Alcohol and You audio transcript

Alcohol and You – An NHS self help guide

The written version of this guide was Commended at the British Medical Association Patient Information Awards 2019.

You may be interested in this guide if…

• You want to know more about drinking alcohol
• You are interested in what the current guidelines for safe limits are
• You think you may have a problem with your drinking
• People have told you that you have a drink problem
• You are worried about someone else’s drinking

What will this guide do?

• Give you more information about different types of drinking
• Help you recognise your own pattern of drinking
• Help you decide what kind of drinker you are
• Describe how you might change if you want to by using ideas based on evidence.
• Suggest how you might get further help

There is a lot of information in this guide and it may be helpful to listen to it several times, to get the most from it.

How do people use alcohol?

Some people choose not to drink alcohol at all. Of those people who drink alcohol, most people in this country (55-65%) drink at low risk levels.

But different people use alcohol in different ways. These are some of the different ways people use alcohol.

Which of these people are you most like, in the way you use alcohol?
Wayne is typical of the majority of people in Britain. He enjoys a pint or two a couple of times a week. He tends to do this either with his mates at the local pub in the evening, or at family celebrations such as birthday parties. He and his partner like to organise a baby sitter once in a while and treat themselves to a meal with wine at a restaurant. It is the company of his friends and family that Wayne enjoys. He’s not that bothered about the alcohol, although he enjoys it when he does have a drink.

If you are like Wayne, then probably you are drinking at what health guidelines call a low risk level. If you are otherwise in good health, then the alcohol you drink should cause you no harm. But you may still find this guide helpful to you. You will be able to check that you really are a low risk drinker. It will also help you understand how and why it is important not to increase your drinking.

Gemma likes to go out with her friends about twice a week. She usually just has one or two drinks but sometimes finds she drinks a bit more than this. This tends to happen when she drinks with her friends in rounds or during “happy hour” when the drinks are cheaper. She does not feel she drinks too much. She accepts the occasional hangover without concern. Recently, she has started having a glass of wine at home most evenings.

If you are like Gemma then you might be surprised to learn that you are drinking at a level which health guidelines call increasing risk. This means that while you are unlikely to be actually causing harm to yourself right now, you are putting yourself at risk. Your drinking is at a level where you may be putting yourself at risk of having an accident or having serious health problems in the long run.  In fact, if you drink like Gemma, then probably there are days when you feel tired or hung-over because of the way you use alcohol. If you feel you may be drinking at increased risk, then using this guide will help you return to being a low risk drinker. You will then avoid the long-term risks to your health that too much alcohol can cause.

John likes to have a drink on a regular basis. He goes to the pub most nights and has at least 3 to 4 pints. Recently he has been having arguments with his partner. She is not happy, both with the amount of time he spends in the pub and the amount of money he spends when he’s in there. Also, recently, he has had to take time off work when he has been hung-over the following day. He is now finding it difficult to fall asleep unless he has had a drink. He also finds he has to drink more to get the same effect he once had from smaller amounts. His partner thinks he has a problem and that it is getting worse and it continues to be a source of arguments.

If you are like John then you could be damaging your health right now. Probably, you are drinking more alcohol than your body can cope with. If that is the case, then you are probably drinking at what health guidelines call a higher level of risk. Over time your body will have more and more difficulty dealing with the alcohol you are drinking. Your health will suffer. It might even be, looking back to how you used to be when you drank less than you do now, that you do notice some differences. You may feel bloated or have ‘tummy troubles’. Perhaps you don’t feel as energetic as you used to. You may not sleep as well or wake feeling as rested.  Possibly you feel less happy, even low in mood some days. If this sounds like you, then you should use this guide to help you cut down both how much and how often you drink. You’ll be surprised how much better you feel if you do.

Mary feels she needs to drink every day. If she does not have a drink she suffers from shaking, feeling sick, feeling anxious and sweating. She recently lost her job due to her drinking and can only afford to drink the cheapest brands. She drinks a bottle of vodka most days.  She has tried putting her first drink of the day off for as long as possible, but now finds it is getting earlier each day and is sometimes as soon as she gets up. She thinks she is drinking too much and would like to change but feels afraid of the feelings she has when she tries to cut down. She knows she needs to talk to someone about her drinking and has thought of making an appointment to see her doctor, but hasn’t yet done so.

