ALCOHOL CONSUMPTION/ABUSE

Alcohol drinking can be roughly classed as social, heavy, problem or dependent, each level being associated with increased risks to health and safety. However, the most recent guidelines emphasise that no level of drinking can be described as 'safe', and the term 'less harmful' is now preferred for low levels of drinking. 

New draft guidelines on drinking were published in the UK in January 2016, proposing rates for both men and women: 

• It is safest not to drink regularly more than 14 units per week
• If drinking this amount, it should be spread over three days or more. One or two heavy drinking sessions increases the risks of death from long term illnesses, accidents and injuries
• The risk of developing a range of illnesses, e.g. cancers of the mouth, throat and breast, heart disease, liver disease and epilepsy, increases with any amount of alcohol drunk on a regular basis
• A good way to cut down the amount of alcohol consumed is to have several drink-free days each week

Some people, such as young adults, older people, those with low body weight, those with other health problems and those taking medicines or other drugs, are more likely to be affected more by alcohol and should be more careful of their level of drinking on one occasion (commonly known as binge drinking).

 

Indications that a patient may be drinking beyond recommended limits include: non-specific gastrointestinal complaints; back pain; high, uncontrolled blood pressure; weight gain; frequent accidents and injuries; tired all the time/poor sleep. Most people who have alcohol-related health problems are not alcoholics, but have regularly drunk more than the recommended levels for some years – 21% of adults drink more than 14 units of alcohol per week, Although total alcohol consumption among both adults and young people (aged 11-15) has declined in recent years, there are 1.2 million hospital admissions (7.2% of all hospital admissions) related to alcohol consumption, where an alcohol-related disease, injury or condition was the primary reason for admission or a secondary diagnosis.

What is a unit?

• 10ml or 8g of pure alcohol (ethanol)
• One 25ml single measure of whisky (ABV 40%)
• One-third of a pint of beer (ABV 5–6%)
• Half of a standard (175ml) glass of wine (ABV 12%)

Calculation

No. of units = strength (ABV%) x volume (ml) ÷ 1000 eg, a pint of Stella Artois = (5.2 x 568 ÷ 1000) = 2.95 units

More examples

• Beer, cider, lager (5%) bottle, 330 ml = 1.7 units
• Beer, cider, lager (5%) pint, 568ml = 2.8 units
• Spirits (38/40%) small measure, 25 ml = 1 unit
• Sherry, port (17.5–20%) standard measure, 50ml = 0.9–1 unit
• Red/white/rose wine (11–14%) small glass, 125ml = 1.4–1.75 units
• Red/white/rose wine (11–14%) standard glass, 175ml = 1.9– 2.5 units
• Red/white/rose wine (11–14%) large glass, 250ml = 2.8–3.5 units

Assessment/management of alcohol misuse

Screening To identify problem drinking and potential alcohol problems, use the three quick AUDIT-C screening questions, which scores patients according to the amount and frequency of their alcohol consumption. An online version is available at https://www.patient.co.uk/doctor/alcohol-use-disorders-identification-test-audit.  

Intervention Brief intervention by clinicians can be effective. It is generally restricted to four or fewer sessions, each session lasting from a few minutes to 1 hour, and is designed to be conducted by health professionals who are not specialists in the treatment of addictions. Brief intervention is most often used with patients who are not alcohol dependent, in whom the goal may be to moderate drinking rather than achieve abstinence.

The Alcohol Identification and Brief Advice e-learning project (Alcohol IBA) helps professionals with identifying individuals whose drinking might be harming their health and delivering simple, structured advice.