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Alcohol misuse

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Drinking a moderate amount of alcohol will not do you any physical or psychological harm. However, for some people, social drinking can lead to heavier drinking, which can cause serious health problems.
Brought to you by NHS Choices

Overview

Introduction

It is estimated that one in 13 people in the UK are dependent on alcohol (an alcoholic), with several million drinking excessively, to the extent that they are putting their health at risk.

Alcoholism causes many social and health-related problems

Heavy drinking is linked to suicide, murder, fatal accidents and many fatal diseases. It can increase your chances of developing cirrhosis of the liver, and it is associated with many different types of cancer, including cancer of the breast, mouth, larynx (voice box) and liver.

As well as being directly related to many serious diseases, drinking large amounts of alcohol can also lead to poor sexual performance, and it can harm an unborn baby.

If you have an alcohol-related problem, there are many ways in which you can get help to reduce your drinking. There are also many services that can help you give up alcohol altogether.

The problems associated with alcoholism, or alcohol dependence, are wide ranging and can be physical, psychological and social. For someone with a drink problem, drinking becomes a compulsion and takes precedence over all other activities.

A person with alcohol dependence:

  • has a strong desire to drink alcohol,
  • has difficulty controlling their use of alcohol,
  • persistently uses alcohol despite being aware of the harmful effects,
  • shows increased tolerance for alcohol, and
  • shows signs of withdrawal when without alcohol.

Definition

Alcohol dependence can remain undetected for many years. Although some scientists think that there may a genetic link to alcohol dependence, it is very difficult to prove. The easy availability of alcohol and social patterns can influence the likelihood of a person becoming alcohol dependent.

Binge drinking

Binge drinking is defined as drinking eight or more units of alcohol in one session if you are a man, and more than six units in one session, if you are a woman. Studies are starting to reveal that drinking a large amount of alcohol over a short period of time may be significantly worse for your health than frequently drinking small quantities.

In the UK, binge drinking is becoming a big problem. Teenagers as young as 16 admit to binge-drinking and around 40% of patients admitted to A&E are diagnosed with alcohol-related injuries or illnesses.

Facts

Alcohol facts

Research has shown that a very high percentage of adults in the UK - over 90% of men and 86% of women aged 16 or over - drink alcohol.

What's a unit?

To reduce health risks from drinking, the Department of Health recommends that adult males should drink no more than three to four units of alcohol a day, and that adult females should drink no more than two to three units of alcohol a day. However, it is important to remember that alcohol affects different people in different ways. Women tend to have different metabolisms; they also tend to be lighter and have smaller builds, and their bodies contain less water, which may lead them to have a lower tolerance to alcohol than men.

Calculating units of alcohol

A unit of alcohol corresponds to 10ml of pure alcohol.

In the past, it was fairly easy to calculate the amount of units that you were drinking because different types of alcoholic drinks shared the same alcohol content. For example, a half pint of beer, a glass of wine, or a shot of whiskey all contained one unit of alcohol.

However, due to increases in the levels of alcohol that are contained in some drinks, this is no longer always the case. Also, many pubs and bars now serve larger measures of spirits or wine.

This is why drink manufacturers now provide a measurement of the percentage of pure alcohol that is contained in a particular drink. This measurement is known as alcohol by volume, or ABV. The ABV can usually be found on the label of the bottle, or on the can. If you are ordering drinks in the pub, the bar staff should be able to tell you the abv of the drink that you are ordering.

The most accurate way of calculating the number of units of alcohol in an alcoholic drink is:

  • find out how many millilitres are in the drink (a pint is 568 ml, a glass of wine is usually either 175ml, or 250ml, and a shot of spirits is usually either 25ml, or 35ml),
  • multiply the abv by the number of millilitres in the drink before,
  • dividing the result by 1,000.

For example, if you were drinking a pint of strong lager than had an ABV of 5% you would:

  • multiply the abv by the amount of millimetres in the pint; which in this case would be 5x568 = 2,840, and then you would
  • divide the result by a 1,000, which in this case would be 2840 divided by 1,000 = 2.840 units.