If you are like Mary then you may find it difficult to stop drinking alcohol. You may begin to feel more unwell if you don’t drink than if you do. If that is the case then you could be what health guidelines call a dependent drinker.

If you think you may be physically dependent on alcohol then it is very important that you see your Doctor before you stop drinking. The reason for this is that it can be harmful to stop suddenly and the effects of sudden withdrawal can be very severe and possibly life threatening.

Even if you are a dependent drinker, don’t worry. There is help available. You can find out how to get help later in this guide.

There are circumstances when it is best to avoid alcohol completely, such as pregnancy.

Pregnancy and drinking
The Chief Medical Officers’ guideline is that:

• If you are pregnant or think you could become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.
• Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.

The risk of harm to the baby is likely to be low if you have drunk only small amounts of alcohol before you knew you were pregnant or during pregnancy.

If you find out you are pregnant after you have drunk alcohol during early pregnancy, you should avoid further drinking. You should be aware that it is unlikely in most cases that your baby has been affected. If you’re worried about alcohol use during pregnancy, do talk to your doctor or midwife.

But let’s not jump to conclusions! Before you finally decide what sort of drinker you think you are, listen more of this guide and do one or two of the exercises. This may help you be more clear what type of drinker you are. More importantly, you’ll discover what you want to do about it and what you can do.

What is alcohol and how much is it ‘safe’ to drink?

Before we go any further, let’s be clear about what alcohol is. Alcohol itself is a colourless chemical. It can be made from almost anything that has sugar in it. For example, beer is made from barley, cider from apples, wine from grapes, whiskey from grain, and vodka from potatoes. Depending on what they are made from, and how they are made, different drinks have different amounts of alcohol in them. Beer and cider can be 2% to 7% alcohol; wines 9% to 15%; and spirits, like whiskey and vodka, are often 40% alcohol. These percentages are ‘Alcohol by Volume’. On bottles you may see this shortened to ‘ABV’ next to the percentage number.

Alcohol is also measured in units. One unit is often referred to as one standard drink. More and more drinks are labelled with the units of alcohol they have in them. Here are some examples of the typical number of units (standard drinks) of alcohol in different drinks.

One standard drink is:

• Half a pint of regular beer, lager or cider
• A small glass of wine
• A single measure of spirits
• A small glass of sherry
• A single measure of an aperitif

The following quantities of alcohol contain more than one standard drink.

• A pint of regular beer, lager or cider is two standard drinks
• A pint of premium beer, lager or cider is three standard drinks
• An alcopop or a can or bottle of regular lager is one and a half standard drinks
• A 440ml can of premium lager or strong beer is two standard drinks
• A 440ml can of super strength lager is four standard drinks
• A 175ml glass of wine is two standard drinks
• A bottle of wine is nine standard drinks

Alcohol also contains calories.  There are about 55 calories in every unit of pure alcohol.  But remember, drinks have other ingredients besides alcohol and they will add to the calorie count!

This is how many calories there are in half a pint of beer or lager
Canned and draught bitter – 90 calories in half a pint
Ordinary Lager with a 3-4% ABV – 80-85 calories in half a pint
Premium Lager with a 5% ABV – 90 calories in half a pint
Draught Mild bitter – 70 calories in half a pint
Brown ale – 80 calories in half a pint
Bottled Stout – 105 calories in half a pint
Dry cider – 95 calories in half a pint
Sweet cider – 110 calories in half a pint

This is how many calories there are wine
Dry white wine – 85 calories in 125 millilitres
Medium white wine – 95 calories in 125 millilitres
Sweet white wine -120 calories in 125 millilitres
Sparkling white wine such as Champagne or cava – 95 calories in 125 millilitres
Rose wine, medium – 90  calories in 125 millilitres
Red wine – 85  calories in 125 millilitres

This is how many calories there are in spirits.50 ml is equivalent to a pub double.
Whisky, gin, vodka – 120 calories in 50 millilitres
Premium whisky, gin, vodka – 140  calories in 50 millilitres
Liqueurs and brandy – 150  calories in 50 millilitres

This is how many calories there are in mixers
Tonic water – 40 calories in 50 millilitres
Cola – 45 calories in 50 millilitres
Caffeine based energy drink – 45 calories in 50 millilitres
And finally a Can of slimline/diet Tonic, cola etc – Zero calories in 50 millilitres

What drinks do you usually have?

