Recommended amount of alcohol
The amount of alcohol contained in any alcoholic drink is measured in units. A unit is equivalent 10ml of pure alcohol.
The recommended daily limits for alcohol consumption are:
- no more than 3-4 units per day for men
- no more than 2-3 units per day for women
If you regularly exceed the recommended daily limits, you are putting your health at risk.
Pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink, they should not drink more than 1-2 units of alcohol once or twice a week and should avoid getting drunk.
How to measure units
Any drink that you buy will contain a measurement of its alcohol by volume (ABV). ABV is a measurement of how much of that drink is made up of pure alcohol.
The easiest way to work out how many units of alcohol a drink provides is:
- find out what the drink’s ABV is
- then multiply that by how many millilitres of liquid are in the drink
- then divide that by 1,000
So for a standard pint of strong lager:
- its ABV would be 5%
- a pint contains 568ml
- 5 times 568 equals 2,840
- divide that by 1000, to give a measurement of 2.8 units
The units found in some standard drink sizes are listed below:
- a can of standard lager, beer, bitter – 1.8 units
- a can of strong lager, beer, bitter – 2.2 units
- a pint of standard lager, beer, bitter – 2.3 units
- a pint of strong lager, beer, bitter – 2.8 units
- a small glass of wine (125ml) – 1.5 units
- a large glass of wine (250ml) – 3 units
- a bottle of alcopops – 1.4 units
- a glass of spirits (25ml) – 1 unit
- a bottle of wine – 9 units
- a one litre bottle of standard cider – 4 units
- a one litre bottle of strong cider – 9 units
- a 700ml bottle of spirits – 27-28 units
Types of alcohol misuse
There are three main types of alcohol misuse:
- hazardous drinking
- harmful drinking
- dependent drinking
Hazardous drinking is defined as when a person drinks between the recommended weekly limit of 21 units for men and 14 units for women and up to 50 units for men and 35 units for women a week.
It is also possible to drink hazardously by binge drinking, even if you stick within your weekly limit. Binge drinking is when you drink an excessive amount of alcohol in a short space of time – eight units in a day for men, six units in a day for women. For more information, see the Lifestyle and Welbeing section on alcohol and binge drinking
If you are drinking hazardously, you may not yet have any health problems directly related to alcohol, but you are increasing your risk of experiencing problems in the future.
Hazardous drinking, especially binge drinking, also carries additional risks such as:
- being involved in an accident
- becoming involved in an argument or fight
- taking part in risky or illegal behaviour when drunk – such as drink driving
Higher-risk drinking is regularly drinking over 50 units of alcohol a week (adult men) or over 35 units a week (adult women). It’s also known as ‘harmful’ drinking.
Harmful drinking is defined as when a person drinks over the recommended weekly amount and has experienced health problems directly related to alcohol.
In some cases, these problems may be obvious, such as:
- alcohol-related accident
- acute pancreatitis (inflammation of the pancreas)
Many of the health problems caused by harmful drinking do not cause any symptoms until they reach their most serious stages, such as:
- high blood pressure
- cirrhosis (scarring of the liver)
- some types of cancer, such as mouth, liver, bowel and breast cancer
- heart disease
So it can be easy to underestimate the levels of physical damage caused by harmful drinking.
Harmful drinking can also cause related social problems such as:
- difficulties with your partner or spouse
- difficulties with family and friends
- problems at work or college
Alcohol is both physically and psychologically addictive and it is possible to become dependent on alcohol.
Dependent means that a person feels that they are unable to function without alcohol and the consumption of alcohol becomes an important – or sometimes the most important – factor in their life.
One way to think about whether you're dependent on alcohol is to ask, “Do I carry on drinking even though I know it’s harming me or upsetting my family?”
Depending on the level of dependence, a person can experience withdrawal symptoms if their supply of alcohol is suddenly stopped. Withdrawal symptoms can be both physical and psychological.
Physical withdrawal symptoms include:
- hand tremors (‘the shakes’)
- visual hallucinations (seeing things that are not actually real), and, in the most serious of cases
- seizures (fits)
Psychological withdrawal symptoms include:
Moderately dependent drinkers do not usually experience withdrawal symptoms, or withdrawal symptoms are mild to moderate.