Typical units of alcohol

Measurements of alcohol for some other popular drinks are listed below.

  • A standard glass of wine (175ml) at 12% abv is 2.1 units, and a large 250ml glass is 3 units.
  • A measure (35ml) of spirit (40% abv) is 1.4 units.
  • A bottle (275ml) of ordinary strength alcopops (5% abv) is 1.4 units.
  • A shot (35ml) of spirits, typically between 35-40% abv, is 1.3 units.
  • A pint (568ml) of low strength (3.5-4% abv) beer, or lager, is 2.3 units.
  • A standard measure of port, or sherry, (50ml) is 1 unit.

The quantity of alcohol in a person's bloodstream (or blood alcohol content) is used to measure their level of intoxication (drunkenness). It is calculated in milligrams of alcohol per 100 millilitres of blood. The UK BAC limit for legal driving is 80mg/100ml.

Who's at risk?

More than seven million people in England (32% of men and 15% of women) are at risk of problems caused by alcohol. The following people are at particular risk.

  • Young people under 18 (in particular, 11-15 years):
    This is the age when most young people start to drink alcohol. Although the proportion of young people who are drinking has declined in recent years, those who do drink are downing more alcohol, more often.

    The reported average weekly consumption of alcohol by young people aged 11-15 years doubled in the 1990s. This was from an average of five units a week in 1990 to 10 units a week in 2000.

    Research shows that the younger a person is when they start to drink, the greater their risk of alcohol-related problems later in life.
  • Young adults:
    Binge drinking is most likely in people aged 16-24 years. Out of this age group, 21% of men and 9% of women are thought to binge drink.
  • Women:
    In the last 10 years, the number of people drinking more than the recommended limits on any one day has increased by 50% in women (it has remained stable in males). The number of young women (aged 16–24 years) who are drinking to excess has also doubled.
  • People with managerial/professional jobs: Men and women in the managerial/professional work sector are more likely to exceed the daily recommended limits compared with people in routine or manual occupations.


Causes of drinking too much

Sometimes, alcohol misuse starts because social drinking can get out of hand. Other times, alcohol misuse can start due to problems in life, such as depression, bereavement or financial problems. Ex-drug users can also begin using alcohol in the belief that it won’t be a ‘problem’ in the same way that their drug was.

Research shows that genes could influence people’s drinking habits (and possibly their susceptibility to addiction). However, if you think that you're drinking too much, it is more important to get the support you need in order to break the habit, rather than concentrating on where the blame lies.

Risks

Risks of alcohol misuse

Excessive alcohol consumption can affect your physical and mental health, your work, and your social and personal relationships.

Short-term effects

Alcohol affects your physical coordination, causing slurring of speech, blurring or double vision and loss of balance.

You are more likely to find yourself in dangerous situations if you have been drinking a lot, as alcohol affects your judgment and you may do things you would not consider doing when sober. For example, a recent report showed that a quarter of all young prisoners had been drinking when they committed their crime.

Other high-risk behaviour associated with heavy alcohol consumption is:

  • casual and unprotected sex, which can lead to unplanned pregnancy or sexually transmitted infection,
  • fights and arguments,
  • accidents at home and on the road.

Binge drinking, or drinking large amounts of alcohol in a short space of time, can lead to unconsciousness, coma, and sometimes death. Vomiting while unconscious can cause someone to choke on their vomit and suffocate.

Long-term effects

Health risks associated with heavy drinking include:

  • liver damage (cirrhosis and alcoholic hepatitis),
  • alcohol-related anaemia and nutritional disease,
  • gout,
  • pancreatitis (inflammation of the pancreas),
  • heart muscle damage (cardiomyopathy) and coronary heart disease,
  • alcoholic dementia (brain damage),
  • sexual problems, such as impotence,
  • infertility,
  • potentially fatal alcohol poisoning,
  • high blood pressure,
  • stroke,
  • anxiety, depression and poor concentration,
  • suicide and attempted suicide,
  • hallucinations.