How much of it do you usually drink on days when you are drinking?

So how many units of alcohol do you usually have when you are drinking alcohol?

Government guidelines state that there is no safe drinking limit for alcohol.
Current recommendations are no more than 14 units of alcohol a week.

This is the same for both men and women.

If you are drinking close to your limit, then two or three alcohol-free days a week will reduce your risk, allowing your liver time to rest. Government guidelines suggest spreading your intake over the week, rather than drinking all of your units together.

Weekly drinking guideline
This applies to adults who drink regularly or frequently i.e most weeks. The Chief Medical Officer’s guideline for both men and women is that:

• To keep health risks from alcohol to a low level it is safest not to drink more than 14 units a week on a regular basis.
• If you regularly drink as much as 14 units per week, it is best to spread your drinking evenly over three or more days. If you have one or two heavy drinking episodes a week you increase your risks of death from long term illness and from accidents and injuries.
• The risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases the more you drink on a regular basis.
• If you wish to cut down the amount you drink, a good way to help achieve this is to have several drink-free days each week.

Single occasion drinking episodes
This applies to drinking on any single occasion (not regular drinking as described earlier).The Chief Medical Officers’ advice for men and women who want to keep their short term health risks from single occasion drinking episodes to a low level is to reduce them by:

• limiting the total amount of alcohol you drink on any single occasion
• drinking more slowly, drinking with food, and alternating with water
• planning ahead to avoid problems e.g. by making sure you can get home safely or that you have people you trust with you. The sorts of things that are more likely to happen if you do not understand and judge correctly the risks of drinking too much on a single occasion can include:
• accidents resulting in injury; causing death in some cases
• misjudging risky situations, and
• losing self-control (e.g. engaging in unprotected sex)

Some groups of people are more likely to be affected by alcohol and should be more careful of their drinking on any one occasion. For example those at risk of falls, those on medication that may interact with alcohol or where it may exacerbate pre-existing physical and mental health problems.

If you are a regular weekly drinker and you wish to keep both your short and long term health risks from drinking low, this single episode drinking advice is also relevant for you.

What does alcohol do?

Alcohol dissolves quickly in the blood stream and affects your judgement. You may do things you wouldn’t do if you hadn’t drunk alcohol, and some of these things you may later regret. It can cause unsteadiness and loss of balance, slurred speech, and blurred vision. It can even lead to unconsciousness and death.

The reason why you shouldn’t drive or operate machinery after drinking alcohol is because it affects your judgement. It also affects your co-ordination – that is, your ability to control your body, and your reaction time slows down. It often does all this without you realising that it is affecting you in these ways.

Your body treats alcohol as a poison. It works hard to get rid of it. But it takes a healthy liver about one hour to get rid of one unit of alcohol. Fresh air, black coffee, and cold showers won’t help to get alcohol out of your system.

Effects of alcohol misuse
Alcohol misuse can cause aggressive, irrational behaviour, arguments, violence, depression and nervousness. It can cause memory loss and can make you alcohol dependent.

It can also cause:

• premature ageing
• a drinkers nose
• frequent colds
• reduced resistance to infection
• increased risk of pneumonia
• a weakness of heart muscle
• heart failure
• anaemia
• impaired blood clotting
• vitamin deficiency
• bleeding
• severe inflammation of the stomach
• vomiting
• diarrhoea
• malnutrition
• trembling of the hands
• tingling fingers
• numbness
• painful nerves
• in men it can cause impaired sexual performance
• in pregnant women the Risk of harming your baby
• impaired sensation in legs leading to falls
• numb, tingling toes and painful nerves in the feet

Regularly drinking large amounts of alcohol increases the risk of serious illnesses. These include: inflammation of the pancreas; stomach ulcers; liver disease, including cancer; cancers of the mouth, throat and breast; and brain damage. Drinking excessive amounts can also lead to hearing loss.

