Alcohol and Sensible Drinking

What are the recommended safe limits of alcohol drinking?

• Men should drink no more than 21 units of alcohol per week (and no more than four units in any one day).
• Women should drink no more than 14 units of alcohol per week (and no more than three units in any one day).
• Pregnant women. The exact amount that is safe is not known. Therefore, advice from the Department of Health is that pregnant women and women trying to become pregnant should not drink at all. If you do chose to drink when you are pregnant then limit it to one or two units, once or twice a week. And never get drunk.

In general, the more you drink above the safe limits, the more harmful alcohol is likely to be. And remember, binge drinking can be harmful even though the weekly total may not seem too high. For example, if you only drink once or twice a week, but when you do you drink 4-5 pints of beer each time, or a bottle of wine each time, then this is a risk to your health. Also, even one or two units can be dangerous if you drive, operate machinery, or take some types of medication.

What is a unit of alcohol?

One unit of alcohol is 10ml (1cl) by volume, or 8g by weight, of pure alcohol. For example:

• One unit of alcohol is about equal to:
  • Half a pint of ordinary strength beer, lager, or cider (3-4% alcohol by volume), or
  • A small pub measure (25ml) of spirits (40% alcohol by volume), or
  • A standard pub measure (50ml) of fortified wine such as sherry or port (20% alcohol by volume).
• There are one and a half units of alcohol in:
  • A small glass (125ml) of ordinary strength wine (12% alcohol by volume), or
  • A standard pub measure (35ml) of spirits (40% alcohol by volume).

But remember, many wines and beers are stronger than the more traditional 'ordinary' strengths. A more accurate way of calculating units is as follows. The percentage alcohol by volume (% abv) of a drink equals the number of units in one litre of that drink. For example:

• Strong beer at 6% abv has six units in one litre. If you drink half a litre (500ml) - just under a pint - then you have had three units.
• Wine at 14% abv has 14 units in one litre. If you drink a quarter of a litre (250ml) - two small glasses - then you have had three and a half units.

Some other examples

Three pints of beer, three times per week, is at least 18-20 units per week. That is nearly the upper weekly safe limit for a man. However, each drinking session of three pints is at least six units, which is more than the safe limit advised for any one day. Another example: a 750ml bottle of 12% wine contains nine units. If you drink two bottles of 12% wine over a week, that is 18 units. This is above the upper safe limit for a woman.

Isn't alcohol good for you?

For men over 40 and for women past the menopause, it is thought that drinking a small amount of alcohol (1-2 units per day) helps to protect against heart disease and stroke.

Do you know how much you are drinking?

When asked "How much do you drink?" many people give a much lower figure than the true amount. It is not that people lie usually lie about this, but it is easy to not realise your true alcohol intake. To give an honest answer to this question, try making a drinking diary for a couple of weeks or so. Jot down every drink that you have. Remember, it is a pub measure of spirits that equals one unit. A home measure if often a double.

If you are drinking more than the safe limits, you should aim to cut down your drinking.

What are the problems with drinking too much alcohol?

Health risks

About 1 in 3 men, and about 1 in 7 women, drink more than the safe levels. Many people who drink heavily are not 'addicted' to alcohol, and are not 'alcoholics'. To stop or reduce alcohol would not be a problem if there was the will to do so. However, for various reasons, many people have got into a habit of drinking regularly and heavily. But, drinking heavily is a serious health risk.

If you drink heavily you have an increased risk of developing:

• Hepatitis (inflammation of the liver).
• Cirrhosis (scarring of the liver). Up to 3 in 10 long-term heavy drinkers develop cirrhosis.
• Stomach disorders.
• Pancreatitis (severe inflammation of the pancreas).
• Mental health problems including depression, anxiety, and various other problems.
• Sexual difficulties such as impotence.
• Muscle and heart muscle disease.
• High blood pressure.
• Damage to nervous tissue.
• Accidents - drinking alcohol is associated with a much increased risk of accidents. In particular, injury and death from fire and car crashes. About 1 in 7 road deaths are caused by drinking alcohol.
• Some cancers (mouth, gullet, liver, colon and breast).
• Obesity (alcohol has many calories).
• Damage to an unborn baby in pregnant women.
• Alcohol dependence (addiction).

In the UK about 33,000 deaths a year are related to drinking alcohol, a quarter due to accidents.

Alcohol dependence

If you are 'alcohol dependent' you have a strong desire for alcohol and have great difficulty in controlling your drinking. In addition, your body is used to lots of alcohol. Therefore, you may develop withdrawal symptoms 3-8 hours after your last drink as the effect of the alcohol wears off. So, even if you want to stop drinking, it is often difficult because of withdrawal symptoms.

Withdrawal symptoms include: feeling sick, trembling, sweating, craving for alcohol, and feeling unwell. As a result, you may drink regularly to prevent withdrawal symptoms.

