For many years, Jessica Duenas led what she calls a double life. She was the first in her immigrant family to go to college. In 2019, she won Kentucky's Teacher of the Year award. That same year, Duenas typically downed nearly a liter of liquor every night.
By the time she was 34, she was diagnosed with alcoholic hepatitis, a serious inflammation of her liver that doctors warned could could soon lead to irreversible scarring and even death if she didn't didn't stop drinking, and quickly.
"I couldn't keep down any food," Duenas says. "My belly was supersensitive, like if I pressed on certain parts of it, it would hurt a lot. My eyes were starting to get yellowish."
Cases of alcoholic liver disease — which includes milder fatty liver and the permanent scarring of cirrhosis, as well as alcoholic hepatitis — are up 30% over the last year at the University of Michigan's health system, says Dr. Jessica Mellinger, a liver specialist there.
The pathway to that sort of liver disease, especially severe versions, varies from person to person, liver specialists say, and can be exacerbated by obesity, certain genetic factors, and underlying health problems. Drinking a glass or two of wine — even every day — is unlikely to cause this sort of liver damage in many people, the experts say, though it's possible.
But Mellinger says she and other doctors are seeing patients who have edged up to higher amounts of drinking in the last year — to a bottle of wine, or 5-6 drinks, a day — which increases the chances of liver disease severe enough to require hospitalization. And binge drinking, even if less frequent, can also be damaging.
The Centers for Disease Control and Prevention has not yet compiled data on any overall increase in hospitalizations from alcoholic liver disease since the pandemic began. But, Mellinger says, "in my conversations with my colleagues at other institutions, everybody is saying the same thing: 'Yep, it's astronomical. It's just gone off the charts.' "
The damage can be lethal. Survival rates for alcoholic hepatitis and cirrhosis vary but can be as low as 10% in the most severe cases, research suggests.
In the U.S., more than 44,000 people died of alcoholic liver disease in 2019. And although liver diseases still affect more men, younger women are driving the increase in deaths, a trend that began several years ago and is now supercharged by the pandemic, says Mellinger. "We're seeing kids in their late 20s and early 30s with a disease that we previously thought was kind of exclusive to middle age," she says.
Alcoholic liver disease often takes years to manifest. But it can become a threat for women more quickly because their bodies process alcohol somewhat differently than men's.
Women have also borne the brunt of many new pressures of pandemic life, from virtual school and increased responsibilities at home, even as ads and pop culture have continued to validate the idea of drinking to cope: Mommy Juice, Rosé All Day, Wine Down Wednesdays. On top of that, eating disorders and underlying trauma from physical or sexual violence often add fuel to the fire, fanned by social isolation.
"Whether this is early life sexual trauma or they are in a recent or ongoing abusive relationship, we see this link very, very closely," says psychiatrist Dr. Scott Winder, a clinical associate professor at the University of Michigan who treats patients with alcoholic liver disease. "Just the sheer amount of trauma is really, really tragic."
Alcoholic liver disease is complex because it isn't just one thing; it's the physical manifestation with roots in emotional and psychological distress. Successful treatment needs to address both, Winder says, but usually doesn't.
He calls that a "tragic gap" in care. A patient discharged from the hospital with alcoholic liver disease is often motivated to get psychological help but frequently can't find outpatient care until weeks or months later, he says.
"The cultures of hepatology and the cultures of psychology and psychiatry are very disparate; we see patients very differently," so physicians aren't coordinating care, even when they should, he says.
For patients with advanced liver disease, that often leaves no options for curative treatment. Some need a liver transplant to survive, but they won't qualify if they're still drinking.
"Unfortunately, transplantation is finite," says Dr. Haripriya Maddur, a hepatologist at Northwestern University. "There aren't enough organs to go around. What it unfortunately means is that many of these young people may not survive, and die very young — in their 20s and 30s. It's horrific."
Facing death frightened Duenas, who is now 36. She says after her doctor told her she had alcoholic hepatitis, she thought: "My secret's out."
She made multiple attempts to curb her drinking but ended up consuming ever more and became despondent.
"I felt so terrible about who I was as a person because of my addiction that I just threw myself into everything else to make everything else look good," she says.
