How to Make Peace With Giving Up Alcohol
When you have hepatitis C, even the occasional drink is off-limits. Our four-step plan can help with the emotional fallout.by Amy Marturana Winderl Health Writer
A hepatitis C diagnosis doesn’t require a ton of major life adjustments. Most people can continue doing everything they’ve always done—work, exercise, travel. That’s also true during treatment, thanks to modern medications with minimal side effects that rarely interrupt your life. But there is one thing your doctor will tell you to ditch as long you’ve got hep C: alcohol.
For anyone who enjoys wine with dinner or a cocktail at social outings, this can be a big bummer. But it’s not merely a suggestion for those who have this liver infection, caused by the hepatitis C virus, also known as HCV. It’s medically necessary, at least until treatment is finished (more on that, below).
“For people with hepatitis C, complete abstinence is very important,” says Nikolaos Pyrsopoulos, M.D., the chief of gastroenterology and hepatology at New Jersey Medical School and medical director of liver transplantation for University Hospital in Newark, New Jersey. “When people who have hepatitis C regularly consume alcohol, liver damage is more accelerated.”
Here’s why: Hepatitis C causes inflammation in the liver. Over time, this inflammation can lead to serious liver damage and scar tissue buildup—which makes it much harder for your liver to do its job and can lead to liver disease, among other problems. And because alcohol also produces inflammation in the liver, scar tissue piles up even faster, Dr. Pyrsopoulos explains.
So...Can You Ever Drink Again?
Maybe. After you’ve successfully completed treatment and are cured of hepatitis C—meaning a blood test three months after treatment doesn’t detect any of the virus in your blood—you may be able to safely resume drinking in moderation. It really depends on your unique situation and the bigger picture of your health.
What does this “bigger picture” include? Mostly, alcohol isn’t forbidden unless you’ve already been diagnosed with advanced liver disease and have excessive scar tissue. If that is you, you’ll “need to abstain because it could push [you] towards needing a liver transplant,” Dr. Pyrsopoulos says. Always check with your physician before you pour a glass of bubbly—she knows your situation best.
Even if you find out it’s safe for you to drink after hepatitis C treatment, it’s important not to go overboard and to stick to the USDA Dietary Guidelines, Dr. Pyrsopoulos says. That means no more than one standard drink per day if you’re a woman, and two if you’re a man. And no, you can’t “bank” drinks for the weekend. That’s not how it works.
According to the Centers for Disease Control and Prevention (CDC), one standard drink translates to:
12 ounces of beer (5% alcohol content)
5 ounces of wine (12% alcohol content)
8 ounces of malt liquor (7% alcohol content)
1.5 ounces or one sho of 80-proof (40% alcohol content) distilled spirits or liquor, like gin, rum, vodka, or whiskey
It’s worth repeating: Until you finish treatment for hep C and get the green light from your doctor, there’s no safe amount of alcohol you can drink. Zilch, zip, zero. While this can certainly feel like a blow to your normal lifestyle, there are ways to make it less so. When you’ve gotta abstain, follow these four steps to help you deal with drinking FOMO.
Step 1: Accept the Upset
Feeling down about having to stop drinking cold turkey is a completely normal and expected reaction. In fact, it would be more surprising if you were totally unphased. It’s ok to be pissed.
“There’s a real mourning process here that’s worth going through,” says Rebecca Block, Ph.D., a clinical psychologist in New York City. “It’s like losing a dependable, reliable, fun friend. It’s a sad loss.”
At the same time, being diagnosed with a chronic illness like hep C can also make you feel like you’ve lost a version of yourself, a healthy self who didn’t have to consider a chronic illness, Dr. Block says.
“Maybe you imagined yourself going to a wedding or graduation events and having a glass of champagne. Those ideas of your future self have to change, and there’s a real loss of a version of yourself that’s sad and worth mourning,” she says. Allow yourself to go through the process of thinking about what you lost and letting yourself be sad about it. Ultimately, it can help you accept what you need to do to take good care of yourself.
