Rise In Alcoholic Liver Disease In Young Women : Short Wave **Heads up. This episode discusses addiction and alcoholism.**

Some doctors are seeing a disturbing spike in lethal alcoholic liver disease, especially among young women. The recent trend has been supercharged, they say, in the pandemic. Emily Kwong speaks to NPR science correspondent Yuki Noguchi about this and some of the challenges to getting proper treatment.

To read more on the story, check out Yuki's reporting here.

You can email us at ShortWave@npr.org.

'Off The Charts' Rise In Alcoholic Liver Disease Among Young Women

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EMILY KWONG, HOST:

Hi, SHORT WAVE listeners. Just a heads-up for those of you listening - this episode looks directly at addiction and alcoholism and how that affects a person's health.

MADDIE SOFIA, HOST:

You're listening to SHORT WAVE...

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SOFIA: ...From NPR.

KWONG: Hey, everybody, Emily Kwong here with Science Desk correspondent Yuki Noguchi, who covers consumer health. Yuki, this is your first time on SHORT WAVE, so welcome.

YUKI NOGUCHI, BYLINE: Hey, Emily. It's good to be here.

KWONG: And you're here to talk about a worrisome trend that you've been reporting on, which is that more people at younger ages are getting alcoholic liver disease.

NOGUCHI: Yeah, that's right. We're talking about liver disease caused by excessive drinking. And advanced alcoholic hepatitis and cirrhosis are super serious. They're really lethal. And the thing is, you know, in the past, this was something that affected older men more. But doctors are telling me younger women under the age of 40 are driving the increase now.

KWONG: Oh, wow. OK.

NOGUCHI: And this is a trend that began several years ago before the pandemic. But it's really been supercharged in the last year.

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JESSICA MELLINGER: In my conversations with my colleagues at other institutions, everybody is saying the same thing. They're like, yep, it's astronomical. It's just gone off the chart.

NOGUCHI: That's Dr. Jessica Mellinger. She's a liver specialist at the University of Michigan. The CDC hasn't reported data yet on hospitalizations from alcoholic liver disease since the pandemic began. But Mellinger says she's been tracking this, and she's seen a 30% increase in hospitalizations just at her health system alone. And that was in the first few months of the pandemic.

KWONG: 30% - that is a really big jump, Yuki.

NOGUCHI: I mean, I think so, too.

KWONG: Yeah. I know alcohol consumption has increased during the pandemic. You know, people are drinking more because of the stress...

NOGUCHI: Yeah, that's right.

KWONG: ...And isolation of the past year. So can you develop this from drinking, say, a glass or two of wine a night?

NOGUCHI: You know, that's generally not what's going to cause liver disease of the kind that we're talking about. I mean, there are factors like obesity or genetics.

KWONG: OK.

NOGUCHI: But, generally speaking, no. The problem with drinking is that it can creep up over time. And, in fact, Mellinger says, you know, she's seen a lot of this with her patients, you know, who started out with a glass of wine, and then worked their way up to a bottle, you know, which is the equivalent of, like, five or six drinks a day. And that really increases your chances of getting liver disease severe enough to land you in the hospital. And, you know, even if you don't drink every day, and let's say you binge drink in the weekends, I mean, even if that's less frequent, that can also be very damaging.

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MELLINGER: I personally switched all of my research in my liver transplant training year to alcoholic liver disease because I was seeing so many young people in the hospital. I was like, what is going on here? You know, we're seeing kids in their late 20s, you know, and early 30s with a disease that we previously thought was kind of exclusive, you know, to middle age.

KWONG: Wow. OK.

NOGUCHI: Yeah. And, you know, I want to tell you about this phenomenon through the eyes of one woman who I talked to starting last year. And she has struggled with this. She's in her 30s. She's struggled with alcohol, you know, for much of her adult life. And then, of course, the pandemic hit.

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KWONG: Today on the show, we explore the rise of alcoholic liver disease, especially in young women, through one woman's story.

NOGUCHI: And we'll talk about some of the challenges of getting proper treatment.

KWONG: This is SHORT WAVE, the daily science podcast from NPR.

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KWONG: OK, Yuki, we are talking about the increase in alcoholic liver disease, which doctors are especially noticing in young women during the pandemic. Tell me about that.

NOGUCHI: Yeah, and I want to introduce you to Jessica Duenas.

KWONG: OK.

NOGUCHI: I started talking to her over a year ago.

JESSICA DUENAS: Hello. This is Jessica.

