providing care to those with liver disease is that there is “controversy” among hepatologists on how to approach alcohol use, Robert G. Gish, MD, medical director of the Hepatitis B Foundation, told Healio.
Some hepatologists tell patients they do not have to stop alcohol use and are allowed to occasionally drink. However, he said he agrees with other hepatologists who are stricter in their approach.
“If you have liver disease, elevated enzymes [or] a fatty liver, you should not drink alcohol. If you cannot stop, then ask for help to stop alcohol intake,” Gish said.
Although Gish said there needs to be a “consistent message” about alcohol use from hepatologists and liver societies, he added that it is not “realistic to tell everyone in the world to stop drinking alcohol.”
In an interview with Healio, Gish and Silva-Brave share their perspectives as a physician and patient on alcohol consumption, the urgency of reversing fatty liver disease and the role Dry January may play in helping individuals rethink how they consume alcohol.
Healio: What about the drinking culture needs to change to reduce alcohol-related liver disease?
Gish: Binge drinking and intoxicated behavior should not be socially acceptable. There is something about social messaging or drunk behavior in certain groups that is not acceptable, but it is amplified.
We want to change that and that is going to happen through media. Hollywood does a really good job at that. Hollywood can control and influence messaging through subtle messages inside their movies involving alcohol and drugs. It can be very subliminal, but useful.
Silva-Brave: One of the biggest problems is people start drinking at a young age — younger than 25 years — when the body and brain are still developing. There are a lot of studies that show these people, like me, end up having the most problems with addiction and physical health. Since it has become so normal for young people to drink alcohol, earlier education would be a big start in changing that.
Healio: Are trends like Dry January helpful in curbing alcohol use?
Gish: It is important to use repetitive messaging. I have seen a lot of messaging for Dry January. Social media is our main way of interacting with people, so putting out messages on social media may temper alcohol use.
Silva-Brave: It is a good idea. If someone truly has an alcohol problem, the idea of stopping for several months is very scary — even the idea of stopping for 1 month is scary and hard. However, some people are up for the challenge.
I heard a person say that they were doing Dry January, but they gave in. They joked and said, “This might be a sign that I have a problem, because I could not make it 16 days.” They might have been joking, but for some people, it could be a wake-up call.
A lot of times it is about getting to that deeper issue: “What is it that I miss about it? Why do I not feel comfortable without it? Why do I not feel relaxed?”
If you felt like Dry January was easy, keep the momentum rolling. There are plenty of people who may not necessarily have an alcohol use problem, but they realize they feel so much better afterwards and try five or more times a year.
I do not think it is a solution to everything, but it is giving people some way of changing without saying, “The only way is abstinence.”
Healio: What are your thoughts on the U.S. Surgeon General’s recent advisory on alcohol use?
Gish: As a physician, I think the government is doing a good job of taking a conservative or hyper-safe approach. People tend to go above a recommended exposure or safe level of drinking because they think they are different, that they are protected or have immortality syndrome. They know alcohol has been around for the last 10,000 years. Alcohol consumption is not going to go away, but warning people is really going to make people think about their safe limits.
The key thing is that there is a huge interaction between alcohol and smoking, alcohol and any form of chronic liver disease and now metabolic dysfunction-associated steatotic liver disease with alcohol-related liver disease. Fatty liver disease increases the risk for 13 different types of cancers.
There are 100 million people who have obesity and 70 million people with fatty liver disease. Alcohol exposure on top of fatty liver disease is going to have an amplifying effect. We need to take a conservative approach through messaging to continue to temper alcohol consumption.
One big move toward less alcohol exposure is that almost every restaurant now has mocktails — and not just in Dry January. This is a good trend. It is in contradiction to what we saw during the COVID-19 pandemic when there was a huge uptick in alcohol exposure, alcohol-associated liver disease and alcohol-related hepatitis. Hospitals were full of people with alcohol-related liver disease, but that has been declining.
It is like what happened with smoking: More than 60% of adults were smoking and now we are down to 12%. Education and messaging works.
Silva-Brave: As a patient, I like the harm-reduction approach to it and appreciate that the Surgeon General is putting it out there that alcohol consumption causes many types of cancers, not just one type of cancer. It is on the right track.
Obviously, no alcohol is the best thing, but people have been drinking forever, so it is not going to stop. However, more studies are showing alcohol is like putting poison into your body.
Healio: How else does alcohol impact the body?
Gish: Alcohol affects many parts of the body: It suppresses hormones and disturbs the microbiome in the intestinal tract, changing it from an anti-inflammatory environment to a proinflammatory environment.
It also changes people’s sleep cycles. Sleep is so important for general health and mood.
Healio: Should we start educating youth earlier about the dangers of drinking?
Gish: Yes, we need to start educating at a young age among children and young adults. I used to give a lecture on liver disease every year at the high school where my children went. My message was that people should not be drinking until age 21 years when you can legally buy. Further, alcohol consumption should be done in moderation.
Silva-Brave: Showing a lot of the physical problems of drinking at an earlier age is very important. When I was in school, people would come and talk about smoking and show pictures of lungs before and after smoking. The same should be done for alcohol use where they show what happens to the liver.
I do not think high school students are aware of the physical problems from alcohol. Many people may know someone who is addicted and but think: “That will never be me.”
Healio: What advice should physicians give patients with liver disease regarding alcohol use?
Gish: Drinking alcohol is part of society, so we need to modify behavior through continuous education. Providers need to be trained in motivational interviewing so they can ask what motivates people to behave in an unhealthy fashion and what motivates people to change or stop that behavior.
In addition, there should be an open discussion on the several medications available to help people stop consuming alcohol.
Healio: Do you have tips for people trying to change their drinking habits?
Gish: Do it with your friends and family, so together everyone is moderating or stopping drinking for a period of time. It is a great step to do as a community or as a family.
Silva-Brave: Everyone is at different levels. For me, stopping alcohol use completely was the only way, or I was going to die — my liver was really messed up. There are a lot of people who are at that point, whether it is their liver, brain, ruined relationships or they have problems with the law. For some, their alcohol use may not necessarily be dire, but they need help cutting back.
If people reverse their fatty liver disease, they can work on having a drink every now and then again.
For me, one of the biggest things was finding others who made similar changes to their health. I’m Lakota, and one of our biggest philosophies involves relationships. I found that I needed other people so I could see how they did it and then reached out for help.
If people need to make lifestyle changes, they should find someone who has done the same and reach out to them. Sometimes it may just one person, but many times it is about finding a whole support group.
References:
- A quarter of Americans participated in ‘Dry January,’ here’s what it could mean moving forward. https://civicscience.com/a-quarter-of-americans-participated-in-dry-january-heres-what-it-could-mean-moving-forward/ Published Feb. 6, 2024. Accessed Jan. 22, 2025.
- Global Liver Institute (@globalliverinstitute). Jan. 8, 2024. Instagram.
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