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Alcohol & Drugs

One of the reasons you will have had a liver transplant is to improve your health and quality of life. However, because alcohol is very much part of our culture and way of life, you will need to make decisions about how you approach alcohol in the future.

Alcohol use was not the cause of my liver disease – can I still drink?

In general, drinking alcohol after transplant is not recommended, even for people who have not had alcohol-related liver disease. Alcohol is broken down by the liver and so drinking alcohol places the liverunder extra strain. In the first few months of transplant, it is especially important to protect your liver from extra strain so that it can recover from the transplant and enable the body to heal and liver function to return to normal.

For people who have had their transplants as a result of diseases such as Wilson’s Disease or alpha-1 antitrypsin deficiency, the liver transplant may offer a complete cure. If there are no problems with the medications you are taking, it may be possible to return safely to moderate alcohol consumption. It is best to seek advice from your transplant centre about if and when it is safe to start drinking alcohol.

For most people, however, the transplant will be a treatment rather than a cure for their liver condition. There is a risk that autoimmune conditions, Hepatitis B and C, and NASH can recur in transplanted livers. Consuming alcohol places the liver under further strain and can accelerate the damage that is caused by these conditions. There is further advice in the section below about living without alcohol.

I have had alcohol related liver disease – can I still drink?

If you have had a liver transplant because of alcohol related liver disease you will have been asked to remain alcohol free for the rest of your life. There are several reasons for this.

  • Your transplanted liver may not be able to break down alcohol as effectively as your own liver because of the immunosuppressant drugs you are taking. This could mean that relatively small amounts of alcohol could damage your transplanted liver in quite a short period of time
  • it is possible that if you started drinking alcohol again you might find it hard to stick to just one drink. When this happens a person can find that they start drinking much more than they intended and quickly go back to drinking at levels that caused their original liver disease
  • some people may have undesirable consequences of starting to drink alcohol again. This might include such things as forgetting to take your medication, missing appointments or effects on other aspects of your care. This could affect your transplanted liver and in some cases lead to rejection.

When you were being considered for a liver transplant it is likely that you have signed an agreement to remain alcohol free after your transplant. This is done to help remind you about the importance of not drinking and the reasons why you agreed to be abstinent. It is also part of your acceptance of all the treatment and care offered to you and a demonstration of your commitment to the transplant programme.

The agreement is also likely to highlight the need to maintain contact with the alcohol liaison specialist within the transplant team as well as having routine blood tests to check for alcohol. It is worth remembering that this contact enables the transplant team to spot any potential problems earlier and so offer support and treatment sooner, reducing the likelihood of harm to the new liver.

The most important thing is that you understand the cause of your liver disease and take a decision not to drink alcohol again.

What about shandy or alcohol free drinks – surely they can’t hurt?

People who have had a history of alcohol related liver disease should not drink low alcohol or alcohol free drinks. You might think this seems a bit harsh but,

  • Sometimes drinking alcohol free drinks such as Kaliber or Becks LA can trick your brain into thinking that you are really drinking alcohol. When this happens it can cause a desire or craving to drink alcohol again.
  • When you are in a social situation or at the pub it is possible to get drinks mixed up and find you have mistakenly drunk some alcohol without meaning to. This risk is reduced if you stick to soft drinks.
  • Shandy does contain alcohol. Some people have found that they started drinking a shandy that was mostly lemonade and a tiny bit of lager. Over the course of time the lager can become the bigger part of the drink and you can end up drinking far more than you originally intended. This may cause a return to your original liver disease.
  • There are many more types of soft drinks available than in the past.Take your time to experiment with these to find one that you enjoy and feel comfortable with.
  • If this is bothering you or you have further questions, talk to the substance misuse nurse at your transplant centre or your liver transplant coordinators.

How can I manage without drinking alcohol?

Before you had your transplant it may have been relatively easy not to drink alcohol. You were probably feeling unwell, had less of a social life and were very aware of the need for abstinence as part of being on the liver transplant waiting list. As you return to a more normal life you may find it harder than you expected not to drink. Below are a few ideas that you might find helpful.