NOGUCHI: That was just a few weeks into the pandemic. And at the time, she was 35, living in Louisville, Ky., and was a middle school special education teacher.

DUENAS: I'm doing, you know, as well as can be given the state of the world (laughter).

NOGUCHI: She wasn't just any teacher. She was named 2019 Kentucky Teacher of the Year.

KWONG: OK. Good job, Jessica.

NOGUCHI: Yeah. I mean, I found her lovely in all ways. And she has this inspiring biography. She came from an immigrant family. She identifies as Afro-Latina. And she was the first in her family to go to college - not only got a bachelor's degree, but also a master's - and obviously became a star in her field. But she told me she had been hiding her drinking from everyone, especially the family that was so proud of her. It started in college. And in recent years, she had tried to quit.

DUENAS: But then I started to kind of think that I was cured. And I was like, well, I can probably logistically figure out how to drink in a healthy way now that my body has reset itself, and, you know, it couldn't possibly get worse.

NOGUCHI: But it would. She'd go back to drinking. And at one point, she was drinking almost a liter of liquor a night. That's about 20 shots of alcohol, far beyond the CDC's definition of heavy drinking for women. And in 2019, she was diagnosed with alcoholic hepatitis, a kind of alcoholic liver disease.

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DUENAS: I couldn't keep down any food. I was losing weight. My belly was super sensitive. Like, if I pressed on certain parts of it, it would hurt a lot. My eyes were starting to get yellowish.

KWONG: Oh, that sounds really, really painful and a lot to manage when you're trying to just show up and go to work, right?

NOGUCHI: Oh, totally.

KWONG: Yeah.

NOGUCHI: But she says she never drank at work. She was very clear about that. In fact, she masked the shame that she felt by trying to be an even better teacher. But she says the pressure just became too much.

DUENAS: It's like, I would drink in the evening. I would fall asleep, and I would wake up with my hands shaking. You know, and I would feel sick as a dog during the day. And, you know, I would find myself feeling irritable with students. And I love my students passionately. So when I realized that it was starting to actually affect my treatment of children, I felt like that was it and that I had to get help.

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KWONG: So who did Jessica reach out to for help?

NOGUCHI: Well, she went to rehab. She got into treatment again. And she even came out to her family as an alcoholic, which was a huge relief for her. So by the time I spoke to Jessica - the first time - in April 2020, she'd been in recovery for several months, and her liver was healing. She frequented 12-step recovery meetings on Zoom, and she was doing this with the support of her boyfriend, who was also in recovery. So as she rang off, she sounded really upbeat.

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DUENAS: I am. I am feeling really good right now. You know, the other nice thing is, of course, because I chose not to go through this alone - like, my boyfriend - he's a very sweet person and, you know, is super great during this whole time. And so we're actually going to - it's nice weather here. So, you know, we're going to take the dog out for a walk.

KWONG: That is so sweet. OK, so it has been a year since your first conversation with Jessica. How's she doing right now?

NOGUCHI: Well, it's been quite a year for her, even by pandemic standards. Let's just start with a personal essay she wrote for the Louisville Courier Journal and published in December 2020.

KWONG: OK.

NOGUCHI: The headline is "My Darkest Secret: A Kentucky Teacher Of The Year Shares Story Of Addiction And Recovery."

KWONG: Oh, so she decided to share her story publicly.

NOGUCHI: Yeah. I mean, she did it because she wanted to talk about hiding her own addiction and how her recovery became really challenging in the pandemic. And she talked about some really tragic news in that essay. Last April, actually on the day that I first called her, her boyfriend relapsed and then later died from a heroin overdose.

DUENAS: You know, we were making plans for the future. And, you know, everything we talked about - it was like, OK, when COVID's over, we're going to try and get married. We're going to try and, you know - we had all these visions, and those came crashing down.

KWONG: I'm so sorry to hear that. That's really sad.

NOGUCHI: Yeah. I mean, it was just devastating. And, you know, it was so hard, and she relapsed and ended up in the hospital or in rehabs, she says, about eight times since then and really struggled to stay sober. Eventually, she moved to Florida to be with her family and leaned on their support and focused on her recovery. She wrote that personal essay for her local paper and, you know, just described her past year.

And I want to read one of the last paragraphs. (Reading) Today, I stand proud of who I am and embrace all parts of me. My recovery will no longer be my secret. Instead, it is my story to share, to tell others that we all deserve a fighting chance at a good life, no matter how many times giving up feels like the only way out.

KWONG: That is really powerful. My recovery will no longer be my secret. I mean, since publishing that essay in December, she must have heard from people. Like, what was the public reaction to that piece?

