Alcohol Misuse

Introduction

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.

It is estimated that 1 in 13 people in the UK are alcoholics, with several million drinking excessively, to the extent where they are putting their health at risk.

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 has been associated with many different types of cancer, including cancer of the breast, mouth, larynx (voicebox) 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, and there are also many services that you can use that will help you stop altogether.

Definition

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.

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

Recent research has shown that a very high percentage of adults in the UK (over 90% of men and 86% of women aged 16 years or over) drink alcohol.

To reduce health risks from drinking, the Department of Health recommends that adult males should drink no more than 3-4 units of alcohol a day, and that adult females should drink no more than 2-3 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, have smaller builds, bodies that contain less water, which may lead them to have a lower tolerance to alcohol than men.

One unit is defined as 7.9g of pure alcohol (also known as ethanol). However, because alcohol is a liquid, it is easier to measure it by volume, and one unit is 10ml of alcohol. This is roughly equivalent to half a pint of beer, cider or lager, a 25ml (pub) measure of spirit such as vodka, whisky or gin, a 50ml (pub) measure of fortified wine such as port or sherry, or a small 125ml glass of wine, at 8% AbV (Alcohol by Volume).

Different drinks have different amounts of pure alcohol in them as they contain other ingredients such as water, sugar or fruit juice. Each drink has a different quantity of AbV, so one unit can be found in different measures, depending on the type of liquid.

The number of units can be worked out from the percentage AbV, which equals the number of units of alcohol in a litre of the liquid. For example, many wines in pubs and restaurants are likely to be around 12% (note that the unit above is based on a wine with 8% AbV). A litre of wine at 12% AbV equals 12 units. An average bottle contains 75cL, which is therefore 9 units (75% of 12). If six glasses are poured, each will contain 1.5 units of alcohol. Alternatively, multiplying the %AbV by 10 gives the number of millilitres of alcohol in one litre of the drink.

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.

Risks

Excessive alcohol consumption can affect your physical and mental health, your work, and your social and personal relationships. You are also more likely to find yourself in dangerous situations if you have been drinking a lot, as alcohol affects your judgement and you may do things that 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.

Health risks associated with heavy drinking include:

• liver disease (cirrhosis of the liver),
• alcohol related anaemia and nutritional disease,
• chronic calcifying pancreatitis,
• heart muscle damage (cardiomyopathy), and
• alcoholic dementia.

Heavy drinking also increases the risk of high blood pressure, cerebral haemorrhage (stroke), coronary heart disease and heartbeat irregularities. People who drink large amounts of alcohol over long periods of time are also at much greater risk of liver damage. This may lead to alcoholic hepatitis and cirrhosis.

Psychiatric disorders are also more common in people who drink more than 10 units a day.

They include:

• depression,
• suicide and attempted suicide,
• personality 0deterioration,
• sexual problems,
• delirium tremens (sudden and severe mental changes, such as seizures, following alcohol withdrawal),
• hallucinations, and
• memory loss.

Treatment

As with any addiction, if you are 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 1 in 3 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 web sites 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-behaviour 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 or 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 5-7 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.

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 or an eye-opener)?

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 to 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?