Recent evidence suggests that any level of alcohol consumption puts us at risk of developing certain cancers.

Alcohol can also affect our mental health. Sometimes people drink to help with symptoms of anxiety or depression, but unfortunately any relief is temporary and alcohol only tends to make things worse in the longer term. Alcohol has also been found to be linked to suicide and self-harm.

Drinking large amounts of alcohol can also lead to personal and social problems.

What kind of drinker are you?

To find out what kind of drinker you are, think about the amount of alcohol you drink and also the pattern of your drinking. The pattern of your drinking is made up of the times when you drink alcohol and the times when you do not, and who you drink alcohol with.

Think about how you used alcohol in the last week. Now start a diary.  Perhaps you cannot remember exactly what you had to drink last week, or when. In that case, keep a diary in the coming week. Each day, write down where, what, why and with whom you were drinking.  Record the number of units consumed in the session and the amount spent.

How much money did you spend on alcohol in the week?

When you have completed your Drinking Diary, use it to help you answer the following ten questions.

Question 1 – How often do you have a drink that contains alcohol?
If your answer is:

• ‘never’ you will score Zero,
• ‘monthly or less’ score 1,
• ‘2-4 times a month’ score 2,
• ‘2-3 times per week’ score 3.
• If your answer is ‘four or more times in a week’ score 4 points

Question 2 – How many standard alcoholic drinks (i.e. units) do you have on a typical day when you are drinking?
If your answer is:

• ‘1-2’ you will score Zero,
• ‘3-4’ score 1,
• ‘5-6’ score 2,
• ‘7-9’ score 3.
• If your answer is ‘10 plus’ score 4 points.

Question 3 – How often do you have six or more standard drinks (units) on one occasion?
If your answer is:

• ‘never’ you will score Zero,
• ‘less than monthly’ score 1,
• ‘monthly’ score 2,
• ‘weekly’ score 3.
• If your answer is ‘daily or almost daily’ score 4 points

Question 4 – How often in the last year have you found you were not able to stop drinking once you had started?
If your answer is:

• ‘never’ you will score Zero,
• ‘less than monthly’ score 1,
• ‘monthly’ score 2,
• ‘weekly’ score 3.
• If your answer is ‘daily or almost daily’ score 4 points

Question 5 – How often in the last year have you failed to do what was expected of you because of drinking?
If your answer is:

• ‘never’ you will score Zero,
• ‘less than monthly’ score 1,
• ‘monthly’ score 2,
• ‘weekly’ score 3.
• If your answer is ‘daily or almost daily’ score 4 points.

Question 6 – How often in the last year have you need an alcoholic drink in the morning to get you going?
If your answer is:

• ‘never’ you will score Zero,
• ‘less than monthly’ score 1,
• ‘monthly’ score 2,
• ‘weekly’ score 3.
• If your answer is ‘daily or almost daily’ score 4 points.

Question 7 – How often in the last year have you had a feeling of guilt or regret after drinking?
If your answer is:

• ‘never’ you will score Zero,
• ‘less than monthly’ score 1,
• ‘monthly’ score 2,
• ‘weekly’ score 3.
• If your answer is ‘daily or almost daily’ score 4 points.

Question 8 – How often in the last year have you not been able to remember what happened when drinking the night before?
If your answer is:

• ‘never’ you will score Zero,
• ‘less than monthly’ score 1,
• ‘monthly’ score 2,
• ‘weekly’ score 3.
• If your answer is ‘daily or almost daily’ score 4 points.

Question 9 – Have you or someone else been injured as a result of your drinking?
If your answer is:

• ‘No’ you will score Zero,
• ‘yes, but not in the last year’ score 2,
• ‘yes during the last year’ score 4 points

Question 10 – Has a relative/friend/doctor/health worker been concerned about your drinking or advised you to cut down?
If your answer is:

• ‘No’ you will score Zero,
• ‘yes, but not in the last year’ score 2,
• ‘yes during the last year’ score 4 points

Now add up the numbers. What is your total?

