How to tell if you’re drinking too much. Plus, a step-by-step guide to reducing alcohol consumption.
Medically reviewed by Dr Roger Henderson and words by Dan Rutherford
Dr. Aiysha Malik, Technical Officer, Department of Mental Health and Substance Abuse at WHO Regional Office for Europe said alcohol is an ‘unhelpful coping strategy’ for dealing with feelings that might be arising during the coronavirus pandemic.
While it is OK to drink in moderation, Dr Malik said, he advised against exceeding that limit, as it could weaken your immune system and make you more susceptible to catching COVID-19.
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So how do you know if you are drinking too much alcohol?
First of all, it can be hard for someone to tell exactly how much they normally drink. Some people – particularly, accustomed drinkers are less aware of feeling drunk. For these people, it may be a good idea to keep a diary of alcohol consumed over a period of time and make a note every time you have a drink.
Safe weekly drinking guidelines
Present advice on safe drinking is:
- no more than two units of alcohol per day for men and women (14 in a week).
- you should have at least two drink-free days a week.
When drinking at home, people are almost always more generous, so it’s a good idea to get into the habit of using a spirit measure.
Staying within the ‘safe’ limits does not mean that a person is capable of driving a motor vehicle. When driving, it’s best not to drink at all.
Advice for pregnant women
Pregnant women are advised not to drink alcohol.
There is currently no clear evidence as to what is safe for the developing baby so the advice is to avoid all alcohol if possible, especially in the first three months of pregnancy where there is an increased risk of miscarriage.
The more alcohol you drink during pregnancy, the greater the risk of the baby being born with a condition known as foetal alcohol syndrome (FAS).
FAS causes growth deficiencies, central nervous system defects, learning difficulties and facial malformations.
How to tell if you have a drinking problem
First, let’s look at what counts as a unit of alcohol:
- Half a pint (250ml) of average strength beer.
- 125ml glass of wine 8 per cent ABV.
- 76ml of wine of 13 per cent ABV
- One standard pub measure of spirits (25ml).
- 25ml of fortified wine, such as sherry or port.
If I don’t feel drunk, I don’t have an alcohol problem, right? Alcohol tolerance can lead someone with a dangerously high consumption to be falsely reassured that as long as they don’t feel drunk, they will be fine.
Many people routinely drink a bottle of wine in an evening, without realising that they have consumed over the advised weekly intake of alcohol, as most wine is now 12 to 13.5 per cent in strength.
Pubs and restaurants routinely serve 250ml glasses of wine (3.5 units of alcohol).
Needing a lot of alcohol to get drunk can perhaps indicate that you are already drinking too much, too often.
Alcohol tolerance can be compared to a lack of the ability to feel pain. If you didn’t feel pain, you wouldn’t immediately remove your hand from a hot stove and notice it was burnt until it was too late.
If you have developed a tolerance for alcohol, you can no longer trust your body’s signals to tell you when you’ve had too much. Instead, you will have to keep count of drinks to know when you’ve drunk too much.
How to reduce how much you drink
A person who drinks too much may feel it is impossible for them to reduce their alcohol consumption.
If a drinking habit is heavy, it’s often hard work to reduce it – simply because it is always difficult to change habits. You may not even be sure whether you want to cut down.
Fortunately, there are many different ways to reduce alcohol consumption and most people are able to find a way that suits them.
A step-by-step guide to reducing alcohol consumption
Keep a record of all alcohol consumption.
Work on ways to make it easier to reduce the alcohol intake.
Talking to a partner or friend could flag up some self-help ideas, such as:
- I can stop drinking alcohol on weekdays.
- I can stop drinking alcohol during the day.
- I can substitute every second drink with water, non-alcoholic beer, coffee or soft drink.
- I can take a different route home, so I won’t be tempted to visit a pub.
- I can visit my family instead of my drinking friends.
- Use a smaller wine glass, and drink by the glass and not the bottle.
