Alcohol, Harm & Dependence

Alcohol and glasses of wine
“First you take a drink, then the drink takes a drink, then the drink takes you.” 
F. Scott Fitzgerald (1896 - 1940) - American novelist

Alcohol: our favourite drug

  • Alcohol is the UK’s favourite drug: UK household expenditure on alcohol has more than doubled to £19.9 billion in 2017, from £9.3 billion in 1985.

  • Most of us use it for enjoyment and relaxation as it is legal, readily available, culturally acceptable, and often expected. However, for some of us, drinking alcohol can become a daily necessity and a serious health problem.

  • Alcohol can cause much more serious harm than illegal drugs such as heroin and cannabis.

  • It is a central nervous system (CNS) depressant, and a tranquilliser, it makes us impulsive, is highly addictive, and is harmful at any level.

  • It is the cause of many preventable hospital attendances and admissions, especially at the weekend.

Do I need to cut down or even stop drinking alcohol?

It can be helpful to think about the financial, social, mental, and physical costs of continued drinking. Do you still enjoy alcohol healthily and socially? Have you or someone else thought that you should cut it down? Have you felt guilty about your drinking? Have people annoyed you by criticising your drinking? Do you drink alcohol every day? Could you stop drinking alcohol safely, or do you need a drink to steady your nerves?

Healthy and social drinking can slowly become unhealthy and anti-social in those who are vulnerable and predisposed to harmful drinking and subsequent dependence. Your genetics and family history can play a large part in your risk. Daily drinking may be an early sign of alcohol dependence.    

One unit of alcohol is equivalent to 10ml or 8g of pure alcohol. You can work out how much alcohol is in your drink - based on its strength and size - by using the following equation:

  • strength (alcohol by volume or ABV) x the volume of the drink (in millilitres) ÷ 1,000 = the total number of units in your drink

So to find the number of units in a pint of 4% ABV beer, calculate:

  • 4 (ABV%) x 568 (ml) ÷ 1,000 = 2.3 units

Alcohol statistics

  • 7% of adults in England regularly drink over the Chief Medical Officer’s low-risk guidelines: less than 14 units per week for men and women with alcohol-free days.

  • In the UK, in 2015 there were 8,758 alcohol-related deaths (around 14 per 100,000 people). The mortality rates were highest among people aged 55-64.

  • In England, there are an estimated 595,131 dependent drinkers ("alcoholics"), of whom only 108,696 are currently accessing treatment (<20%).

  • Alcohol misuse is the biggest risk factor for death, ill health, and disability among 15-49 year-olds in the UK.

  • Alcohol harms are estimated to cost the NHS around £3.5 billion annually.

  • While the price of alcohol has increased by 36% since 2005, it remains 60% more affordable than it was in 1980.

  • Statistics in 2020 have shown that the number of problem drinkers in the UK has doubled from around 4 million to 8 million people since the COVID-19 lockdown.

 

Problems with Alcohol

  • Many of these problems are caused by having too much to drink at the wrong time or place.

  • Alcohol affects your judgment, so you do things you wouldn't normally think of. It takes away your inhibitions.

  • It makes you less aware of risks and so more vulnerable.

  • You are more likely to have fights, arguments, money troubles, family upsets, impulsive casual sex and unwanted pregnancies. 

  • Alcohol leads to accidents at home, on the roads, in the water, and on playing fields.

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Physical health problems with Alcohol

  • Being very drunk (acute intoxication) can lead to:

    • severe hangovers

    • stomach pains (gastritis)

    • vomiting blood (haematemesis)

    • unconsciousness

    • death.

  • Chronic drinking can cause:

    • hypertension (high BP)

    • heart disease

    • stroke 

    • liver disease (cirrhosis)

    • pancreatitis and

    • increased risk of cancer of the mouth, larynx, oesophagus, breast, and bowel causing up to 30% of all cases.

  • Even just 3 units of alcohol daily can increase the risk leading to premature death.

Mental health problems with Alcohol

  • Heavy drinking (more than 8 drinks per week) can cause and worsen depression and anxiety

  • Alcohol makes people lose their inhibitions and behave more impulsively increasing the risk of deliberate self-harm and suicide

  • Alcohol can cause memory problems and brain damage, e.g. Wernicke’s encephalopathy

  • Heavy drinking can cause paranoia, morbid jealousy, hallucinations, and delusions (psychosis)

  • Heavy drinkers stopping alcohol suddenly can develop the medical emergency of Delirium Tremens (DTs) – psychosis, body tremors, and confusion. Urgent medical treatment is needed

  • Heavy drinking can adversely affect relationships with a partner, family, friends, and work.

Warning signs of Alcohol addiction (physical and psychological dependence)

  • You don't feel right without a drink or need a drink to start the day (“eye-opener”)

  • Get very shaky, sweaty, and anxious or tense a few hours after your last drink (physical withdrawal), or even life-threatening withdrawal seizures

  • Can drink a lot without becoming drunk (tolerance)

  • Need to drink more and more to get the same effect (tolerance)

  • Try to stop, but can't (due to withdrawal symptoms)

  • Carry on drinking even though you can see it's interfering with your work, family, and relationships

  • You get "memory blanks" (amnesia) where you can't remember what happened for a period of hours or days.

 

https://www.nice.org.uk/guidance/cg100/chapter/Recommendations#acute-alcohol-withdrawal

https://alcoholchange.org.uk/alcohol-facts/interactive-tools/check-your-drinking/alcohol-units

https://jnnp.bmj.com/content/79/8/854.short

https://patient.info/doctor/CAGE-Questionnaire

https://www.drinkaware.co.uk/facts

https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-alcohol/2018/part-7#expenditure-on-alcohol-purchases

https://www.independent.co.uk/news/health/alcoholism-alcohol-abuse-funding-drugs-addiction-coronavirus-lockdown-b445410.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872355/