Alcohol - use and misuse

Over 90% of the population drink alcohol and only a minority come to any harm as a result. Socially we might use alcohol to help us relax and alter the way we feel. Taken in moderation it presents few problems and may even have some health benefits.

How much is it OK to drink?

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

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

We often underestimate the amount we drink, 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 are more likely to drink than others. You can download a drink diary from this link (24K PDF). Some useful tips about sensible drinking habits are given at the end of this page.

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Why drink?

Sometimes we may drink to relieve a depressed mood, to 'drown our sorrows' -drinking too much can be a sign of depression.

It is important to be clear about the extent to which depression is causing excessive drinking or excessive drinking is causing depression. If you think you're drinking too much and are feeling low, it's best to consult with a health professional to make sure you're getting the help and support you need.

Alcohol is a depressant drug, it reduces our ability to face up to our problems and releases our inhibitions. For many people it plays an important part in overcoming social fears.

For some, alcohol releases powerful feelings of self-hatred, producing angry, aggressive or even 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 their self-confidence or obtaining relief from anxiety and distress. If dissolving tensions and grief in this way is so common, it is understandable that excessive drinking, depression and anxiety are so closely linked.

Some people who are depressed and lacking in energy may use alcohol to help them keep going and cope with life. This is a very short-term solution because any benefits of the alcohol soon wear off, drinking becomes routine and difficult to change. Alcohol produces tolerance so that we need a larger and larger dose to get the desired effect.

This tolerance or habituation is a step towards dependence or alcoholism.

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Hangovers

Hangovers are depressing experiences. We wake 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 trouble at home, conflicts with partners and family, the quality of our work deteriorates and we may feel unjustly criticised by partners, friends and colleagues.

Psychologically, a hangover intensifies feelings of despair and self-loathing. A hangover confirms to us that we are foolish, weak and condemned to repeat the mistakes we have made before. We may also have specific regrets about something we said or did while drunk, that we may bitterly regret.

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.

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Getting help

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 can be 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 health professional 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.

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Helpful tips

Don't use alcohol to 'drown your sorrows'
Take stock of your drinking habits - a diary helps
Space your drinks with a non-alcoholic drink in between
Don't drink on an empty stomach
Have two or three drink-free days in the week
Don't suggest a drink to someone who is upset
Offer non-alcoholic drinks as well as alcohol on social occasions
Alcohol is a drug - use it with care

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Alcohol Use Disorders Identification Test (AUDIT)

The AUDIT was developed by the World Health Organization (WHO) as a simple method of screening for excessive drinking and to assist in assessment. The AUDIT helps to identify alcohol dependence and some specific consequences of harmful drinking. It is particularly designed for health care practitioners and a range of health settings, but can also be self-administered or used by non-health professionals. Scores of '8' or more are considered to indicate harmful alcohol use.

Item	Score
1. How often do you have a drink containing alcohol?
Please go to questions nine and ten if your reply to question 1 is 'never', or if your answer to 'question 2' is '1 or 2 drinks' and 'question 3' is 'Never'
2. How many drinks containing alcohol do you have on a typical day when you're drinking?
3. How often do you have six or more drinks on one occasion?
AUDIT-C Score out of a maximum of 12 (please complete the full questionnaire if your score is 3 or more)
4. How often during the last year have you found that you weren't able to stop drinking once you had started?
5. How often during the last year have you failed to do what was normally expected from you because of drinking?
6. How often during the last year have you needed a drink in the morning to get yourself going after a heavy drinking session?
7. How often during the last year have you had a feeling of guilt or remorse after drinking?
8. How often during the last year have you been unable to remember what happened the night before because you had been drinking?
9. Have you or someone else ever been injured as a result of your drinking?
10. Has a relative, friend, doctor or other health worker been concerned about your drinking or suggested you cut down?
AUDIT Score = out of a maximum of 40

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Scoring the AUDIT and AUDIT-C

Overall AUDIT scores of 8 or more are considered an indicator of hazardous and harmful alcohol use.

The AUDIT-C is a shortened version of the AUDIT using the first 3 questions only.^{2 ,3} Using a cutoff score of four or more the Audit-C has a sensitivity of 86% of patients with heavy drinking and / or active alcohol abuse or dependence with a specificity of 72%. Using a cutoff score of three or more, AUDIT-C identifies 90% of patients with active alcohol abuse or dependence and 98% of patients with heavy drinking (specificity was only 60%, false-positive rate 40%). It is recommended that a score of three or more on the AUDIT-C, or a report of drinking six or more drinks on one occasion in the last year should lead to completion of the full AUDIT questionnaire.

Please note: These results are intended as a guide to your health and are presented for educational purposes only. They're not intended to be a clinical diagnosis. If you're concerned in any way about your health, please consult with a qualified health professional.

Privacy: This assessment neither saves nor transmits any information about you or your scores. Clicking the 'Clear results' button above clears your results and resets the form.

Thanks for reading to the end.

My best wishes to you,

Steve Cottrell

Babor, T.F., Higgins-Biddle, J.C., Saunders, J.B., Monteiro, M.G. The Alcohol Use Disorders Identification Test, Guidelines for Use in Primary Care, Second Edition, Department of Mental Health and Substance Dependence, World Health Organization.
Bush, K., Kivlahan, D.R., McDonell, M.B., et al; The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998 Sep 14; 158(16): 1789-95.
Bradley, K.A., DeBenedetti, A.F., Volk, R.J., et al; AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007 Jul; 31(7): 1208-17. Epub 2007 Apr 19.

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Page last updated:Monday, January 4, 2016