What if I can’t reduce my drinking by myself?
It may be difficult for a person to reduce their alcohol consumption without outside assistance.
There are several places where it is possible to get help and counselling.
A GP will be able to help by:
- giving advice
- referring a heavy drinker to a counsellor or an organisation that can provide help, such as Alcoholics Anonymous (in light of the coronavirus pandemic, AA are currently holding anonymous meetings via Zoom).
Dedicated alcohol detoxification facilities are available in the NHS but waiting lists can be lengthy and it is necessary to show a real desire to cut down on drinking.
There are several private units but these are expensive and it is unusual for the NHS to fund placement.
Alcohol withdrawal symptoms
For a very heavy drinker, stopping alcohol abruptly can be dangerous.
In addition to the anxiety that abrupt withdrawal can cause, a small proportion of people develop a potentially serious condition called delirium tremens (DTs). This can cause confusion and even convulsions.
Patients at risk of DTs are best managed by planned withdrawal from alcohol in hospital, along with supportive counselling and drug therapy to counteract the physical effects. Benzodiazepines are the drug of choice, such as diazepam or lorazepam.
Is there a drug to stop me drinking?
The short answer is ‘no’, but there are medications that can be prescribed by a medical specialist after someone has stopped drinking, or who has successfully withdrawn from alcohol.
Antabuse (disulfiram) is a prescription-only medicine that’s designed to deter people from drinking.
Antabuse does not remove the craving for alcohol, but it will help a drinker avoid being tempted in a weak moment.
It should only be prescribed in combination with psychological support and under supervision from a specialist alcohol detoxification team.
Will it help me?
For some people, Antabuse is a good idea and a safety measure.
Ex-drinkers who have used Antabuse say it is a relief to know they can’t drink.
It allows alcoholics to focus on things other than not drinking too much.
However, Antabuse is a controversial medicine.
It does not help everyone who takes it, nor is it the only way to give up alcohol.
This is because if a person drinks while they are taking Antabuse, it will cause serious and unpleasant symptoms such as:
- severe headache
- a feeling of pressure in the chest
- in the worst cases, shock and collapse.
In the event of shock, treatment will be required from a doctor or in a hospital emergency department. Because of its effect on the liver, it is no longer the first choice medication for treating alcohol addiction.
Campral EC (acamprosate) is the preferred drug to help people abstain from excessive drinking.
It works in the brain where it is thought to act by reducing the desire to drink alcohol.
It doesn’t produce the same effect that Antabuse does if alcohol is consumed and is normally only prescribed where someone has successfully stopped drinking.
Its use is usually combined with counselling to prevent a return to alcohol abuse and is commonly prescribed for up to 6 months.
Naltrexone is another drug that can be prescribed, again with supervision and support from a specialist medical team. If drinking persists 4 to 6 weeks after prescribing, it is stopped.
I think I have a drinking problem. How do I find help?
If you drink more than the recommended amount and you find it difficult to cut down, there are several places you can turn to for advice and guidance.
Throughout the country, there are local alcohol advice centres where you can ask for help. They can put you in touch with clinics where you will find specialists, nurses and social workers who can help. Phone numbers are listed in the telephone directory or can be obtained from the local health trust or your GP.
Many of these have online resources available during lockdown.
What help can I get at a clinic?
- You may know you need help cutting down and want to go directly into treatment.
- You may want to speak to people at the clinic to judge the seriousness of your problem or get advice about what possibilities are open to you.
- You can also make contact if you are worried about one of your relatives or friends, who you think may have a drink problem.
Alcoholics Anonymous (AA)
Alcoholics Anonymous is the world’s biggest union of self-help groups concerned with alcohol abuse.
The therapy in these groups takes place without the interference of public bodies, doctors, psychologists or other professionals.
Attending the meetings is on a voluntary basis. The only requirement is an honest desire to quit drinking. You will meet people who have been through the same hardships as yourself.