• If you scored up to 7, you are probably drinking sensibly and with low risk. (low risk)
• If you scored between 8 and 15, then your drinking is possibly becoming hazardous to your health. You are increasing the risk to your health. (increasing risk)
• If you scored between 16 and 19, then your drinking is probably harmful now or in the longer term. Although you may not notice it, there is a high risk that your health is suffering because of alcohol. (higher risk)
• If you are scoring 20 or more, then you may be alcohol dependent. (high risk and possible dependence)

Now put the information together that you have learned about yourself.

My drinking is probably:

• Low risk
• Increasing risk
• Higher risk
• High risk and possible dependence

If you believe that you are a high risk and dependent drinker then it is very important that you see your Doctor before you stop drinking.

If you are unhappy with the amount you drink, and believe you may be an increasing or higher risk drinker then you should find help in the following pages.

Why do you drink alcohol?

To get the most out of the help out of this guide, think of all the reasons why you drink alcohol. Some common reasons why people drink alcohol will be mentioned next …. You may drink for reasons of your own. You should add any of your own reasons at the end of this list.

Why I drink alcohol

• Because my friends do.
• Because it helps me relax.
• Because it helps me sleep at night.
• Because it helps me stay calm when I’m mixing socially.
• Because I get bored – it’s something to do.
• Because I feel anxious if I go without alcohol.
• Because I feel low in mood.
• Because I like the feeling of being drunk.
• Because it helps me to forget some things in my life that cause me stress and make me unhappy e.g. debts; a difficult personal relationship; problems at work.

Now think about what might be good about stopping drinking alcohol or cutting down on the amount you do drink. Some of the advantages of drinking less, or not at all, are mentioned next. You can also add other good things of your own.

Think of the top three advantages for you of cutting down or even stopping your drinking.  These will be your top three reasons for reducing or stopping your drinking.

Advantages of stopping or reducing alcohol

• I’ll have more cash to spend on other things.
• I’ll lose weight.
• I’ll sleep better at night.
• I’ll wake-up in a morning feeling refreshed.
• I’ll feel happier and my mood will improve.
• I’ll feel more in control.
• I’ll look and feel healthier and fitter.
• I’ll get on better with my family and friends.
• I’ll become much more relaxed.

What do you want to do?

You now understand a lot about your drinking. You know how much you drink. You know when you drink. You know why you drink. You also know what you will gain by reducing or stopping your drinking.

Do you want to continue drinking alcohol, but less of it and less frequently?

Or do you want to stop drinking alcohol altogether?

Think about the consequences of continuing drinking in the way you do now. What is good and what is bad about that? How would you see your life in six months’ time?

If I continue to use alcohol like I do now
What are the advantages and disadvantages?

What’s good about drinking?

What’s bad about drinking?

How do I see myself and my life in six months’ time if I continue drinking?

Now think about reducing or stopping drinking. What will be good and bad about that?

How would you expect your life to be in six months’ time if you reduced your drinking or stopped altogether?

If I reduce or stop my use of alcohol
What are the advantages and disadvantages?

What’s good about drinking less or not drinking at all?

What’s bad about drinking less or not drinking at all?

How do I see myself and my life in six months’ time if I reduce or stop my drinking?

Now come to a clear and honest conclusion about yourself and your drinking, and what you want to do about your drinking.

 I am

• A low risk drinker
• An increasing risk drinker
• A high risk drinker
• A high risk and possibly dependent drinker

I want to

• carry on
• cut down
• stop

Remember:
If you are a very heavy and possibly dependent drinker of alcohol, then it is very important that you see your Doctor before you stop drinking.

How can you control your drinking?

The way you drink alcohol now is in part a habit. It is a habit that took time to develop. Now you should take time to make new habits in the way you use alcohol.

Planning
Begin to take control of your drinking by planning when and how much you will drink.

