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This article describes the various forms of alcoholic liver disease (ALD), with particular emphasis on cirrhosis, the form of liver disease that often is most associated with alcohol abuse and about which the most information is available. Epidemiological research has evaluated the prevalence of ALD and the factors that often contribute to the disease. Although the most potent factor in ALD is the excessive consumption of alcoholic beverages, gender and ethnic differences also account for some important variations in rates of liver disease. Mortality rates from cirrhosis have declined in the United States and some other countries since the 1970s. A number of factors may have contributed to this decline, including increased participation in treatment for alcohol problems and Alcoholics Anonymous membership, decreases in alcohol consumption, and changes in the consumption of certain types of alcoholic beverages. KEY WORDS: alcoholic liver cirrhosis; epidemiological indicators; gender differences; ethnic differences; AODR (alcohol and other drug related) mortality; morbidity; AOD (alcohol and other drug) use pattern; risk factors; trend; aggregate AOD consumption; beneficial vs adverse drug effect; Alcoholics Anonymous; United States; survey of research O ne of the most enduring insights Alcohol consumption increased into the effects of alcohol has substantially in many countries after ROBERT E. MANN, PH.D., is a senior been the assertion that heavy World War II, which spurred greater scientist in the Department of Social, alcohol consumption increases mortality interest in the effects of alcohol con-Prevention and Health Policy Research rates, especially those from cirrhosis of sumption on cirrhosis and other forms at the Centre for Addiction and Mental Health and an associate professor in the the liver and other forms of liver disease of alcoholic liver disease (ALD). One Department of Public Health Sciences (see the sidebar, p. 211). The scientific of the most influential efforts to sumstudy of alcohol-related mortality marize research in this area was under-at the University of Toronto, both in Toronto, Canada. began in the 1920s with Pearl's studies taken in 1975 by an international (1926) of death rates among various group of scientists sponsored by the REGINALD G. SMART, PH.D., is a principal types of drinkers. He and others found World Health Organization (WHO). and senior scientist in the Department of that heavy drinkers had higher rates of The resulting book, Alcohol Control overall mortality and of mortality from Policies in Public Health Perspective (Bruun Social, Prevention and Health Policy et al. 1975), reviewed studies of clinical Research at the Centre for Addiction and cirrhosis than did lighter drinkers or and nonclinical populations of heavy Mental Health in Toronto, Canada. abstainers. Since then, mortality studies drinkers. All studies found that a greater have continued to demonstrate that proportion of heavy drinkers died of RICHARD GOVONI, PH.D., is a research heavy drinkers and alcoholics ...

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