  • Reduce the temptation to drink. Don’t keep any alcohol at home, particularly in the fridge
  • identify your triggers. These can be certain people or places. Often triggers can be the way we feel, such as when we are stressed, angry, anxious or down. Try to avoid your triggers if you can, or develop a plan so that you are prepared and able to deal with a situation without alcohol
  • if your triggers for drinking are difficult feelings such as anger, anxiety or depression, it may help to talk to someone about managing these without drinking. Most of the organisations that work with people to stop them drinking have skills and practical advice to help you with this
  • look back at your list of reasons for stopping drinking and remind yourself regularly about why you are giving up alcohol. Remember it is not just about the transplant – you may have noticed other unexpected benefits such as having more money, developing new interests and having better relationships with those you love for example
  • keep busy! Boredom is often a reason for drinking or returning to drinking - think about hobbies you have neglected or you want to take up
  • change your habits. If having a drink straight after work was something you always did, you will need to alter your routine. Do something else or find another way to relax
  • take it one day at a time. It can be very daunting to think about not drinking forever. When it gets difficult try saying to yourself, ‘I’ll just not drink for today.’ If that feels too much, break it down to ‘Just for this morning’ or ‘Just for the next couple of hours’. 
  • Cravings or urges to drink will pass. You might find it helpful to remember the ‘four Ds’:
    1. Delay for at least five minutes so that the urge to drink will pass
    2. Drink some water or soft drink you like, and sip it slowly
    3. Deep breathe – slow, full deep breaths will control your nerves
    4. Distract yourself, do something else to keep your hands and mind busy.

Do also talk to friends, family or alcohol support such as alcohol counsellors, alcoholics anonymous or contact telephone helplines such as Drinkline.

  • Don’t try to test yourself. It might seem a useful challenge to deliberately go somewhere you know you might be tempted to drink to see if you can manage to stay off it, but this can be quitedangerous and can lead to a slip back into old drinking habits
  • tell close friends and people who you see often about not drinking alcohol and why this is important to protect your health. If you do this, they are likely to be more understanding, put less pressure on you and will make sure that they have a suitable soft drink available for you when you see them
  • be convincing! When you are in a social situation be clear about which soft drink you are having, ask confidently and don’t hesitate.

If you seem unsure people are more likely to try and persuade you to drink alcohol instead. It is worth preparing ahead and thinking through scenarios and how you will respond.

Being alcohol free is part of a whole range of things that you need to do in order to keep yourself healthy after your transplant. It is important to take regular exercise and eat a balanced diet especially as some of the side effects of the immunosuppressants make weight gain easier.

Remember alcohol contains lots of calories – even a pint of very weak beer (3.5% abv) can contain up to 180 calories. Exercise is also a useful way of managing stress as well as controlling your weight.

Can I use illicit drugs after transplant?

Many of the reasons for not using recreational drugs are similar to the reasons for not using alcohol post transplant. There may be a tendency to use more of a substance than intended, and under the effects of the drug you might forget to take your immunosuppression medication or keep your hospital appointments (or perhaps simply misjudge them as not very important).

All drugs have an effect on the liver, but in particular, street drugs are notoriously impure, often of unknown strength and frequently containing one or more other drugs as well as contaminants. Whatever the route of administration, these drugs will impact on your judgement, behaviour and affect the liver.

Surely cannabis is OK?

Cannabis is a psychoactive drug. It can aid relaxation (though may also induce anxiety and paranoia). It is linked to untoward effects on motivation and judgement. It is also linked to the “gateway theory”,where people who start using this drug may move onto other harmful drugs. There are some clinical reports of direct effects on the liver. As such, the use of cannabis is actively discouraged.

I am on a methadone programme. Should I stop it?

Some patients who have used opiates in the past (such as heroin) are treated with a substitute medication such as methadone or buprenorphine (Subutex).

Substitute medication is aimed at helping a person to manage cravings for opiates and provide a safer alternative to illicit or unmanaged use. If you are on a methadone or Subutex programme it is likely that you will be under a treatment team for this, either within a drugs clinic or your own GP surgery. It is very important that you do not stop your medication unless you do so as part of a planned detoxification with your drug treatment team, or because your medical team need to stop it for medical reasons. In the case of the latter, your medical team should discuss this with you and your drug treatment team and be aware of the possible complications of this, which could include opiate withdrawal symptoms, reduced tolerance to opiates and craving to use drugs again.

There is also good evidence that people who stop using opiate drugs such as heroin and methadone may sometimes substitute for this by increasing their alcohol use, and so you, your family and your treatment team should be mindful of this.

Alcohol and drug misuse

There are about 500 local advice and counselling centres in the UK. Most of these are funded by the NHS and are free to access. You can look them up in the telephone book or use the directory on the Alcohol Concern website. Alternatively your GP or practice nurse should be able to provide you with details of your local service and arrange to refer you, though in the majority of instancesself referral is preferred and more straightforward.