Social problems related to heavy alcohol intake include:

  • divorce,
  • domestic violence,
  • child abuse,
  • workplace problems (such as absenteeism and impaired performance),
  • financial problems,
  • homelessness,
  • criminal behaviour.


Can drinking too much harm my unborn baby?

Drinking during pregnancy can result in fetal alcohol syndrome or fetal alcohol spectrum disorder. These disorders lead to lifelong intellectual and behavioural problems for the child.

Not a pretty sight

Heavy drinking affects your looks. It can cause:

  • Weight gain -
    alcohol is high in empty calories (a pint of beer or two glasses of wine have the same number of calories as a bar of chocolate).
  • Dry skin and broken veins.
  • Bloodshot eyes.
  • Smelly bodies -
    5-10% of the alcohol you have drunk is excreted through your urine, breath and sweat.
  • Bruises, scarring and broken bones - heavy drinkers are more likely to get into fights.

What happens with a hangover?

Alcohol has a diuretic effect, which means that the body loses too much water and causes dehydration. This effect can be made worse by congeners (substances that are found in all alcoholic drinks to give a distinct flavour but which can be more concentrated in dark drinks). Alcohol also stimulates the production of insulin, which reduces blood sugar levels and causes drowsiness, weakness, trembling, faintness and hunger.

Treatment

Treating alcohol dependency

As with any addiction, if you are dependent on alcohol (an alcoholic), the first step is to acknowledge that you have a problem. Once you have accepted that you have a problem, the next step is to seek help.

If you have an alcohol problem, there are many different professional services and support groups that can help you to reduce your alcohol consumption and give you the advice and support that you need to stop drinking altogether.

Group therapy sessions, or one-to-one counselling with trained medical and psychiatric professionals, are two common methods that may be recommended if you have an alcohol-related problem. As well as attending therapy sessions, you may also receive specific treatment for any associated nutritional problems, or other secondary effects that you may have.

Self help

It is estimated that about one in three people who have an alcohol problem are able to reduce their drinking or stop drinking altogether without the need for professional help. There are many self-help books, leaflets and websites available that offer help and advice about how you can stop or reduce drinking.

Counselling

Some people who have a drinking problem find it extremely useful to talk about their situation with their GP or practice nurse. You may then be referred to a specially trained counsellor, who will discuss in more detail the issues surrounding your drinking problem and help you to plan how you can control and manage your drinking. Sometimes, cognitive behavioural therapy (CBT) is used to treat alcoholism. This therapy is designed to help you change your attitude and behaviour towards alcohol.

Treating other conditions

Sometimes, drinking alcohol is used to mask a range of other, underlying health problems. For example, people with an alcohol-related problem often also have problems with stress, anxiety, depression or other mental health problems. If you feel you may have a mental health problem, you should see your GP, who will be able to prescribe medication or recommend other forms of treatment for you.

Always remember that heavy drinking is not the answer, and in the long-term, it is likely to make any underlying condition that you have worse.

Detoxification

Detoxification (detox) is a process that involves taking a short course of medication in order to prevent you having withdrawal symptoms when you stop drinking alcohol. Benzodiazepine medicines, such as chlordiazepoxide, are often used for detox. Usually, a high dose of medication will be prescribed for the first day that you stop drinking alcohol, before being gradually reduced over the next five to seven days. This should reduce any unpleasant withdrawal symptoms that you might otherwise have. You should not drink any alcohol during the period of detoxification.

Staying off alcohol

Sometimes, people who successfully go through the detox process start drinking again at some point, and it may take several attempts before you manage to significantly reduce your alcohol consumption or are able to stop altogether.
However, you are more likely to be successful if you have counselling or other support from your family, friends, your GP, local alcohol support groups and other self-help groups.

Tips

  • Replace some of your drinks with non-alcoholic or low alcohol drinks.
  • If you drink mainly when you go out, try going out later or having your first drink later.
  • If you drink mainly at home, trying buying non-alcoholic alternatives.
  • Buy smaller glasses and watch how much you pour.
  • If you use alcohol to ‘wind down’ after a hard day, find alternatives such as exercise classes or relaxation techniques.
  • Avoid drinking on an empty stomach.
  • Avoid mixing different types of alcohol.

