Alcohol is one of the commonest causes of abnormal liver function tests (LFTs). Unless there is an alternative explanation for abnormal LFTs, it would be reasonable to advise a period (about 2 months) of significant reduced alcohol intake or abstinence and then repeat the LFTs.

Alcohol related liver disease (ARLD) does not show symptoms until the most advanced stages. Liver damage begins with fatty liver, progresses through fibrosis and eventually cirrhosis occurs. Normal LFTs don’t equate to a normal liver.

Even if the LFTs improve or normalise, patients should be referred for assessment if there is suspicion of chronic liver disease with clinical signs or abnormal blood tests (reduced albumin, abnormal clotting, or low platelet count).

People with alcohol problems are more likely (than those without alcohol problems) to have a psychiatric or personality disorder. Conversely, a significant number of people with a psychiatric disorder suffer from alcohol dependence. The psychological effects of alcohol include depression, anxiety, and personality change.

It may be difficult to work out whether alcohol or psychological/ psychiatric problems came first. They should be addressed with a holistic approach by a multi-disciplinary alcohol care team.

Traditionally, people offering short-term help in the voluntary sector tended to call themselves counsellors, while people who had trained on a psychotherapy course would call themselves psychotherapists. People with primarily psychological problem may contact the local Improving Access to Psychological Therapies (IAPT) service. In the presence of any physical alcohol related problems, it would be more appropriate to see a psychiatrist who is medically qualified, as he/she can prescribe medication if necessary.

For hazardous and harmful drinking, early identification & brief advice (IBA) and brief interventions (counselling sessions) in hospital and primary care are effective in reducing alcohol consumption. This may be available through the local Community Alcohol Team/ Service.

Community detoxification for alcohol dependence may be possible under supervision with or without medication to help ease withdrawal symptoms. A tranquiliser called Chlordiazepoxide is commonly used.

In more severe alcohol dependency, residential or inpatient detoxification involving an admission to a hospital is recommended due to the risk of more severe withdrawal symptoms, such as seizures and hallucinations.

The detoxification is followed by a recovery program. For the people who have successfully achieved abstinence from alcohol, Acamprosate (Campral) and Disulfiram (Antabuse) help prevent relapse.