Step 2: Reflect On Why You Drink in the First Place
After sitting with your feelings for a bit, ask yourself why giving up alcohol feels like a loss to begin with.
“Coming to peace with this involves first thinking about the motivations behind why you're drinking alcohol,” says Eric C. Strain, M.D., a professor of psychiatry and behavioral sciences and director of the behavioral pharmacology research unit at Johns Hopkins University School of Medicine in Baltimore, Maryland.
“There are a multitude of reasons why people drink, but you can kind of think about it broadly: You drink alcohol because of reasons outside of you or inside of you,” Dr. Strain says. “The outside reasons are things like peer pressure and social circumstances, and the inside things may be you get anxious easily, it helps you fall asleep, or you like the taste of a particular drink.”
This is also a good time to ponder any potentially problematic drinking behaviors—like, if you’re leaning on it as a crutch too often at social get-togethers or if it’s played a role in a breakup or other messy situation.
Dr. Strain suggests making a list of pros and cons to figure out the role alcohol plays in your life and reveal any not-so-great things that may make it easier to give up. “This practice can be really helpful over time,” he says. “If you do it over the course of a week or two, you start to remember things like, ‘I did drink too much once and I hurt my relationship.’”
If you find that you do have an unhealthy relationship with alcohol—or you’re not sure—consider seeking out behavioral help as you navigate this diagnosis. Your primary care doctor can direct you to the best type of therapist or doctor to help you successfully stop drinking.
Step 3: Come Up With Substitutions for the Positives
Once you’ve examined about the role alcohol plays in your life, it’s time to figure out what can replace the positive aspects.
“What I encourage people to do is really think about the function of alcohol as opposed to focusing on how to stop drinking,” Block says. “Then, you can find substitutes that give a good approximation of what the alcohol was doing.”
For example, a common positive function of alcohol is that it can be a group activity that brings people together, Block says. (Or, in the time of corona, over Zoom happy hours.) “Lots of times, meals or going out for drinks can be a nice shared event. It can feel very daunting for people to give up the notion of joining in that kind of activity or merriment, that celebratory way of coming together.”
That you? There are alternate ways to get that same sense of community and not feel left out. Block suggests creating your own special mocktail—it can help provide the celebratory feeling that comes from toasting. Easier said than done, but worth trying: Instead of framing this situation as giving something up, consider it an opportunity to create a new ritual.
If a post-work glass of wine after work was your way to transition out of job mode and relax, replace it with something else that satisfies that sipping-drink-on-couch itch, such as kombucha, bubbly water with a splash of juice, or even flavorful herbal tea. You could also ditch the drink entirely and use nightly walk to mark the end of the work day, Block suggests. Might feel like a bummer at first, but give it some time—it may grow on you.
If it’s less about replacing a daily routine and more that a beverage is your “treat,” swap it for an equally indulgent goody, like a cookie or decadent piece of chocolate.
Step 4: Focus On the Long-Term Reward
Even if you’re thinking “wow this really blows,” it can be easier to accept such an unwelcome change when you focus on the good it will ultimately bring into your life.
“Remind yourself you’re worth taking care of and this is what you have to do to take care of yourself,” Block says. You may feel deprived, and that’s ok (you don’t have to be happy about this), but try to home in on other wonderful things you can consume or do in place of alcohol—all while being kind to your body and taking an important step for future you.
Breaking it into shorter chunks of time can help, too. “If you think about it as being forever, you’ll just feel defeated. But if you say, ‘I can do this for tonight and will deal with the rest later as it comes’ it can feel much more doable,” Block says. And it very well may be something you only have to do for eight to 12 weeks.
In the meantime, always keep the end goal front of mind. No glass of red is more valuable than your health.
Moderate Drinking Definition: U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015) “2015-2020 Dietary Guidelines for Americans.” health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines
Standard Drink Sizes: Centers for Disease Control and Prevention (CDC). (2020). ”Alcohol Basics: Frequently Asked Questions.” cdc.gov/alcohol/faqs.htm