Severely dependent drinkers do experience withdrawal symptoms, which are usually severe. Most severely dependent drinkers fall into a pattern of ‘relief drinking’, where they drink to avoid or counter withdrawal symptoms.
Severely dependent drinkers usually have an extremely high tolerance to alcohol, and are able to drink amounts that would incapacitate or even kill most other people.
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Alcohol is a powerful chemical that can have a wide range of effects. As alcohol can easily pass through the walls of human cells, once it is in your blood it can reach almost every part of the body, from your brain to your bones to your heart.
The effects of alcohol can be both short term and long term. Similarly, the risks of alcohol can also be both short and long term.
Short-term effects of alcohol
The short-term effects of alcohol are described below. This information is based on the assumption that you have a normal tolerance for alcohol. Dependent drinkers with a higher tolerance to alcohol can often drink much more without experiencing any noticeable effects.
After drinking 1-2 units of alcohol, your heart rate will speed up and your blood vessels will expand, giving you the warm, sociable ‘up’ and talkative feeling that is associated with moderate drinking.
After drinking 4-6 units of alcohol, your brain and nervous system will start to be affected. It will start to ‘dampen’ the part of your brain that is associated with decision making and judgement, making you more reckless and uninhibited.
The alcohol will also impair the cells in your nervous system, making you feel lightheaded while also adversely affecting your reaction time and co-ordination.
After drinking 8-9 units of alcohol, your reaction times will be much slower, your speech will begin to slur, and your vision will begin to lose focus. Your liver (which the body uses to filter alcohol out of the body) will be unable to remove all of the alcohol overnight, so it is likely you will wake with a hangover.
After drinking 10-12 units of alcohol, your co-ordination will be seriously impaired, placing you at high risk of having an accident. The high levels of alcohol will have a depressant effect on your body and mind, making you feel drowsy.
If you have this amount of alcohol in your body, it will begin to reach toxic levels. Your body will attempt to quickly pass out the alcohol with your urine. However, this will leave you feeling badly dehydrated in the morning, which, in turn, may cause a severe headache.
The excess amount of alcohol in your system can also upset your digestive system, leading to symptoms of nausea, vomiting, diarrhoea, and indigestion.
More than 12 units
Drinking more than 12 units of alcohol will place you at a high risk of developing alcohol poisoning, particularly if you are drinking lots of units in a short space of time. It usually takes the liver about one hour to remove one unit of alcohol from the body.
Alcohol poisoning occurs when excessive amounts of alcohol begin to interfere with the automatic functions of your body such as:
- your breathing
- your heart rate
- your gag reflex – which prevents you from choking
Alcohol poisoning can result in coma and death.
Short-term risks of alcohol misuse
The short-term risks of alcohol misuse include:
- accidents and injury – it is estimated that 70% of all visits to accident and emergency (A&E) departments at peak times are due to alcohol misuse
- involvement in violence and antisocial behaviour – in Wales and England each year, there are over 1.2 million violent incidents are linked to alcohol misuse
- practicing unsafe sex – which can lead to unplanned pregnancies and sexually transmitted infections (STIs)
- loss of personal possessions – many people lose personal possessions, such as their wallet or phone, when they are drunk
- unscheduled time off work or college – which could put your education, or job, at risk
Long-term effects of alcohol misuse
If you drink hazardous amounts of alcohol for many years, the cumulative effect of the alcohol will have a toxic effect on many of your body’s organs, which may result in organ damage.
The organs that are known to be damaged by long-term alcohol misuse include:
- the brain and nervous system
- the liver
- the pancreas
Heavy drinking can also increase your blood pressure and your blood cholesterol levels, both of which are major risk factors for heart attacks and strokes.
Long-term alcohol misuse can weaken your immune system, making you more vulnerable to serious infection. It can also weaken your bones, placing you at greater risk of fracturing, or breaking, them.