The severity of dependence can vary. It can develop gradually and become more severe. You may be developing alcohol dependence if you:

• need a drink every day
• drink alone often
• need a drink to stop trembling (the shakes)
• drink early, or first thing in the morning (to avoid withdrawal symptoms)
• often have a strong desire to drink alcohol
• spend a lot of you time in activities where alcohol is available, for example, if you spend a lot of time at the social club or pub
• neglect other interests or pleasures because of alcohol drinking.

Alcohol drinking and problems to others

Heavy alcohol drinking in one person often seriously damages others. Many families have become severely affected by one member becoming a problem drinker. Emotional and financial problems often occur in such families. It is estimated that 3 in 10 divorces, 4 in 10 cases of domestic violence, and 2 in 10 cases of child abuse are alcohol related. Often the problem drinker denies or refuses to accept that the root cause is alcohol.

Some common myths about drinking alcohol

Myth - "Coffee will sober me up".
Caffeine in coffee is a stimulant so you might feel more alert, but it won't make you sober.

Myth - "I'll be fine in the morning"
Alcohol is broken down by the liver. A healthy liver can get rid of about one unit of alcohol an hour. Sleep will not speed up the rate at which the liver works. Just because you have a night's sleep does not necessarily mean you will be sober in the morning. It depends on how much you drank the night before.

Myth - "Alcohol keeps me alert"
Alcohol can make you think that you are more alert, but it actually has a depressant effect which slows down your reflexes.

Myth - "Beer will make me less drunk than spirits"
Half a pint of beer contains the same amount of alcohol as a single measure of spirits.

Myth - "I'll be fine if I drink plenty of water before I go to bed"
This can reduce hangover symptoms by helping to prevent dehydration. But it wont make you any less drunk, or protect your liver or other organs from the damaging effect of alcohol.

Myth - "The recommended safe limits are too low"
They are based on good research which has identified the level above which problems start to arise. For example, if a man drinks five units each day (not greatly over the recommended limit) then, on average, he doubles his risk of developing liver disease, raised blood pressure, some cancers, and of having a violent death.

Myth - "Most people drink more than the recommended limits"
Studies show that about 1 in 3 men, and about 1 in 7 women drink more than the weekly recommended levels. So, if you drink heavily, it might be what your friends do, but it is not what most people do, and you are putting yourself and others at risk.

Myth - "It's none of my business if a friend is drinking too much"
This is a matter of opinion. Some people would say that if you are a real friend, it really is your business. You may be the one person who can persuade your friend to accept that they have a problem, and to seek help if necessary.

Tackling the problem of heavy drinking

Once they know the facts, many people can quite easily revert back to sensible drinking if they are drinking above the safe limits. If you are trying to cut down, some tips which may help include:

• Consider drinking low alcohol beers, or at least do not drink 'strong' beers or lagers.
• Try pacing the rate of drinking. Perhaps alternate soft drinks with alcoholic drinks.
• If you eat when you drink, you may drink less.
• It may be worth reviewing your entire social routine. For example, consider:
  • cutting back on types of social activity which involve drinking
  • trying different social activities where drinking is not a part
  • reduce the number of days in the week where you go out to drink
  • going out to the pub or club later in the evening.
• Try to resist any pressure from people who may encourage you to drink more than you really want to.

The problem of denial

Some people who are heavy drinkers, or who are alcohol dependent, deny that there is a problem to themselves. The sort of thoughts that people deceive themselves with include: "I can cope", "I'm only drinking what all my mates drink", "I can stop anytime".

Coming to terms with the fact that you may have a problem, and seeking help when needed, is often the biggest step to sorting the problem.

Do you need help?

Help and treatment is available if you find that you cannot cut down your drinking to safe limits. Counselling and support from a doctor, nurse, or counsellor is often all that is needed. A 'detoxification' treatment may be advised if you are alcohol dependent. Referral for specialist help may be best for some people. See a separate leaflet called 'Alcoholism and Problem Drinking'.

If you feel that you, or a relative or friend, needs help about alcohol then see your doctor or practice nurse. Or, contact one of the agencies listed below.

Further resources and sources of help

Drinkline - National Alcohol Helpline Tel: 0800 917 8282
Offers help to callers worried about their own drinking and support to the family and friends of people who are drinking. Advice to callers on where to go for help.

Alcoholics Anonymous PO Box 1 10 Toft Green, York, YO1 7ND
Helpline: 0845 769 7555 Web: www.alcoholics-anonymous.org.uk
There are over 3000 meetings held in the UK each week with over 40,000 members. The only requirement for membership is a desire to stop drinking.

AL-Anon Family Groups 61 Great Dover Street, London, SE1 4YF
Tel: 020 7403 0888 Web: www.al-anonuk.org.uk
Offers support for families and friends of alcoholics whether the drinker is still drinking or not.

Know Your Units campaign From the NHS
Web: www.units.nhs.uk
Aims to tell drinkers how many units are in their drinks and help them stick to their limits.

Department of Health - Their alcohol misuse page
Web: www.dh.gov.uk/en/Publichealth/Healthimprovement/Alcoholmisuse/index.htm
Includes information on the National Alcohol Strategy, and policy and advice on sensible drinking and the prevention of alcohol misuse.