Duenas checked herself into rehab on New Year's Day in 2020 for four days. Her liver began to heal. And when the world went to pandemic lockdown last March, she attended recovery meetings on Zoom.
Then, on April 11, she discovered her boyfriend — who had also been in recovery — was relapsing on heroin. Two weeks later, she and the police found him dead in his apartment. Though he and Duenas had talked about marriage, he'd died from an overdose just after his 42nd birthday.
Duenas relapsed, hard.
"The next eight months are such a blur," she says — eight hospitalizations, a major car wreck, and repeat stints in rehab. Duenas describes herself as normally politically active. But the last year passed by in a fog. She only vaguely recalls hearing about news in rehab: protests over Breonna Taylor's shooting; Election Day.
Last November, she says, she completely surrendered to the changes she knew she had to make. She quit her beloved job to focus on recovery, and her last drink was on Thanksgiving Day, she says. Days later, she wrote about her long-held secret in the Louisville Courier-Journal: "I'm Jessica, I'm the 2019 Kentucky State Teacher of the Year, I'm an alcoholic and I've been suffering in silence for years."
Hundreds of people wrote back — mostly women describing experiences like hers.
"What I've noticed is quite a few of the women, typically, they were either educators, they were moms or they happened to be nurses or attorneys," Duenas says. They poured their hearts out about the crushing and constant stress of kids, work and home life.
They also vented about pressures from beyond the home. "Imagine being a teacher who gets evaluated on how your students do, given the situation today," Duenas says. "I mean, that makes me want to drink for them, you know — like that's a terrible pressure to be under."
Duenas says she's since heard many, many other stories like her own. She has started interviewing them and relaying their stories on her website about recovery, www.bottomlesstosober.com.
A MARTINEZ, HOST:
More people at younger ages are getting alcoholic liver disease, especially women under the age of 40. Advanced alcoholic hepatitis and cirrhosis can kill half or more of those who get it. Stress and isolation are feeding that trend.
NPR's Yuki Noguchi joins us. Yuki, this spike, how big is it?
YUKI NOGUCHI, BYLINE: Well, it's big enough to alarm Jessica Mellinger. She's a liver specialist at the University of Michigan and says she's seen a 30% increase in hospitalizations there since the pandemic began.
JESSICA MELLINGER: In my conversations with my colleagues at other institutions, everybody is saying the same thing. They're like, yep, it's astronomical. It's just gone off the charts.
NOGUCHI: Off the charts, she says, and likely to get worse. And it's been young women driving that trend.
MELLINGER: I personally switched all of my research in my liver transplant training year to alcoholic liver disease because I was seeing so many young people in the hospital. I was like, what is going on here? We're seeing kids in their late 20s and early 30s with a disease that we previously thought was kind of exclusive to middle age.
MARTINEZ: Wow. That's tough to hear. We know you've been following one woman who's struggled with this. Tell us her story.
NOGUCHI: Yeah, her name is Jessica Duenas, and I first met Duenas last April, just a few weeks into the pandemic. She'd just been named Kentucky's 2019 Teacher of the Year. She was 35 and in love, with a new puppy and a new house in Louisville, and she was four months into recovery. She told me she was tired of leading a double life as a star in her field and a closet alcoholic. She used to drink almost a liter of liquor a night. That's 20 shots of bourbon or vodka and 20 times the Centers for Disease Control's definition of heavy drinking for women. So by age 34, she'd developed alcoholic hepatitis.
JESSICA DUENAS: I couldn't keep down any food. I was losing weight, and I mean losing weight that I wasn't seeking to lose. My belly was super sensitive. Like, if I pressed on certain parts of it, it would hurt a lot. My eyes were starting to get yellowish.
NOGUCHI: She says she never drank at work. She's the first in her immigrant family to go to college, so she masked her problems by working extra hard. But that ate at her.
DUENAS: I felt so terrible about who I was as a person because of my addiction that I just threw myself into everything else to make everything else look good. But I hate myself. I want to die. I feel miserable. I feel like less than a person.