Long-term risks of alcohol misuse
The long-term health risks of alcohol misuse include:
- high blood pressure (hypertension)
- heart disease
- liver disease
- liver cancer
- cancer of the mouth or neck
- breast cancer
- bowel cancer
- sexual problems, such as impotence or premature ejaculation
The long-term social risks of alcohol misuse include:
- family break-up
- domestic abuse
- financial problems
What happens with a hangover?
Alcohol has a diuretic effect, which means that the body loses too much water and causes dehydration. This effect can be made worse by congeners (substances that are found in all alcoholic drinks to give a distinct flavour, but which can be more concentrated in dark drinks). Alcohol also stimulates the production of insulin, which reduces blood sugar levels and causes drowsiness, weakness, trembling, faintness and hunger.
The symptoms of alcohol poisoning include:
- seizures (fits)
- slow breathing (less than eight breaths a minute)
- pale, bluish skin
- cold and clammy skin
- unconsciousness (from which the person cannot be roused)
If you suspect alcohol poisoning, you should dial 999 and ask for an ambulance.
While you are waiting for the ambulance to arrive you should:
- not try to make the person vomit, as their gag reflex will be impaired, which means that they could choke on their own vomit
- turn the person on to their side and place a cushion under their head in order to help prevent them choking on their own vomit
If someone loses consciousness after drinking alcohol, you should never leave them alone to ‘sleep it off’, even if they appear to be breathing normally. The levels of alcohol in a person’s blood can continue rising for up to 30-40 minutes after a person’s last drink, and this could cause their symptoms to suddenly worsen.
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The treatment options for alcohol misuse depend on whether your drinking is hazardous, harmful or dependent, and whether you're trying to drink less or give up drinking completely.
If you are concerned that you are drinking hazardous amounts of alcohol it is likely that you will be referred to a short counselling session, known as a brief intervention.
You may also be invited to a brief intervention if you experience an alcohol-related injury or illness, which could suggest your drinking is at hazardous levels.
A brief intervention lasts around 10-15 minutes and usually consists of a series of steps.
Firstly, the counsellor will provide feedback on the short-term and long-term risks associated with your individual pattern of drinking, while emphasising that it is your responsibility to reduce that risk.
Then the counsellor will provide advice on ways you can reduce your alcohol consumption. For example, you may be told to keep a ‘drink diary’ so you can accurately record how many units of alcohol you drink a week, and then try to lower the amount.
If most of your drinking is done on a social basis, the counsellor can provide advice on how you can continue to socialise while reducing your alcohol consumption, such as alternating alcohol with soft drinks, or choosing low-alcohol drinks such as spritzers or low-strength lager.
Then the counsellor will discuss what additional support is available for you if you require it, such as self-help groups or specialist alcohol services.
The session will end with the counsellor discussing any emotional issues you may feel about trying to reduce your drinking, such as apprehension or anxiety, while providing support about how to cope better with these emotions.
- Replace some of your drinks with non-alcoholic or low alcohol drinks
- If you drink mainly when you go out, try going out later or having your first drink later
- If you drink mainly at home, trying buying non-alcoholic alternatives
- Buy smaller glasses and watch how much you pour
- If you use alcohol to ‘wind down’ after a hard day, find alternatives such as exercise classes or relaxation techniques
- Avoid drinking on an empty stomach
- Avoid mixing different alcoholic drinks
If you are drinking harmful amounts of alcohol you will first have to make the decision whether you want reduce your alcohol intake to a moderate level (moderation) or quit alcohol altogether (abstinence).
Harmful drinking is drinking more than the recommended weekly amount of alcohol (21 units for men and 14 units for women) and experiencing health problems directly related to alcohol.
Obviously, abstinence will have a greater health benefit, though often moderation is a more realistic goal, or at least, a first step on the way to abstinence.
Ultimately the choice is yours, though there are circumstances where abstinence is strongly recommended. These are:
- if you have liver damage
- if you have other medical problems that can be made worse by drinking, such as heart trouble
- if you are taking medication that can react badly or unpredictably with alcohol, such as antipsychotics
- if you are pregnant or are planning to become pregnant
Abstinence may also be recommended if you have previously tried to achieve moderation and failed.
If you do choose moderation as a treatment goal you will probably be asked to attend further sessions so your progress can be monitored and further treatment and advice provided if necessary.
