Sensible Drinking

This factsheet is written for people who want to know more about the effects of alcohol and how to drink sensibly.

Research has shown that, for men over 40 and women after the menopause, having one or two small drinks a day can help prevent coronary heart disease. However, it is estimated that nearly one in three adults in the UK are risking their health by drinking more than the recommended daily amount of alcohol.

How much is too much?

Current UK guidelines recommend that men don't drink more than three or four units of alcohol a day, and that women limit their intake to two or three units a day. You shouldn't save up units through the week and use them to binge at the weekend, and at least one day a week should be alcohol-free.

If you do have an episode of heavy drinking, as a short term measure, you shouldn't drink alcohol for 48 hours.

Strength and units

One unit is 8 grams, or about 10ml, of pure alcohol - regardless of how diluted it is. Below is a list of some common drinks and how many units they have in them.

• One pint of strong lager (alcohol 5% vol) = 3 units
• One pint of standard strength lager (alcohol 3 - 3.5% vol) = 2 units
• One 275ml bottle of an alcopop (alcohol 5.5% vol) = 1.5 units
• One standard (175ml) glass of wine (alcohol 12% vol) = 2 units
• One measure (25ml) of a spirit strength drink = 1 unit

Units for women

The recommended limits are lower for women than for men because the body composition of women has less water than men. So, even if a man and woman weigh the same and are of a similar size, the woman will tend to get drunk faster.

Some experts also think that women develop liver disease at lower levels of drinking than men, although this appears to only be the case in higher levels of alcohol consumption.

Alcohol dependence

Some people who drink frequently or in large quantities can become addicted to alcohol. Doctors use a number of techniques to diagnose patients with drink problems. They may ask you how much and how often you drink and whether you have "blackouts". You may be asked if you have tried to cut down, whether you feel guilty about your drinking, or whether you have a drink in the morning.

According to the Institute of Alcohol Studies, a person is considered to be dependent on alcohol when they have experienced three or more of the following symptoms during a year.

• A strong urge to drink, difficulty controlling how much they drink, or difficulty stopping.
• Physical withdrawal symptoms, such as sweating, shaking, agitation and nausea when they try to reduce drinking.
• A growing tolerance to alcohol - needing larger quantities to get the same effect.
• Gradual neglect of other activities.
• Persistent drinking even though it is obviously causing harm.

Alcohol abuse, or problem drinking, happens when a person is not dependent on alcohol, but is drinking enough to cause themselves actual physical or psychological harm.

Short-term effects

A small amount of alcohol will relax you and make you feel less anxious. But alcohol is a depressant of the central nervous system. In increasing amounts it suppresses the part of your brain that controls judgement, resulting in a loss of inhibitions. It also affects your physical co-ordination, causing blurred vision, slurred speech and loss of balance. Drinking a very large amount at one time (binge drinking) can lead to unconsciousness, coma, and even death. Vomiting while unconscious can lead to death by asphyxiation (suffocation).

Alcohol is involved in a large proportion of fatal road accidents, assaults and incidents of domestic violence.

Long-term effects

Alcohol can be a dangerous drug. Drinking too much too often will cause physical damage, increase the risk of getting some diseases, and make other diseases worse. Excessive drinking over time is associated with:

• hepatitis and cirrhosis of the liver
• gastritis (inflammation of the stomach lining) or pancreatitis (inflammation of the pancreas)
• high blood pressure (which can lead to stroke)
• certain types of cancer, including mouth and throat
• damage to the brain
• heart failure
• neurological problems such as epilepsy
• certain types of vitamin deficiency

Excessive drinking has also been linked to:

• obesity
• sexual problems
• infertility
• muscle disease
• skin problems

Alcohol and pregnancy

Women who drink heavily during pregnancy are at risk of having babies with a condition called fetal alcohol syndrome. This can result in growth deficiencies, nervous system problems, lowered intelligence, and facial abnormalities in the child. It is also called fetal alcohol spectrum disorder - all the symptoms are not always present and can vary in how serious they are.

There is some evidence that pregnant women who drink 10 to 15 units a week are more likely to have underweight babies. It is not known if there is an absolutely safe limit for drinking during pregnancy, but research indicates that it may be wise to avoid alcohol altogether.

Psychological effects

Although alcohol initially makes people feel relaxed, long term excessive use can ultimately increase anxiety and cause depression. It is also related to problems with sleeping, mood-swings, violence and suicide (about two-thirds of suicide attempts are thought to involve alcohol).

Cutting down

If you think you're drinking too much, keep a "drinking diary", noting how much alcohol you drink each week. It will reveal whether you are drinking within safe guidelines and help you identify the situations that you need to avoid to cut down your drinking.

Below are some tips to help you cut down.

• Go out later, so you start drinking later.
• Replace your "usual" drink with one containing less alcohol.
• Skip the "quick drink" at lunchtime or after work.
• Have at least two alcohol-free days a week.
• Do something other than going to the pub.
• Drink more slowly or have non-alcoholic drinks between alcoholic ones.
• Buy beers and wines with lower alcohol content, and keep a supply of non-alcoholic drinks at home.
• Set yourself a limit of, for example three to four units (men) or two to three (women) for any one occasion.
• Find other ways to relax.

Stopping drinking

Cutting down may not be enough if you are alcohol dependent. Confidential advice and support is available through your GP, and may involve a community alcohol team or specialist consultant care. There are also organisations such as Alcohol Concern and Alcoholics Anonymous that help many people (see below).

Treatment

When someone heavily dependent on alcohol stops drinking (detoxification), they sometimes get withdrawal symptoms. These include headaches, nausea, sweating, and tremors. Sometimes more serious symptoms like confusion, paranoia, and having fits or hallucinations can occur.

To prevent withdrawal symptoms, a chronic heavy drinker may be prescribed medication such as diazepam (eg Valium) or chlordiazepoxide for a few days after stopping drinking.

Below are some examples of other drug treatments that are sometimes used to help people dependent on alcohol.

• Disulfiram causes very unpleasant effects if even a small amount of alcohol is consumed. Patients are told that they cannot drink at all when taking this drug. Consuming large amounts of alcohol can occasionally lead to arrhythmias, low blood pressure and collapse. It is prescribed under specialist supervision.

• Acamprosate influences transmitters in the brain to reduce alcohol cravings. It is prescribed to people after detoxification. It may cause side-effects such as headache, diarrhoea and rash.

• Naltrexone is a drug used to treat people addicted to opioids such as heroine. It is sometimes prescribed by specialists to reduce the chances of a relapse in alcohol dependent people who have stopped drinking. People with chronic alcohol dependence are often malnourished, and vitamin supplements are essential.