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Alcohol

Alcohol is our favourite drug. More than 90% of the population drink, and only a minority come to any harm as a result. Socially we may use it to help us relax and alter the way we feel. Taken in moderation it presents few problems and even has some benefits.

How much is too much?

Drinking less than 21 units a week for a man, or 14 for a woman, is unlikely to cause problems as long as it is spread out sensibly throughout the week.

It's suggested that it is sensible to limit consumption to 4 units in any one day for a man, and 3 in any one day for a woman.

A unit of alcohol is the amount contained in a standard measure of spirits, a half-pint of normal strength beer or lager, or a small glass of wine or sherry.

Remember that measures served at home are often much larger than those in bars, and some lagers and fortified wines are much stronger than average.

We often underestimate the amount we drink and one way of keeping a check on this is to record our consumption in a diary over the course of a week.

Doing this from time-to-time helps us see if our drinking is excessive or potentially harmful. A glance at the diary will also highlight any occasions or regular times of the week when we seem more likely to drink than others. You can download a drink diary from this link (24K PDF). Some useful tips about developing sensible drinking habits are given at the end of this fact sheet.

Why drink?

Sometimes we may drink to relieve a depressed mood; to drown our sorrows. Occasionally, drinking too much is a symptom of depression. However, more often it is the other way around, and depression is a consequence of excessive drinking. It is important to be clear about the extent to which depression is causing excessive drinking or the drinking causing the depression.

Alcohol is a depressant of the brain, reducing our ability to face up to our problems and releasing our inhibitions. This is why it plays such an important part in overcoming social fears; for instance, helping conversation flow at a party.

For some, alcohol releases powerful feelings of self-hatred and disgust, producing angry, aggressive, or suicidal behaviour. We all know people who have become gloomy and embittered when drunk and yet have little recollection of their mood the following day.

Some individuals drink alcohol as a means of bolstering self-confidence or obtaining relief from anxiety and distress, including of course depression. If dissolving tensions and grief in this way is so common, it is understandable that excessive drinking and depression are so closely linked.

Some people who are very depressed and lacking in energy, may use alcohol to help them keep going and cope with life. This is a very short-lived solution because any benefits of the alcohol soon wear off and drinking becomes part of a routine and therefore difficult to change. Alcohol is like other drugs acting on the brain, such as tranquillisers; it produces tolerance so that we need a larger and larger dose to get the desired effect.

As a result, the drinker finds that he or she can take large quantities but feel very little benefit. This tolerance or habituation is a step towards dependence.

What is a ‘hangover’?

The down side of the emotional release associated with drunkenness is that it often leaves us tired, depressed and hung-over as our blood alcohol level falls. There is evidence that changes in the chemistry of the brain itself may be produced by alcohol and that these changes increase the likelihood of a depressed mood.

Hangovers are depressing experiences. The drinker wakes feeling ill, anxious and jittery. The day may be spent ruminating over the guilt associated with the events of the previous evening. As drinking bouts become habitual, there may well be troubles at home, conflicts with partners and family, quality of work deteriorates and the drinker may feel that he or she is being unjustly criticised by colleagues.

Failing memory, sexual impotence and declining physical health add to the sense of despair.

Given these circumstances, it is hardly surprising that depression, and even thoughts of suicide, are common events in the life of someone who has become seriously dependent on alcohol. Self-harm and suicide are much more common in people with alcohol problems.

Getting help

As a first step, it is usually best to tackle the drinking habit and then consider dealing with depression if that does not lift of its own accord. If drinking seems to be getting out of hand, or is causing problems to yourself or others, there are a number of self-help measures which will help you to analyse the problem and deal with it, or if necessary, seek help.

Taking stock of current drinking habits is a good starting point. Keeping a careful diary of one week's drinking is a useful way of doing this. The diary will also provide an opportunity for working out the relationship between events in the week and times when you drink more.