You may also receive regular blood tests so the state of your liver can be carefully monitored.
See below for information on available treatments to achieve abstinence.
As with harmful drinking, you will need to choose between moderation and abstinence.
Moderation may be a realistic goal for people with mild to moderate dependency. Abstinence would usually be recommended for people with moderate to severe dependency.
Treatment to achieve moderation is carried out in much the same way as for harmful drinking.
Whatever your level of dependency, it is recommended that you spend a period of time free from alcohol, so your body can recover from its effects, and, in cases of moderate to severe dependency, you can break the cycle of drinking alcohol to avoid withdrawal symptoms. This is known as detoxification or ‘detox’.
How and where you attempt detoxification will be determined by your level of alcohol dependency.
If your level of dependency is low to moderate you should be able to detox at home without the use of medication, as your withdrawal symptoms should be mild.
If your level of dependency is moderate to severe and your consumption of alcohol is high (over 20 units a day) and/or you have previously experienced withdrawal symptoms, you should be able to detox at home though you will be given the option of taking medication to help ease withdrawal symptoms. A tranquiliser called chlordiazepoxide is usually used for the purpose.
If your levels of dependency are severe it is usually recommended that you are admitted to a hospital or clinic to detox. This is because there is a risk you could experience more-severe withdrawal symptoms, such as seizures and hallucinations, and may require specialist treatment.
You will find that the withdrawal symptoms are at their worst for the first 48 hours. The symptoms should then gradually improve as your body begins to adjust to being without alcohol. This usually takes between three and seven days from the time of your last drink.
You will also find that your sleep is disturbed – you may wake often during the night, or have problems going to sleep. This is to be expected, and your sleep patterns should return to normal within a month.
During detox you should drink plenty of fluids – approximately three litres a day. Avoid drinking excessive amounts of tea or coffee as this can make sleep problems worse and cause feelings of anxiety. Water or fruit juice would be a better choice.
You should try to eat regular meals even if you are not feeling hungry. Your appetite will return gradually.
If you are taking medication to ease withdrawal symptoms, then you should not drive or operate heavy machinery as the medication will probably make you feel drowsy. Only take your medication as directed.
Detox can be a stressful time. Ways you can try to relieve stress include listening to music, going for a walk or taking a bath.
If you are detoxing from home you will regularly see a nurse or another healthcare professional. This might be at home, at your GP practice, or at a specialist NHS service. You'll also be given the relevant contact details for other support services, should you need additional support.
Withdrawal from alcohol is an important first step to overcoming your alcohol-related problems. However, withdrawal is not an effective treatment by itself. You'll need to further treatment and support to help you in the long-term.
There are a number of different treatment options available to help you achieve abstinence. Treatment options often differ in effectiveness depending on the individual, so if you feel that a certain treatment option is not working for you, then you should discuss alternative options with your care team and/or your GP.
A number of medications are recommended by the National Institute for Health and Care Excellence (NICE) to treat alcohol misuse. The three main ones are:
Acamprosate (brand name Campral) is used to help prevent relapse in people who have successfully achieved abstinence from alcohol. Acamprosate is usually used in combination with counselling.
Acamprosate works by affecting levels of a chemical in the brain known as gamma-amino-butyric acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.If you're prescribed acamprosate, the course will usually start as soon as you begin withdrawal from alcohol and can last for up to six months.
If you're prescribed acamprosate, the course will usually start as soon as you begin withdrawal from alcohol and can last for up to six months.
Disulfiram (brand name Antabuse) is a medication that can be used if you are trying to achieve abstinence but are concerned that you may relapse, or have experienced previous relapses.
Disulfiram works by causing a series of extremely unpleasant physical reactions if you drink any alcohol, such as:
- chest pain
The unpleasantness associated with these reactions should deter you from drinking any more alcohol.
Aside from alcoholic drinks, it is important to avoid all sources of alcohol as these could also induce an unpleasant reaction. Products that may contain alcohol include:
- some types of vinegar
You should also steer clear of substances that give off alcoholic fumes, such as paint thinners and solvents.
