DR Kieran Moriarty, a respected consultant at the Royal Bolton Hospital, has seen five young women in their 20s die from alcoholic liver disease in 12 years. Here, in his own words he puts frankly and graphically the town's growing dependency on alcohol and of one woman's battle against the booze

IN 1993, Cathy (not her real name), a 29-year-old woman, had been a patient under my care on 15 separate occasions with the complications of alcoholic liver disease -- jaundice, internal bleeding, fluid in the abdomen, confusion and coma.

She had pulled through before, but, despite all her pledges, always lapsed and started drinking again following discharge. This time, she was not responding to treatment and the outlook was bleak.

The nurses were especially distressed to see a young woman of similar age to themselves in this situation.

While doing a ward round with the sister, we came to Cathy and she said to me: "Doctor, I've had enough. I'm going to give up."

The sister and I looked at each other for inspiration. All I could say was: "Well, we're not going to give up on you."

We redoubled our efforts, she pulled through and this time she stopped drinking.

She regained her self respect and she got her six-year-old child back out of care. She started a clothing business, which became so thriving that she was given 27 bottles of spirits at Christmas -- which she poured down the sink!

The reality of alcohol is frightening.

It can damage virtually every organ in the body, including the brain, heart, pancreas, reproductive and digestive systems, and the liver.

Liver disease, as with diseases of other organs, is related to the quantity of alcohol consumed.

We all show different sensitivity to alcohol, but the chances are that if you drink enough for long enough, then one system or another will become diseased.

The maximum recommended alcohol intake per week is 21 units for men and 14 units for women -- one unit = half-pint ordinary strength beer or lager, one glass of sherry or five per cent table wine, or one single spirit (pub measure). It should be remembered that the average measure of spirits we pour for ourselves at home is a treble!

It's not all doom and gloom, however -- evidence suggests that consumption of 1-2 units per day may reduce death rates from coronary heart disease.

How do we recognise that somebody is drinking too much?

The so-called CAGE questions are helpful:

1. Have you ever felt that you should cut down on your drinking? C for cut.

2. Have other people annoyed you by criticising you about your drinking habits? A for annoyed.

3. Have you ever felt bad or guilty about your drinking? G for guilty.

4. Have you ever taken a drink in the morning to steady your nerves, or get rid of a hangover, the eye-opener? E for eye-opener.

Women, and the female liver in particular, seem to be more susceptible to alcohol than the male.

This is because women have less body water to dilute ingested alcohol, more body fat, which stores alcohol in the body for Ionger, and are more prone to immune reactions, when the liver destroys itself after being exposed to alcohol.

This is a paradox, because in virtually all other aspects of health, from the womb to the tomb, the female is biologically stronger than the male. It is, however, a sad truth, and I have watched five young women die in their late 20s of the complications of alcoholic cirrhosis.

Well, what happened to Cathy?

Sadly, in 1999, after six years of abstinence, she relapsed and lost everything, including her child. We had to start from scratch yet again.

It can be especially demanding looking after alcoholic patients, because their care is often fragmented. They do not turn up to appointments, and once they have completed their hospital admission, they go back to old habits.

Finally, after years of trying to help, we often have to watch them die a most unpleasant death with internal bleeding, infection, coma and kidney and liver failure.

In Bolton, and in the North-west generally, there is considerable socio-economic deprivation and a high prevalence of heart, chest and alcohol-related diseases.

Indeed, men and women in the North-west live seven years less than people in Dorset and Cambridge.

Moreover, in Bolton, we are one of the most poorly funded districts in the country.

Therefore, in order to cope with a large amount of illness, including alcoholic liver disease, we have to organise ourselves as well as we possibly could.

We have pioneered a multidisciplinary care approach to patients with alcoholic liver disease and also run a specialised liver clinic to follow up our patients. The numbers have increased so much that we have had to start a second clinic every month.

In 1999, our work was recognised and we were voted the British Hospital Doctor Gastroenterology Team of the Year. I was also voted overall British Hospital Doctor of the Year. We were very honoured.

The judges recognised especially our holistic, multidisciplinary approach to caring for our alcoholic patients.

USEFUL TELEPHONE NUMBERS

BOLTON voluntary group, Bolton Alcohol and Drug Services on 01204 393660/382230. Alcohol Concern Tel: 0171 928 7377. Alcoholics Anonymous 01904 644026 (Head Office). A1-Anon Family Groups 0171 403 0888.