Alcohol Use Is Rising Among Women - and So Are Cases of Severe Liver Disease, Study Finds

Heavy drinkers today are more than twice as likely to develop liver damage compared with two decades ago, researchers say.

A new study has found that significant liver disease among heavy drinkers in the United States has more than doubled over the past two decades, with women increasingly bearing the health consequences of higher alcohol consumption.

The research, published July 23, 2025, in Clinical Gastroenterology and Hepatology, analysed data from a national survey of drinking habits and liver health between 1999 and 2020.

It found that among heavy drinkers, the rate of significant liver damage rose from nearly 2% in 1999–2004 to more than 4% in 2013–2020.

The study was led by Dr. Brian Lee of Keck Medicine of the University of Southern California, alongside Kalpana Gopalkrishnan and Jennifer L. Dodge. The researchers said the rise in liver disease is linked not only to heavier drinking, but also to changes in the U.S. population, including higher rates of obesity and diabetes. Both conditions can contribute to fat accumulation in the liver, compounding alcohol’s toxic effects.

“The modern American drinker looks different than it did 20 years ago,” said Lee, a hepatologist and the study’s lead author.

Women closing the gap with men

The research comes amid broader shifts in drinking patterns. Historically, men drank significantly more than women, but that gap has nearly closed. Women today drink more frequently and in larger quantities than in the past - and their bodies process alcohol differently.

Because women tend to have less water and more fat in their bodies than men, alcohol reaches higher concentrations in their blood. Women also produce less of the enzyme alcohol dehydrogenase, which breaks down alcohol before it enters the bloodstream. These biological differences increase the risk of liver damage, even when women consume less alcohol than men.

“Historically, there’s been differences in prevalence rates [of alcohol use] between men and women. And essentially, that gap has now closed and the ratio between men and women’s drinking is almost at 1 to 1,” said Sherry McKee, director of the Yale SCORE Program on Sex Differences in Alcohol Use Disorder.

Cultural and lifestyle changes

Experts point to lifestyle changes that have created more opportunities for women to drink. With more women in college - an environment typically associated with higher alcohol use - and with many delaying childbirth and marriage, drinking often continues into the post-college years.

“Pair that with the fact that women are delaying childbirth, delaying marriage - it just gives more space for women to continue drinking in the post-college years,” McKee said.

Midlife is now the peak age for heavy alcohol use among women, according to Katherine Keyes, an epidemiology professor at Columbia University’s Mailman School of Public Health.

While stress and workplace drinking culture may play a role, she said the bigger driver is that drinking is marketed — particularly wine and spirits — as fun, sophisticated, or a form of relaxation.

A “perfect storm” for liver disease

The study’s findings also reflect how alcohol use is colliding with other health trends. Rates of metabolic syndrome — a cluster of conditions including obesity, high blood pressure, and diabetes — rose sharply among heavy drinkers during the study period, from 26% to nearly 38%.

“It could be the situation of a perfect storm,” Keyes said. “We have an increase in alcohol consumption … alongside changing prevalence of these other conditions.”

A silent but serious illness

Doctors say liver disease often goes undetected until it is advanced, because patients typically feel healthy even with significant damage.

“Your risk of liver disease might be higher than you think,” Lee said. “The reality is that liver disease is silent, and most people — even with cirrhosis, which is end-stage liver disease — have no symptoms at all.”

Dr. Jessica Mellinger, a liver disease specialist at Henry Ford Health in Michigan, noted that about a quarter to a third of heavy drinkers will eventually develop alcohol-related liver disease. “The more you drink, the greater likelihood you have of getting liver disease of any stage,” she said.

Keyes added that women often wait longer to seek medical help for heavy drinking because of social stigma. “It’s really becoming this hidden epidemic where women wait too long to see someone about a really serious, alcohol-related condition,” she said.

The bottom line

While not all heavy drinkers will develop liver disease, the study highlights a concerning trend: rising alcohol use, particularly among women, combined with worsening rates of obesity and diabetes, is accelerating liver damage in the U.S. population.

Researchers say more awareness of alcohol’s risks — especially for women — is urgently needed to prevent further increases in alcohol-related deaths and disease.