• Use your Drinking Diary to plan when you will drink alcohol and how much you will drink.
• Use your diaries to work out habits in your drinking. Do you drink while eating snacks, or watching TV, or while cooking? If so, try to break these habits by setting yourself new rules and not drinking at these habitual times.
• Identify high-risk times i.e. times when you know that you might drink too much e.g. on a night out with friends, at home after a hard day, on Friday or Saturday nights, and have a plan to deal with this.
• Pick at least two days a week when you will not drink any alcohol.
• On days when you plan to drink, pick the time when you will stop drinking and leave the pub or bar, or the time when you will go to bed.
• On the days when you plan to drink alcohol, write down what types of drinks you will have and how many. Try to work out how many units of alcohol you will drink.
• Keep track of how much you really drink by recording what you actually had next to what you planned to have.
• Plan to eat before you start drinking, and if possible eat while you are drinking. This can help to reduce the effect of alcohol on your body.
• Tell your friends and family if you feel they will support you.
• If you have a supportive partner or friend who also wishes to reduce, it can be really helpful to work on this together.
• Keep a record of your mood. People often find their mood is better on days when they don’t drink, and worse when they do, particularly the day after.

Trimming
Begin to reduce the amount of alcohol you actually drink by trimming back at the times you’ll least miss it.

• If you go out to drink, don’t have a drink at home beforehand.
• If you do pre-drink before going out, try to reduce your alcohol intake once out.
• Try to eat before drinking alcohol. You will probably drink less if you are full.
• Start drinking later in the evening, whether you drink at home or go out to drink; set a time before which you won’t have an alcoholic drink.
• If you drink spirits, dilute them with a mixer (tonic, soda, ginger ale, lemonade etc.) and increase the amounts of the mixer to make them ‘long drinks’.
• If you drink wine, buy small glasses rather than large ones and try ‘spritzers’ (mixing your wine with soda or lemonade). Try to drink lower strength wines. Sparkling wine tends to be slightly lower strength and comes in a smaller measure!
• If you drink beer or lager, stick to standard strength and avoid extra-strength varieties or premium varieties.

Alternatives
Begin to reduce the time you spend drinking alcohol by looking for alternatives.

• Pick one day a week when you usually drink alcohol and do something else instead e.g. go to the cinema, go swimming or some other activity.
• If you tend to drink alcohol at home, experiment with non-alcoholic drinks until you find one that you enjoy. These may be cold soft drinks such as fizzy drinks, cordials or fruit juices. Or they may be hot drinks such as tea, coffee, hot chocolate, or malted drinks. Also, look for new activities at home that may interest you and don’t involve drinking e.g. crosswords, puzzles, gardening. If you tend to drink alcohol when you are out with friends, offer to be the non-drinking driver so you have a good excuse ready for not drinking alcohol.
• If you are drinking alcohol, alternate your alcoholic drinks with non-alcoholic drinks. Remember many pubs now sell tea and coffee.

Particular problems

 I am not drinking alcohol and…

• I feel anxious

Remember:  Try relaxation or mindfulness. Practise slow, deep breathing. Use calming thoughts, distract yourself from anxious thoughts, and make a plan of your time to keep busy. There is a guide in this series on Anxiety which you may find useful which includes more detail on relaxation and mindfulness techniques.

• I can’t sleep

Remember:  Exercise regularly – but not late in the evening! Go to bed and get up at a regular time. Make sure your bed and bedroom are comfortable. Have a bedtime routine and wind down before going to bed. Your sleep will improve once you reduce your alcohol intake and follow these tips. If this remains a problem, there is a guide in this series on Sleep which you may find helpful.

• I’m bored

Remember:  Plan your day out so that you have something to look forward to.  Use the money you are saving on alcohol for something special. Get in touch with supportive friends who won’t try to get you to drink. Look for a new hobby or interest. Get on with some jobs that you have not got round to.

• I’m stressed out and can’t relax

Remember:  Relaxation and leisure time each day is important. Plan your time and do one thing at a time.  Eat a balanced diet. Talk things over with a friend or family member. Set priorities and don’t be afraid to say no.

•  I’m out with friends but don’t feel part of the crowd

Remember:  Try not focus on yourself. Think about those around you. Ask what is going on in their lives, and listen to what is being said.  You do not need to keep up drinking with friends who are heavy drinkers; that’s their choice and not yours. People will not dislike you just because you are not drinking as much.

What if you are a dependent drinker?

If you are a dependent drinker then when you are drinking this is likely to be continuous and heavy. Continuous heavy drinking can lead to a number of health problems.