NOGUCHI: It resonated with so many people. Like, hundreds...

KWONG: Wow.

NOGUCHI: ...Of people wrote to her.

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DUENAS: And what I've noticed is quite a few of the women - typically, they were either educators, they were moms or they happened to be nurses or attorneys. Like, that was kind of, like, the groups that I ended up speaking with a lot.

NOGUCHI: So a lot of people who wrote in were women, and they poured their hearts out to her about managing the crushing stresses of kids and work and home, you know, during the pandemic. And they also vented about the pressures outside the home as well.

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DUENAS: So imagine being a teacher who gets evaluated on how your students do given the situation today. I mean, that makes want to drink for them, you know? Like, that's a terrible pressure to be under.

KWONG: A lot of pressure. So, Yuki, let's circle back to the big picture here. There is this big rise in alcoholic liver disease the doctors are seeing, especially among young women. You talked about that earlier. And focusing on this group, are they particularly vulnerable right now?

NOGUCHI: Yeah. I mean, you know, a lot of what Jessica's talking about, you know, these greater responsibilities at home and remote school - I mean, personally, I can relate to that. That's all falling disproportionately on women. And, you know, domestic violence, eating disorders, isolation - these things also kind of add to the stresses and traumas. And just physically, women's bodies generally, for a number of different reasons, can't process alcohol as much as men. I talked to one psychiatrist, Dr. Scott Winder. He treats patients with alcoholic liver disease, and he told me the pandemic is either surfacing or creating trauma.

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SCOTT WINDER: Whether this is early-life sexual trauma or they're in a recent or ongoing abusive relationship, we see this link very, very closely with drinking. Just the sheer amount of trauma is really, really tragic.

NOGUCHI: You know, Emily, think about all the references you see in ads and in pop culture validating this idea of drinking to cope - you know, mommy juice, rosé all day, wine down Wednesdays. It's pretty much everywhere.

KWONG: It is everywhere. And it kind of - what's hard about it is, it masks the fact that, you know, people are drinking and struggling. They're - I mean, they're drinking because they're struggling and suffering in what is, like, a terrible situation we've all been in this year.

NOGUCHI: Yeah. Yeah. I mean, and it's one of these things where I think it's so relatable. It's - you know, there's so many people who maybe started out as social drinkers and then they became problem drinkers. A version of this story aired earlier this year on the radio, and, you know, it resonated with so many people. I heard from friends who told me about their siblings or their friends or even their own struggles to curb drinking. You know, it just felt like everyone had their own story.

KWONG: I mean, alcoholic liver disease is a medical problem. And then, of course, managing addiction or substance use is just really difficult. So how do you treat all of that at the same time?

NOGUCHI: Exactly. It's a physical manifestation of a disease that's, you know, also mental.

KWONG: Yeah.

NOGUCHI: And that's what makes it so complex because usually treatment doesn't address both at the same time, but it really needs to. And Dr. Winder calls this the tragic gap in care. He says, you know, a patient discharged from the hospital with alcoholic liver disease is often really motivated to get psychological help, but frequently they can't find the outpatient care until weeks or months later. And, you know, by that point, the person, you know, has probably just progressed more in their drinking. So on top of that, you know, to treat liver disease - like, really severe liver disease - some people need a transplant. And at most transplant centers, you don't even qualify if you're still drinking.

I talked to Haripriya Maddur, a hepatologist at Northwestern University.

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HARIPRIYA MADDUR: Transplantation is finite. There's not enough organs to go around - unfortunately, means is that many of these young people, you know, may not survive and, you know, die very young in their 20s and 30s. It's horrific.

NOGUCHI: It really is horrific. I mean, what you're seeing is people who started drinking very early in life are now facing a life-or-death struggle.

KWONG: So I want to end this episode where we began - with Jessica. How is she doing right now?

NOGUCHI: It was a difficult decision, but Jessica gave up teaching to focus on her recovery. And she says she's actually heard so many stories like hers that now she's making a project of telling their stories on her website about recovery and that actually is helping her.

KWONG: Well, I'm so glad she chose to tell her story to you and that you have brought it to us. Thank you so much for this reporting.

NOGUCHI: It's my pleasure, Emily.

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KWONG: This episode was produced by Thomas Lu, fact-checked by Rasha Aridi and edited by Viet Le. The audio engineer for this episode is Stacey Abbott. I'm Emily Kwong. Thanks for listening to SHORT WAVE, the daily science podcast from NPR.

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