NEW YORK — In some bars patronized by regular heavy drinkers, the talk occasionally turns from sports scores and politics to the odds of dying from cirrhosis of the liver.
Researchers say heavy drinkers have vastly higher chances of killing themselves, either through chronic liver disease or sudden death, than moderate drinkers or teetotalers.
But the probability that an alcholic will develop cirrhosis, a deadly chronic liver disease, is not as high as is generally believed, they said. It is not true that everyone who drinks heavily for extended periods of time will ``drink themselves to death.``
The American Liver Foundation estimates 30 percent of people who drink eight to 16 ounces of hard liquor a day for 15 years will develop cirrhosis of the liver. Researchers in the field interviewed recently put the figure much lower, between 10 and 15 percent.
Even then, researchers said they are not sure of all the factors involved in cirrhosis and said nutrition and genetics may play a vital role in determining who develops the disease.
``The odds are well in favor of the alcoholic,`` said Dr. David H. Van Thiel, professor of medicine at the University of Pittsburgh and a leading researcher into cirrhosis. ``Most heavy drinkers will develop a fatty liver, but that`s absolutely not terminal. Most damage to the liver from drinking is reversible.``
There are other ways alcohol can kill, researchers are quick to point out. Heavy drinkers, those who drink on average more than four drinks a day, are more likely to get into accidents. One recent study estimates drinkers are in twice as many car accidents as people who don`t drink.
Massive amounts of alcohol ingested over a few hours can also cause the heart to stop beating and can induce a coma that may be permanent. Researchers said it is not unusual for a comatose drinker to vomit, then choke to death.
Heavy drinking over an extended period of time effects all organs of the body, doctors said, but not necessarily in a way that is fatal.
Research has shown heavy, prolonged drinking kills off brain cells associated with memory and can cause infertility in men and women, said Dr. Markku Linnoila, of the National Institute on Alcohol Abuse and Alcoholism outside Washington.
Yet the organ most affected by alcohol, the liver, is remarkably adaptable.
The liver, weighing roughly three pounds and located on the upper right side of the abdomen, creates bile, breaks down old red blood cells, metabolizes cholesterol, regulates hormones and detoxifies drugs, poisons and alcohol.
Liquor has an almost straight shot into the liver, entering from the portal vein that drains blood from the intestine.
``The liver can handle about 10 grams of alcohol an hour. That`s about one ounce of hard liquor, a beer or a glass of wine,`` said Dr. Esteban Mezey, professor of medicine at Johns Hopkins University School of Medicine and a reasearcher into liver disease.
``It metabolizes ethanol--the alcohol--into carbon dioxide, water and about seven calories per gram,`` he said. ``If it`s more than the liver can handle, the alcohol goes into the blood and brain, it recycles back, and the liver gets another chance.``
Mezey said the average man can imbibe about four drinks a day and the average woman two drinks without damaging their livers.
``It depends a lot on the individual,`` he said. ``Women are lighter than men so they can handle less. A lightweight man would have trouble with four.`` Eventually the overconsumption of alcohol will cause fatty deposits on the liver that make it swollen and heavy. This fat goes away within weeks once the drinker is on the wagon, researchers said.
Cirrhosis, however, is a permanent scarring of the liver. Alcohol helps destroy working liver cells, which are replaced by useless scar tissue, eventually rendering the organ ineffective in preventing a buildup of poisons in the blood.
The disease is difficult to treat, and doctors said alcoholics with cirrhosis must stop drinking if they want to live.
In 1983, the most recent year figures are available, 27,266 Americans died of chronic liver disease, including cirrhosis. Most of those cases were caused by alcohol and the rest by viral hepatitis, various diseases and reactions to drugs.
There is still no test to determine who is prone to cirrhosis, doctors said.
``Eventually, for some reason, you may get cirrhosis,`` Mezey said of heavy drinkers. ``But it`s more likely you`ll drink too much and stop breathing or you`ll get in a car or you`ll vomit and choke. That`s what`s more likely to kill you.``