Research has shown that drinking moderate amounts of alcohol can have health benefits. For men over 40, and women after the menopause, having one or two small drinks a day can help prevent coronary heart disease.

However, it is estimated that a quarter of men and one in six women in Britain drink enough to put their health at risk.

How much is too much?

Government guidelines state that men should drink no more than three to four units per day and women no more than two to three units per day. However, some medical experts believe these levels are too high, and recommend no more than three units a day for men and two a day for women. Either way, you should not "save up" the units over the week and use them to binge at the weekend.

Strength and units

The strength of an alcoholic drink is indicated by the percentage of alcohol by volume (ABV).

A unit is 8 grams of pure alcohol, regardless of the amount of liquid it’s contained in.

The number of units in one litre of any drink is equal to the ABV. So a 500ml can of 8% ABV lager contains 4 units.

One unit is equal to:

• about half a pint (300ml) of ordinary-strength lager, beer or cider,
• a 25ml pub measure of spirit or a small glass of fortified wine, such as sherry or port (17.5% ABV),
• a small glass (125 ml) of 8% ABV wine.

Popular drinks

Note that many popular drinks are considerably different from these once-standard drinks. For example, stronger lagers and pilsners such as Stella Artois, Grolsch or Kronebourg 1664 are often around 5% ABV, much stronger than a traditional bitter, and contain around three units per pint. And wine served by the glass is more likey to be 12% alcohol than 8%. A typical larger (175ml) glass of Australian Chardonnay is therefore nearer two units than one.

Units for women

The reason that the limits for women are less than for men is because the body composition of women has less water than men. Therefore, even if a man and woman are of similar size and weight, the woman will tend to get drunk faster. Women can also develop liver disease at lower levels of drinking than men.

Alcohol dependence

When drunk frequently or in large quantities, alcohol is addictive.

Doctors use a number of techniques to identify patients with drink problems, and there are screening questions drinkers may be asked to explore issues such as the amount and frequency of drinking, whether it damages the drinker’s relationships, or whether they have a drink to "get going" in the morning.

A person is generally considered to be dependent on alcohol when they have experienced three or more of the following symptoms during a year:

• a strong urge to drink,
• difficulty controlling drinking,
• physical withdrawal symptoms, such as sweating, shaking, agitation and nausea when they try to reduce drinking,
• a growing tolerance to alcohol (needing larger quantities to get the same effect),
• gradual neglect of other activities,
• persistent drinking even though it is obviously causing harm.

Problem drinking occurs when a person is not dependent on alcohol, but drinks enough to cause actual physical or psychological harm.

Short-term effects

Alcohol suppresses the part of the brain that controls judgement, resulting in a loss of inhibitions. It also affects physical co-ordination, causing blurred vision, slurred speech and loss of balance. Drinking a very large amount at one time (binge drinking) can lead to unconsciousness, coma, and even death. Vomiting while unconscious can lead to death by asphyxiation (suffocation). Alcohol is implicated in a large proportion of fatal road accidents, assaults and incidents of domestic violence.

Long-term effects

Alcohol can be a dangerous drug. Drinking too much too often will cause physical damage, increase the risk of getting some diseases, and make other diseases worse. Excessive drinking over time is associated with:

• loss of brain cells,
• liver failure,
• irritated stomac lining and bleeding from stomach ulcers,
• high blood pressure (which can lead to stroke),
• certain types of cancer,
• nerve damage,
• heart failure,
• epilepsy.

Excessive drinking has also been linked to:

• vitamin deficiency,
• obesity,
• sexual problems,
• infertility,
• muscle disease,
• skin problems,
• inflammation of the pancreas.

Alcohol and pregnancy

Women who drink heavily during pregnancy are at risk of having babies with a condition called fetal alcohol syndrome, which can result in growth deficiencies, nervous system problems, lowered intelligence, and facial abnormalities in the child.

There is some evidence that pregnant women who drink more than 10 units a week are more likely to have underweight babies. It is not known if there is an absolutely safe limit for drinking during pregnancy, but it may be wise to avoid alcohol altogether.

Psychological effects

Although alcohol initially makes people feel relaxed, long term excessive use can ultimately increase anxiety and cause depression. It is also related to problems with sleeping, mood swings, violence and suicide (about two-thirds of suicide attempts are thought to involve alcohol).

Cutting down

If you think you are drinking too much, keep a "drinking diary", noting how much alcohol you drink each week. It will reveal whether you are drinking within safe guidelines and help you identify the situations that you need to avoid to cut down your drinking.

These tips may help you cut down:

• go out later, so you start drinking later,
• replace your "usual" drink with one containing less alcohol,
• skip the "quick drink" at lunchtime or after work,
• have at least two alcohol-free days a week,
• do something other than going to the pub,
• drink more slowly or have non-alcoholic drinks between alcoholic ones,
• buy beers and wines with lower alcohol content, and keep a supply of non-alcoholic drinks at home,
• set yourself a limit of, for example three to four units (men) or two to three (women) for any one occasion,
• find other ways to relax.

Stopping drinking

Confidential advice and support is available through GPs, and may involve a community alcohol team or specialist consultant care. There are also organisations such as Alcohol Concern and Alcoholics Anonymous that help many people (see below).

Treatment

To prevent withdrawal symptoms, a chronic heavy drinker may be prescribed medication such as diazepam (Valium) for a few days after stopping drinking.

There are two drug treatments that may be used to help someone stop drinking:

• Disulfiram, which causes very unpleasant effects if even a small amount of alcohol is consumed (and severe, occasionally life-threatening effects with large amounts of alcohol).
• Acamprosate, which influences transmitters in the brain and reduces the craving for alcohol. It may have side-effects such as headache, diarrhoea and rash.

People with chronic alcohol dependence are often malnourished, and vitamin supplements are essential.

Related information

Alcoholics Anonymous  (319)338-9111  (24 hr phone)
http://aa-ic.org/

or call 1-800-454-8966 for treatment.