You will continue to experience unpleasant reactions if you come into contact with alcohol for a week after you finish taking disulfiram, so it is important to maintain your abstinence during this time.
When taking disulfiram you'll be seen by your healthcare team about once every two weeks for the first two months, and then every month for the following four months.
Like acamprosate, naltrexone can also be used to prevent a relapse or to limit the amount of alcohol someone drinks. It works by blocking the opioid receptors in the body, stopping the effects of alcohol. It's usually used in combination with other medicine or counselling.
If naltrexone is recommended, you should be made aware that it will also stop painkillers that contain opioids, such as morphine and codeine, from working.
If you feel unwell while taking naltrexone, stop the medication immediately and seek advice from your GP or care team.
A course of naltrexone can last up to six months although it may sometimes be longer.
Before being prescribed any type of medication to help treat alcohol misuse you'll have a full medical assessment which will include blood tests.
Many people with a dependence on alcohol find it useful to attend self-help groups, the best known of which is Alcoholics Anonymous.
Alcoholics Anonymous believes that alcoholic dependence is a chronic and progressive incurable disease for which total abstinence is the only solution.
Alcoholics Anonymous is based on a programme of 12 steps designed to help overcome addiction, and which include the following points:
- you admit that you are powerless over alcohol and your life has become unmanageable
- you recognise that you need a power greater than yourself to restore your strength
- you examine past errors in your life with the help of a sponsor (an experienced member of the group)
- you make amends for those errors
- you learn to live a new life with a new code of behaviour
- you help others who have an alcohol dependence
For a full list of useful organisations, see the Health, Wellbeing & Support search
Twelve-step facilitation therapy
Twelve-step facilitation therapy is based on the programme devised by Alcoholics Anonymous, except you work through the stages one-on-one with a counsellor, rather than as a group.
Twelve-step facilitation therapy may be a preferred treatment option if you feel uneasy or unwilling to discuss your problems in a group setting.
Cognitive behavioural therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy that emphasises a problem-solving approach to alcohol dependence.
CBT’s approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence, such as:
- 'I cannot relax without alcohol’
- ‘My friends would find me boring if I was sober’
- ‘Just drinking one pint can’t hurt’
Once such thoughts and beliefs are identified, you will be asked to base your behaviour on more realistic and helpful thoughts, such as:
- ‘Lots of people have a good time without alcohol, and I can be one of them’
- ‘My friends like me for my personality, not for my drinking’
- ‘I know I cannot stop drinking once I start’
CBT also helps you identify triggers that can cause you to drink such as:
- social anxiety
- being in ‘high-risk’ environments such a pub, club or restaurant
The therapist will then teach you how to avoid those triggers that can be avoided, and cope effectively with triggers that are unavoidable.
Extended brief intervention
Extended brief intervention (EBI) is a one-to-one session with a healthcare professional, usually a doctor, nurse or counsellor. It takes the form of a motivational interviewing technique. The aim is to motivate people to change their behaviour by exploring with them why they drink in the way they do, and help them identify positive reasons for changing.
FRAMES is an acronym that’s often used to describe the components of a brief intervention. It stands for:
- Feedback - on your risk of having alcohol problems
- Responsibility - helping you take responsibility for change
- Advice - providing clear advice when requested
- Menu - explaining the options for change
- Empathy - an approach that’s warm, reflective and understanding
- Self-efficacy - helping you believe in your ability to change
Alcohol dependence does not just impact on an individual, it can also affect a whole family.
Family therapy provides the opportunity for family members to:
- learn about the nature of alcohol dependence
- provide support to the family member who is trying to abstain from alcohol
Support is also available for family members in their own right. Living with someone who misuses alcohol can be stressful, so receiving support can often be very helpful.
There are a number of specialist alcohol services that provide help and support for the relatives and friends of people with a dependence on alcohol.
For example, AlAnon is an organisation affiliated to AA and provides relatives and friends with help and support. Their confidential helpline number is 020 7403 0888 (10am-10pm, 365 days a year).
Keeping a drinking diary
On a daily basis, make a note of:
This should give you a good idea of how much you're drinking, the situations in which you drink and where you could start to cut down
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