Alcohol and Sensible Drinking

See your doctor or practice nurse if you are drinking above the safe limits and are finding it difficult to cut down.

  • Men should drink no more than 21 units of alcohol per week, no more than four units in any one day, and have at least two alcohol-free days a week.
  • Women should drink no more than 14 units of alcohol per week, no more than three units in any one day, and have at least two alcohol-free days a week.
  • Pregnant women. Advice from the Department of Health states that ... "pregnant women or women trying to conceive should not drink alcohol at all. If they do choose to drink, to minimise the risk to the baby, they should not drink more than 1-2 units of alcohol once or twice a week and should not get drunk".

Where do these recommendations come from?

  • The Department of Health recommends that men should not regularly drink more than 3-4 units of alcohol a day and women should not regularly drink more than 2-3 units a day. 'Regularly' means drinking every day or most days of the week. And if you do drink more heavily than this on any day, allow 48 alcohol-free hours afterwards to let your body recover.
  • The Royal College of Physicians (RCP) advises no more than 21 units per week for men and 14 units per week for women. But also, have 2-3 alcohol-free days a week to allow the liver time to recover after drinking anything but the smallest amount of alcohol. A quote from the RCP... "in addition to quantity, safe alcohol limits must also take into account frequency. There is an increased risk of liver disease for those who drink daily or near daily compared with those who drink periodically or intermittently."
  • The House of Commons Science and Technology Committee advise that people should have at least two alcohol-free days a week.
  • Some would argue that the upper limits of the recommendations are too high. For example, one study found that more than two units a day for men and more than one unit a day for women significantly increases the risk of developing certain cancers.

Your liver processes alcohol. It can only cope with so much at a time. Drinking more alcohol than the liver can cope with can damage liver cells and produce toxic by-product chemicals.

The more you drink, and especially above the recommended limits, the greater the risk of developing serious problems. 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.

One unit of alcohol is 10 ml (1 cl) by volume, or 8 g 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 (25 ml) of spirits (40% alcohol by volume); or
    • a standard pub measure (50 ml) 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 (125 ml) of ordinary strength wine (12% alcohol by volume); or
    • a standard pub measure (35 ml) 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 (500 ml) - 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 (250 ml) - 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 750 ml 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.

For men aged over 40 and for women past the menopause, it is thought that drinking a small amount of alcohol helps to protect against heart disease and stroke. The exact amount is not clear, but it is a small amount. So, do not exceed the recommended amount of alcohol as described above in a mistaken belief that it may be good for the heart.

When asked 'How much do you drink?' many people give a much lower figure than the true amount. It is not that people usually lie about this, but it is easy not to 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.

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.

You should regularly talk to your children about the risks of alcohol in a way that is appropriate for their age. If you feel your child is having a problem with alcohol, talk to your GP, as there are services now available for young people.

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

  • Hepatitis (inflammation of the liver).
  • Cirrhosis (scarred liver). Up to 3 in 10 long-term heavy drinkers develop cirrhosis.
  • Some cancers (mouth, gullet, liver, colon and breast).
  • Stomach disorders.
  • Pancreatitis (severe inflammation of the pancreas).
  • Mental health problems, including depression, anxiety, and various other problems.
  • Wernicke's encephalopathy - an alcohol-related brain disorder treated with thiamine (vitamin B1).
  • 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.
  • Obesity (alcohol is calorie-rich). One glass of wine has as many calories as a bag of crisps and a pint of lager is the calorie equivalent of a sausage roll.
  • 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 and pregnancy

Alcohol gets to a baby through the placenta if a pregnant woman drinks alcohol. A baby cannot process alcohol very well. So, any alcohol in your baby stays in their body much longer than in you. This is known to be a risk for causing serious problems such as: a low birth weight; learning, behavioural, and thinking (cognitive) problems; defects of the heart and other organs; abnormal facial features. When these problems are severe, the condition is called fetal alcohol syndrome.

However, there has been debate over the years as to whether small amounts of alcohol are safe to drink during pregnancy; also, if there is a time of pregnancy when alcohol is most likely to cause harm. But, recent research supports the advice of not drinking any alcohol whilst pregnant.

For example, a study by Feldman et all (cited below) looked at the relationship between drinking alcohol during pregnancy and it causing facial defects in the baby. This study showed that the more alcohol a woman drank, the more likely there was to be a facial defect in the baby. BUT, there was no safe amount to drink during pregnancy, as there was still some risk with small amounts of alcohol. The study also found that drinking alcohol has risks throughout pregnancy, but it may be most likely to cause facial defects during weeks 6-12 of pregnancy. The authors of the study concluded that ... "women should continue to be advised to abstain from alcohol consumption, from conception throughout pregnancy."

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. The 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.

If you develop severe withdrawal symptoms you may be offered hospital admission or treatment at home. You may be offered medication such as benzodiazepine, carbamazepine or clomethiazole.

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.

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 won't 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.

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 involved.
    • Reducing 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 at any time".

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

Help and treatment are available if you find that you cannot cut down your drinking to safe limits. Counselling and support from a doctor, nurse, or counsellor are 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 separate leaflet called Alcoholism and problem drinking.

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

Original Author:
Dr Tim Kenny
Current Version:
Peer Reviewer:
Dr Beverley Kenny
Last Checked:
14/06/2012
Document ID:
4191 (v41)
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