That “once-in-a-while” binge could be doing far more damage to your liver than you realize.
Many people believe that keeping their alcohol intake low most of the time makes up for the occasional night of heavy drinking. But new research suggests that this pattern may still pose serious risks to liver health.
A study from Keck Medicine of USC, published today (April 2) in Clinical Gastroenterology and Hepatology, found that even infrequent episodes of heavy drinking can significantly increase the likelihood of liver damage.
Occasional Binge Drinking and Liver Scarring Risk
The researchers focused on people with metabolic dysfunction–associated steatotic liver disease (MASLD), the most common liver condition in the United States, affecting about one in three adults. They found that individuals with MASLD who engage in episodic heavy drinking face a much higher risk of developing liver fibrosis, which is the buildup of scar tissue in the liver.
Episodic heavy drinking is defined as consuming four or more drinks in one day for women and five or more drinks in one day for men, at least once a month.
The findings showed that people who consume large amounts of alcohol in a single day at least once per month are three times more likely to develop advanced liver fibrosis compared to those who spread out the same total amount of alcohol over time.
Younger adults and men were more likely to report episodic heavy drinking. The data also revealed a clear pattern: the more alcohol consumed in a single sitting, the greater the extent of liver scarring.
“This study is a huge wake-up call because traditionally, physicians have tended to look at the total amount of alcohol consumed, not how it is consumed, when determining the risk to the liver,” said Brian P. Lee, MD, MAS, a hepatologist and liver transplant specialist with Keck Medicine and principal investigator of the study. “Our research suggests that the public needs to be much more aware of the danger of occasional heavy drinking and should avoid it even if they drink moderately the rest of the time.”
How Drinking Patterns Influence Liver Health
To better understand the impact of drinking habits, Lee and his team analyzed data from the National Health and Nutrition Examination Survey, a long-running study designed to represent the health of the U.S. population. Their analysis included more than 8,000 adults surveyed between 2017 and 2023.
The goal was to examine how drinking patterns relate to advanced liver fibrosis. The researchers specifically looked beyond total alcohol consumption to see how concentrating drinks into a single day might affect risk, even among moderate drinkers. Moderate drinking is defined as up to seven drinks per week for women and 14 or fewer for men.
MASLD was a key focus because of how widespread it has become. The condition is linked to excess weight, obesity, and metabolic issues such as Type 2 diabetes, high blood pressure, and high cholesterol, and its prevalence continues to rise. Although MASLD is not classified as an alcohol-related disease, the researchers wanted to determine whether alcohol use could still contribute to its progression.
More than half of the adults in the study reported engaging in episodic heavy drinking, and nearly 16% of those with MASLD fell into this category.
Why Occasional Heavy Drinking Can Be Harmful
To isolate the effects of drinking patterns, the researchers compared people with MASLD who were similar in age, sex, and average weekly alcohol intake. Some were categorized as episodic heavy drinkers, while others were not. This allowed the team to determine that those who concentrated their drinking into occasional heavy episodes had nearly three times the odds of developing advanced liver fibrosis.
Lee suggests that consuming large amounts of alcohol in a short period can damage the liver in multiple ways. It can overwhelm the organ’s ability to process alcohol and trigger inflammation, which can lead to scarring over time. Individuals with MASLD may be especially vulnerable, since previous research has shown that conditions such as obesity and high blood pressure can more than double the risk of liver disease.
Rising Liver Disease Rates and Broader Implications
According to Lee, alcohol-related liver disease has more than doubled over the past two decades. He attributes this increase to higher alcohol consumption during the pandemic and a growing number of people with underlying risk factors such as obesity and diabetes.
“Although this study focused on patients with MASLD, these findings may also be pertinent to a broader patient population,” said Lee. “With more than half of adults reporting some episodic heavy drinking, this issue deserves further attention from both physicians and researchers to help better understand, prevent, and treat liver disease.”
Reference: “Episodic Heavy Drinking and Implications for Steatotic Liver Disease Nomenclature: A National Cross-Sectional Study” by Yinan Su, Jennifer L. Dodge and Brian P. Lee, 2 April 2026, Clinical Gastroenterology and Hepatology.
DOI: 10.1016/j.cgh.2026.03.004
The study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism, grant number K23AA029752.
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