Keep a drinking diary

On a daily basis, make a daily note of:

  • All the alcoholic drinks you had,
  • How many units you drank (visit www.drinkaware.co.uk for a unit calculator),
  • What time you had them,
  • Where you were.

This should give you a good idea of how much you're drinking, the situations when you have a drink and where you could start to cut down.

Recommendations

If you answer yes to two or more of the following questions, you need to think about your alcohol intake:

  • Have you ever thought you should cut down on your drinking?
  • Have other people ever annoyed you by commenting on your drinking?
  • Do you ever feel guilty about the amount of alcohol you are drinking?
  • Have you ever taken a drink in the morning to relieve the symptoms of alcohol (commonly known as 'hair of the dog')?

If you answer yes to three or more of the following questions, you should consider seeking help from your GP, who will be able to refer you to a specialist:

  • If you are a man, are you drinking more than 50 units of alcohol a week?
  • If you are a woman, are you drinking more than 35 units a week?
  • Do you have a strong desire or need to drink alcohol?
  • Do you find it difficult to resist the urge to drink, stop drinking, or control the amount that you drink?
  • Does your behaviour change or do you feel differently if you cannot get a drink?
  • Do you drink to relieve or prevent those feelings?
  • Do you seem to be able to drink more than most other people around you?
  • Do you have a higher tolerance to alcohol than others?
  • Does the desire to drink, or the effects of alcohol, stop you taking part in your other interests and pleasures?
  • Do you still drink, despite knowing about the harmful consequences?

I want to try for a baby. Can I still drink alcohol?

If you're trying to conceive, or are already pregnant, the government advises that you should avoid drinking alcohol. If you do choose to drink, to minimise the risk to the baby, you shouldn’t have more than one or two units once or twice a week and you shouldn’t drink so that you feel drunk.

Expert view

Dr Michelle Butterworth, specialist registrar in addiction psychiatry at South London and Maudsley NHS Trust, suggests some of the questions that you might want to discuss with your doctor.

What is alcohol misuse?
Alcohol misuse is using alcohol in such a way that it causes harm to you and to those close to you - physically, psychologically and socially.

Can drinking too much harm my health?
Definitely. At the lower end of the spectrum, simply overdoing it causes a hangover, which is a result of dehydration and low blood sugar levels. A hangover also alters the way the brain cells work, causing tremors and sleep disruption. Moving up the scale, drinking too much can cause accidents, violence and reckless or dangerous behaviour. If you drink heavily, you're at risk of alcoholic hepatitis (when the liver becomes inflamed), cirrhosis and damaging the ability of your brain to work effectively.

How do I know I have a problem?
It’s not just about what or how much you're drinking. You have a problem with alcohol if:

  • You want to drink at a time when it’s not appropriate.
  • You have difficulty controlling or limiting what you drink.
  • Your judgment is affected.


What are the signs I could be alcohol dependent?

  • If you wake up sweating and shaking.
  • If you drink every day.
  • If you need increasing quantities to get the same effect.
  • If you crave alcohol.
  • If your drinking starts to take over other areas of your life.


I only drink a lot on Friday and Saturday night. That can’t hurt, can it?

It depends on how much you're drinking. If you're ‘saving up’ your units or drinking more than twice the maximum recommended units of alcohol per day in one session, then it is harmful to your health and possibly to others.

Can I cut down on my own?
If you're drinking heavily but not alcohol dependent, you may be able to cut down on your own. If, however, you are physically dependent on alcohol, trying to stop on your own can cause serious health problems. In both cases, it's best to talk to your GP or a drug and alcohol advisor.

Ask your doctor

  • How much alcohol is safe?
  • Why am I drinking too much?
  • What will happen if I carry on drinking?
  • What support are you able to give me?
  • Should I give up drinking totally?
  • How do I give up alcohol?
  • Are there support groups I can use for help?

Useful links

NHS Choices links

External links

This article was originally published by NHS Choices

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