Alcohol-related Problems

oPatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

See separate related articles Alcoholism - Recognition and Assessment and Alcoholism and Alcohol Abuse - Management

The recommended maximum alcohol intake a week is 21 units for men and 14 units for women. In 2009 knowledge of daily benchmarks and measuring alcohol in units had increased among both men and women. The proportion of adults who had heard of daily benchmarks increased from 69% in 2006 to 90% in 2009.[1] 

The amount of alcohol consumed weekly by men in England in 2009 was 15.6 units, slightly lower than the previous year's estimate of 18 units. In women, the figures were 9.9 units in 2007, 7.7 units in 2007 and 9.9 units in 2009. This is thought to be due to differences in fluctuations in data analysis rather than any variance in real terms.[1]  There is also a rise in binge drinking - usually in the younger adult - and the risk for alcohol dependence increases with binge drinking. 

In 2010/2011 there were 190,900 admissions where the primary diagnosis was attributable to the consumption of alcohol.[2] 

Moderate (12.5-<50 g/day) to heavy (>50 g/day) alcohol intake is associated with an increased risk of oesophageal cancer.[3]

Younger people were more likely than older people to exceed the daily benchmarks:[2] 

Over 56% of young men aged 16 to 24 had drunk more than twice the recommended level on at least one day during the previous week. This compares with 6% of men aged 75 and over.

52% of women in the youngest age group had exceeded twice the recommended level on at least one day compared with only 3% of those aged 75 and over.

Having initially risen, the proportion of young women who drink heavily has fallen, although the statistics should be treated with caution due to the small sample size. The proportion of 16 to 24 year-old women who had drunk more than six units on at least one day in the previous week fell from 24% in 2009 to 17% in 2010.

Alcohol misuse accounted for 1.5% of all premature deaths in England in the UK. The alcohol-death rate is on the increase. There were 8,664 alcohol-related deaths in 2009, rising to 8,790 in 2010.[4] The risk increases once intake exceeds more than three drinks per day.[5] 

These result from continued use of excessive amounts of alcohol. Binge drinking and chronic drinking of alcohol are more likely to cause harm.[7] 

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Medical problems

  • Liver: alcoholic hepatitis, cirrhosis, liver cancer.
  • Gastrointestinal tract: oral cavity cancer, oesophageal neoplasm, oesophageal varices, pancreatitis.
  • Cardiovascular system: atrial fibrillation, hypertension, strokes and cardiomyopathy with heart failure.
  • Neurological system: acute intoxication with loss of consciousness, withdrawal, seizures, subdural haemorrhage, peripheral neuropathy, Wernicke-Korsakoff syndrome and cerebellar degeneration.

Psychiatric problems

  • Alcohol dependence syndrome
  • Suicidal ideation
  • Depression
  • Anxiety

Miscellaneous

  • Loss of libido
  • Fetal alcohol syndrome
  • Impaired performance at work.
  • Relationship problems.
  • Violent crimes - eg, domestic violence and drink driving offences.
  • Antisocial behaviour.

Affects of alcohol on the liver[8] 

Alcoholic liver disease includes fatty liver, alcoholic hepatitis and cirrhosis. These three conditions probably represent a spectrum of liver damage resulting from continued abuse of alcohol.[9]

  • In fatty liver, there is an accumulation of fat within the hepatocytes. This is reversible with abstention from alcohol.
  • Alcoholic hepatitis presents as acute right upper quadrant (RUQ) pain with jaundice, fever and marked derangement of LFTs. At a microscopic level there is inflammation of the liver.
  • In liver cirrhosis, the hepatocytes are damaged so much that they are replaced by scar tissue which is permanent. Alcoholic hepatitis and cirrhosis may co-exist. Alcoholic hepatitis and cirrhosis may lead to encephalopathy, portal vein hypertension and hepato-renal syndrome. This group of patients is also at increased risk of infections and they are usually also malnourished.
  • Treatment involves abstinence from alcohol, and good nutrition. There is no specific therapy for alcohol-related hepatitis and cirrhosis. It is important to look for, and promptly treat, the complications which include ascites, spontaneous bacterial peritonitis, hepatic encephalopathy and oesophageal varices.
  • Patients with ascites may need to be maintained on high doses of diuretics. Again, abstinence from alcohol is crucial.

See separate article Cirrhosis for more details.

Affects of alcohol on the gastrointestinal tract

Alcohol increases the risk of oral cancers. This is especially associated with spirits and the risk is increased with concomitant use of tobacco. Adenocarcinoma of the stomach and oesophagus is thought to be related to alcohol use. Some of these cases may be genetically determined.[10] 

Portal hypertension is a complication of cirrhosis and leads to a raised venous pressure in veins in the oesophagus and stomach. These swollen veins are superficial and bleed easily. Bleeding from oesophageal varices is serious and is associated with a high level of morbidity and mortality.[11] 

Management of bleeding varices is a medical emergency and requires adequate resuscitation (patients may need to be intubated to protect their airway). Blood transfusions are necessary and correction of abnormal clotting with vitamin K and fresh frozen plasma (FFP) may also be required. Various options for treatment are available including vasoactive drugs, obturation with glue and balloon tube tamponade.

See separate article Oesophageal Varices or more details.