If the diary shows that drinking is outside sensible limits or causing problems, a good first plan is to set yourself a target to reduce your intake, or stop completely. Identify the challenging situations and factors when you might be tempted to drink: These may include the people you drink with, the time of day when you drink, and the feelings that trigger drinking. Take steps to avoid or deal with these situations. It is often a great help to involve a partner or friend in agreeing the goal and discussing progress.

It is, of course, often very hard to give up drinking totally, even for a short time. Try this and see how you feel without it. At first you may feel a craving or a sense of loss, and even some shakiness and restlessness. If these symptoms are severe, it is wise to consult your doctor for help and advice about coming off alcohol and receiving help with what are withdrawal symptoms.

If your dependence on alcohol is very severe, it may be that you will benefit from seeking help with the problem, either from a self-help group such as Alcoholics Anonymous, a voluntary agency such as the Council on Alcohol, or through a specialist alcohol treatment unit within the NHS. Your family doctor should be able to advise on these.

A few weeks abstinence from alcohol will often produce an improved sense of wellbeing, fitness, and much less depression. Friends and family may well start treating you better because they can talk to the real person rather than through a haze of drink. If the depression which was so prominent before has lifted, this strongly suggests that the mood was caused by the drinking, rather than the other way round. If this is what you find, keep on monitoring your drinking using the diary every four weeks and keep to the target you have set yourself.

Depression?

If the depression is still with you after two or three weeks of not drinking and still seems very severe, then it is time to talk to your family doctor about further help. An opportunity to talk about your feelings can be very helpful, particularly if the depression seems linked to some crisis in your life, such as a relationship problem, bereavement or other loss.

If the depression does not lift and is particularly severe, your doctor may suggest antidepressants. In most cases you will be advised not to drink alcohol while taking these. Remember these antidepressants will take two or three weeks to work. Do not expect immediate changes, but persevere in taking them.

Treatment for both alcohol problems and depression can be very successful. It often requires continued contact with someone you can trust, either your own doctor, counsellor or a specialist psychiatrist.

It is also advisable to continue to keep a regular record of your drinking habits, using the diary to ensure that you are keeping to your plan. Remember also that many antidepressants need to be continued for a long time.

Do not stop them too soon and discuss any planned reduction with your family doctor or specialists. Changing habits and style of life is always a challenge and takes time to achieve.

There may be setbacks but the evidence is that, with appropriate help, even the most severe depression and drinking problems can be overcome.

Helpful tips

  • Remember not to use alcohol as a means of drowning your sorrows or improving the way you feel.
  • If hangovers are more than an occasional event, take careful stock of your drinking habits, and review these by means of a diary.
  • Sip your drink slowly and do not gulp. Space your drinks with a non-alcoholic drink in between.
  • Don't drink on an empty stomach.
  • Don't get into the habit of drinking every day. Have two or three drink-free days in the week.
  • Don't suggest a drink to someone who is emotionally upset.
  • As a host, make sure you offer non-alcoholic drinks as well as alcohol on social occasions.
  • Ask your doctor or chemist if it is safe to drink with any medicine that you have been prescribed.
  • Remember that alcohol is a drug. Use it with care and do not rely on it to lift depression.

Units of alcohol

  • 1 pub measure of spirits (whisky, gin, vodka) = 1 unit
  • 1 glass of fortified wine (sherry, martini, port) = 1 unit
  • 1 average sized glass of table wine = 1.5 units
  • 1 pint of beer = 2 units
  • 1 can of beer = 1.5 units
  • 1 bottle of 'super' or 'special' lager = 2.5 units
  • 1 litre bottle of table wine = 12 units
  • 1 bottle of table wine = 9 units
  • 1 bottle of fortified wine (sherry, martini, port) = 14 units
  • 1 bottle of spirits (whisky, gin, vodka) = 30 units

These guidelines are approximate and may vary depending on brand chosen and size of measure


Original work copyright Royal College of Psychiatrists (RCP) 1998, adapted with permission from RCP, in collaboration with the Service User Steering Group.
Flesch-Kincaid level 8.4
Date written: May 2007
Date for review: November 2015
Page last updated: 21.11.2013