NOGUCHI: Sadly, that feeling of entrapment isn't uncommon. We'd spoken on April 11 of last year. At that time, her liver was healing. She frequented 12-step recovery meetings on Zoom. As she rang off, she sounded upbeat.
DUENAS: I am feeling really good right now, of course, because I chose not to go through this alone. Like, my boyfriend - he's a very sweet person, and he's been super great during this whole time. It's nice weather here. So you know, we're going to take the dog out for a walk.
NOGUCHI: I called Duenas again recently. It turns out shortly after we talked that day, she found her boyfriend. He'd relapsed on heroin.
DUENAS: He looked trapped and, like, completely out of control and completely outside of himself. Like, that image is still frozen in my head.
NOGUCHI: Two weeks later, she went to his apartment.
DUENAS: Banged on the door, no response - called his phone...
NOGUCHI: Neighbors intervened. Police arrived.
DUENAS: And when they got the door open, he had - he was gone. He had overdosed.
NOGUCHI: He died at 42. They'd planned to marry, have children.
DUENAS: Honestly, the next eight months are such a blur. Yuki, like, I was hospitalized about eight times. My hospitalizations ranged from three-day detoxes in emergency rooms to one five-week stay in a residential rehabilitation facility. I could not stay sober at all.
NOGUCHI: She took medical leave. She flipped her car over in a wreck. Duenas says she's normally politically active, but she only vaguely recalls last year's news from rehab - protests over Breonna Taylor's shooting, Election Day. By November, she was ready. She says her last drink was on Thanksgiving. Days later, she wrote about her secret in the Louisville Courier-Journal.
DUENAS: I'm Jessica. I'm the 2019 Kentucky State Teacher of the Year. I'm an alcoholic, and I've been suffering in silence for years.
NOGUCHI: Hundreds of people responded to her piece.
DUENAS: What I've noticed is quite a few of the women, typically, they were either educators, they were moms or they happened to be nurses or attorneys. Like, that was kind of like the groups that I ended up speaking with a lot.
NOGUCHI: These women poured their hearts out about managing crushing stresses of kids, work and home. They also vented about pressures outside the home.
DUENAS: Imagine being a teacher who gets evaluated on how your students do given the situation today. I mean, that makes me want to drink for them, you know? Like, that's a terrible pressure to be under.
NOGUCHI: Duenas says she's heard so many stories like hers. Now she's making a project of telling their stories on her website about recovery.
MARTINEZ: Yuki, why is this hitting so many young women like Duenas, especially right now?
NOGUCHI: Well, you know, a lot of it's what she talked about - you know, greater responsibilities at home and with remote school. That's all falling disproportionately on women. You know, domestic violence, eating disorders, isolation also makes those kinds of stresses and traumas worse. And you add to that, women's bodies just can't process as much alcohol as men.
So psychiatrist Scott Winder sees patients with alcoholic liver disease, and he told me the pandemic is surfacing or creating trauma.
SCOTT WINDER: Whether this is early life sexual trauma or they're in a recent or ongoing abusive relationship, we see this link very, very closely. Just the sheer amount of trauma is really, really tragic.
NOGUCHI: You know, and then you have ads and pop culture validating the idea of drinking to cope - you know, mommy juice, rosé all day, wine down Wednesdays.
MARTINEZ: All right. So you're talking about then the medical problem of liver disease and then on top of that, the underlying emotional struggles in addiction. So how do you treat all of that at the same time?
NOGUCHI: Well, that's exactly what makes this disease so complex. You know, usually treatment does not address both at the same time. But to treat severe liver disease, some people need a transplant, and you don't even qualify if you're still drinking. Haripriya Maddur is a hepatologist at Northwestern University.
HARIPRIYA MADDUR: Unfortunately, transplantation is finite. There's not enough organs to go around. What it unfortunately means is that many of these young people may not survive and die very young in their 20s and 30s. It's horrific.
NOGUCHI: You know, that means they started drinking very early in life, and now they're facing a life-or-death struggle.
MARTINEZ: Yuki, thank you so much for sharing that story with us.
NOGUCHI: Thank you.
MARTINEZ: That's NPR health correspondent Yuki Noguchi.
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