Both acute and chronic pancreatitis are associated with excessive alcohol consumption. One study found that consumption of spirits was more likely than wine or beer to cause acute pancreatitis.[6] The pathophysiology of alcohol-related pancreatitis is not clearly understood. Patients usually present with epigastric pain with vomiting. The amylase is high in acute pancreatitis but may be normal in patients with chronic pancreatitis. Pancreatitis can be associated with a number of complications such as shock, sepsis and abscess formation. Long-term complications include diabetes mellitus and weight loss from steatorrhoea.

See separate articles Acute Pancreatitis and Chronic Pancreatitis for more details.

Affects of alcohol on the cardiovascular system

  • Excessive alcohol use is associated with hypertension and subsequent target organ damage such as strokes, myocardial events and renal failure.[12] 
  • It is also associated with a dilated cardiomyopathy with heart failure and atrial fibrillation which may revert to sinus rhythm.[13] 

Again, abstinence from alcohol is paramount.

Affects of alcohol on the nervous system[14]

  • Acute alcohol intoxication can present with blackouts, head injuries and subdural haemorrhages. Alcohol withdrawal is associated with fits which may be unresponsive to anti-epileptics.
  • The Wernicke-Korsakoff syndrome results from lack of thiamine (commonly seen in alcoholics due to malnutrition). Wernicke's syndrome occurs acutely and patients present with confusion, visual impairment (diplopia) and ataxia. Korsakoff's syndrome occurs more chronically and is characterised by memory deficits and confabulation .

See separate article Wernicke-Korsakoff Syndrome for more details.

Alcohol withdrawal occurs within a few hours of not having a drink and can last beyond 48 hours. Patients experience hallucinations, anxiety and a coarse peripheral tremor. On examination, patients may be pyrexial, tachycardic and hypertensive. They may also develop seizures and auditory and visual hallucinations.

Delirium tremens is the severe end of the spectrum of alcohol withdrawal and consists of a severe form of the above symptoms; it may be associated with circulatory collapse and ketoacidosis.

See separate article Acute Alcohol Withdrawal and Delirium Tremens tor more details.

This is characterised by the following:

  • A strong desire to drink.
  • Difficulty controlling alcohol intake.
  • Physiological withdrawal when intake is reduced.
  • Tolerance, such that increasing amounts are required to produce the same effect.
  • Harm resulting from continued alcohol use - eg, work or relationship problems.

Treatment of alcohol dependence includes education, support, counselling and controlled alcohol withdrawal. Patients may need to be admitted to hospital for detoxification.[15]

Further reading & references

  • Nichols M, Scarborough P, Allender S, et al; What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels. BMJ Open. 2012 May 30;2(3). pii: e000957. doi: 10.1136/bmjopen-2012-000957. Print 2012.
  1. Drinking: adult's behaviour and knowledge - 2009 Report, UK National Statistics
  2. Statistics on Alcohol: England, NHS Information Centre, 2012
  3. Islami F, Fedirko V, Tramacere I, et al; Alcohol drinking and esophageal squamous cell carcinoma with focus on light-drinkers and never-smokers: a systematic review and meta-analysis. Int J Cancer. 2011 Nov 15;129(10):2473-84. doi: 10.1002/ijc.25885. Epub 2011 Apr 7.
  4. More men dying in the UK as a result of alcohol, Office for National Statistics, 2012.
  5. Prevention and reduction of alcohol misuse - Evidence briefing (2nd edition), NICE/Health Development Agency, March 2005
  6. Sadr Azodi O, Orsini N, Andren-Sandberg A, et al; Effect of type of alcoholic beverage in causing acute pancreatitis. Br J Surg. 2011 Nov;98(11):1609-16. doi: 10.1002/bjs.7632. Epub 2011 Aug 3.
  7. Nichols M, Scarborough P, Allender S, et al; What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels. BMJ Open. 2012 May 30;2(3). pii: e000957. doi: 10.1136/bmjopen-2012-000957. Print 2012.
  8. Guidelines on the Management of Alcoholic Liver Disease, European Association for the Study of the Liver (2012)
  9. Zhu H, Jia Z, Misra H, et al; Oxidative stress and redox signaling mechanisms of alcoholic liver disease: updated experimental and clinical evidence. J Dig Dis. 2012 Mar;13(3):133-42. doi: 10.1111/j.1751-2980.2011.00569.x.
  10. Terry MB, Gammon MD, Zhang FF, et al; Alcohol dehydrogenase 3 and risk of esophageal and gastric adenocarcinomas. Cancer Causes Control. 2007 Nov;18(9):1039-46. Epub 2007 Jul 31.
  11. Sarangapani A, Shanmugam C, Kalyanasundaram M, et al; Noninvasive prediction of large esophageal varices in chronic liver disease patients. Saudi J Gastroenterol. 2010 Jan-Mar;16(1):38-42.
  12. Higashiyama A, Okamura T, Watanabe M, et al; Alcohol consumption and cardiovascular disease incidence in men with and without hypertension: the Suita study. Hypertens Res. 2012 Aug 30. doi: 10.1038/hr.2012.133.
  13. Conen D, Tedrow UB, Cook NR, et al; Alcohol consumption and risk of incident atrial fibrillation in women. JAMA. 2008 Dec 3;300(21):2489-96.
  14. Alcohol and Health, Institute of Alcohol Studies, 2004
  15. Alcohol dependence and harmful alcohol use; NICE Clinical Guideline (February 2011)

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Gurvinder Rull
Current Version:
Peer Reviewer:
Dr John Cox
Document ID:
804 (v26)
Last Checked:
16/10/2012
Next Review:
15/10/2017