Continuous heavy drinking
Many people who drink very heavily every day do not eat properly. In particular, they do not get enough Vitamin B. At the same time, the body needs extra Vitamin B to repair the damage caused by alcohol. It particularly needs Vitamin B to repair damage to nerve cells in the body, including the brain. Very heavy drinking flushes vitamins out of the body. So the very heavy drinker needs more Vitamin B than most people but usually gets less. This leads to nerve damage. Many very heavy drinkers first experience damage to their nerves as ‘pins and needles’ in their fingers and toes. The very heavy drinker can also be left with no ability to lay down new memories. This is a type of dementia specifically associated with very heavy drinking. It is caused by a lack of thiamine, which is a type of Vitamin B needed by the brain to make new memories.

Very heavy drinkers may also experience being breathless when doing ordinary activities, like walking upstairs. They may feel constantly tired. And they may find that they bruise very easily. This is because the alcohol is damaging the blood cells that carry oxygen and other blood cells that help stop bleeding.

Very heavy drinkers may also get diabetes because of damage to their pancreas, which normally produces insulin. They may also damage their liver, but they are unlikely to actually feel that damage being done.

If you experience any of these symptoms it is important you this discuss this with your GP.

Suddenly stopping very heavy drinking
The body, and especially the brain, will try to adjust to cope with large amounts of alcohol if the alcohol is present in the body all the time. That means that the body, and especially the brain, has to re-adjust if the alcohol is taken away.

If your body has adjusted to coping with continuous large amounts of alcohol and then the alcohol is suddenly stopped then you may experience the following:

• Shaking or tremors all over.
• Very heavy sweating.
• Extremely high blood pressure, and looking very red in the face.
• Vomiting and diarrhoea, and the only way to keep down any food will be after drinking more alcohol.
• Very tense and agitated, being unable to settle down or do anything.
• Feeling very confused, not knowing the time, or where you are and having a very poor short-term memory so that you cannot recall what happened recently.
• Hallucinating: you may just ‘sense’ that bad things are happening, or you may actually see or hear things that aren’t there; typically, people in this state ‘see’ spiders, rats or snakes.
• You may suffer ‘fits’, during which you lose control of your body, collapse, and become unconscious.

These are symptoms of physical withdrawal from alcohol. The symptoms are very dangerous. They can be fatal. They can also lead to permanent brain damage. Continuing to drink heavily however will eventually lead to serious health problems. Although your body tries to adjust, it gradually gets worse rather than better at dealing with the damage alcohol causes.

Remember
If you believe that you are dependent on alcohol, then it is very important that you see your Doctor or a local specialist service to help you stop drinking.  Remember, with the right kind of help, anybody can come off alcohol safely.

What about setbacks?

You might not have any set-backs! But you probably will, as set-backs are normal. If you do have a set-back it is important not to give up on the goals you have set yourself.

A set-back can also be a good thing. It can be something you can learn from. So if you do have a set-back, think about it afterwards. Was it a difficult situation you found yourself in? Was it something you were thinking about that caused you to feel bad? Or maybe you were using alcohol to celebrate an event?  What was it that caused you to have the set-back?

Write it down and plan how you will deal with that situation, thought or feeling next time.That way, you can try to avoid similar set-backs in the future.

Set-backs are a normal part of life. Remember that living life with much less alcohol than you used to use, or even without any alcohol at all, involves learning new habits. So for a time it’s easy to slip back into old habits. If you slip back remember the goals you set yourself for your drinking and try again. Listen through this guide again to listen to this guide again to remind yourself. Given time, your new ways of behaving will become old, settled habits themselves.

In moments of doubt just answer this question:
Do you want to control alcohol or do you want alcohol to control you?

A list of useful contacts, books and references are available in the written version of this guide.

Written by

• Healthcare staff – Nick Holdsworth, Pip Anslow, David Crawford, Debra Hall, Allan Jacques, Dave McNally, Susan Reynolds and Ann Widdas, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.
• Dr Lesley Maunder and Lorna Cameron, Consultant Clinical Psychologists.

Many thanks also to Margaret Orange, Treatment Effectiveness and Governance Manager (Addictions), Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has developed this resource with the support of NHS
healthcare staff, service users and local voluntary sector groups.