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Drug and Alcohol Rehab

Facts about Alcohol

How can you tell if you’re a binge drinker?

Even if you don't drink alcohol every day, you could be a binge drinker if you regularly drink:

• to get drunk
• more than the recommended daily guidelines in a single session quickly.

If you find it hard to stop drinking once you have started, you could also have a problem with binge drinking and possibly alcohol dependence.

Government guidelines on alcohol units

The Government's guidelines say that a man should not regularly drink more than 3-4 alcohol units a day and a woman should not regularly exceed 2-3 units a day.

Calories in alcohol

The unit calculator shows you the number of calories in the alcohol you have consumed. Many people are very surprised by the number of calories in alcoholic drinks- it is easy to make the mistake of thinking that drinks are calorie-free. 

What is an alcohol unit?

One alcohol unit is measured as 10ml or 8g of pure alcohol. This equals one 25ml single measure of whisky (ABV 40%), or a third of a pint of beer (ABV 5-6%) or half a standard (175ml) glass of red wine (ABV 12%).

To find out more about alcohol units, calories in alcohol and the impact drinking can have on your health. If you are worried about your drinking, you should consult your GP or simply telephone us for help.

Can’t find your drink?

Work out your alcohol units for yourself with this handy sum: Strength (ABV) x Volume (ml) ÷ 1000 = No. of units.

 E.g.  Pint of Stella - 5.2 x 568 ÷ 1000 = 2.95 

Drink enough alcohol, and you are likely to damage your liver. This can happen quickly or over a longer period. Increasing numbers of people in the UK are being hospitalised and dying, as a result of liver disease associated with alcohol.

Up to one in three adults drinks enough alcohol to create a risk of developing alcohol-related liver disease.

Facts and Figures

A major risk factor for liver disease is alcohol consumption, but the evidence is unclear as to the precise relationship between the amount of alcohol you drink and the incidence of liver disease.

For example, an Italian study found that liver disease risk increased after consuming 30g (about 3.8 units) of alcohol per day and that after this risk increased with the amount of alcohol consumed (1). Whereas a Chinese study found that 20g of alcohol (about 2.5 units) per day doubled the risk of liver disease, but thereafter found the risk did not increase with each additional dose. (2).

A number of studies suggest that consuming enough alcohol might trigger the disease process, but that higher levels of alcohol consumption do not have any additional impact (a relationship known as a threshold effect).

Other risk factors include:

• Alcohol dependence: However, around 8 in 10 people with alcohol dependence will not have liver damage.(3)
• Gender: Women are more susceptible to alcohol-related liver damage than men, with one study suggesting the risk is almost 50% higher (4).
• Body mass index: Being overweight or obese increases the risk of alcohol-related liver disease.
• Race: Some data suggests people of African origin are more susceptible than Caucasians (5).
• Genetic predisposition: There’s no clear data on this, but the fact that only a minority of heavy drinkers develop liver disease suggests a genetic predisposing factor (6).
• Pattern of drinking: Drinking alcohol only at meal times appears to carry a lower risk of alcohol-related liver disease than other patterns of alcohol consumption (1).

Progression

There are two patterns of liver disease, acute (known as acute alcoholic hepatitis) and chronic, which reflect whether it develops over a matter of months or years respectively.

Chronic Liver Disease

There are four stages of chronic liver disease.

1. The commonest and mildest form of liver damage is a ‘fatty’ liver. This can be identified by blood tests, and is reversible with abstinence from alcohol.

2. The next step cannot be identified by blood tests, but a liver biopsy will show inflammation in addition to the excess fat. This is called steatohepatitis. In severe cases, jaundice may develop. A diagnosis of acute alcoholic hepatitis can then be made (see below).

3. At the next stage, fibrosis (scar tissue) is present. Again, this cannot be detected by blood tests or routine scans.

4. Cirrhosis occurs when the fibrosis reaches the stage when the normally soft liver is divided into thousands of pea-sized pockets of liver tissue, wrapped in fibrosis. Once cirrhosis develops, the prognosis partly depends on whether or not you continue drinking. People with compensated cirrhosis – meaning they have no symptoms – and who then stop drinking, have an 80% chance of being alive after 10 years.

The majority of those with decompensated cirrhosis – displaying symptoms – will die within three years.

Acute Liver Disease- known as Acute Alcoholic Hepatitis.

This type of liver disease is caused by heavy drinking over a period of months. This is the pattern that is likely to occur when young people get liver disease, although older people who drink excessively later in life are also susceptible. It is potentially reversible with no long-term effects if you recover and stop drinking alcohol completely.

However, 70-90% of patients with acute alcoholic hepatitis – likely to be those who have been drinking for longer, and therefore unlikely to be young people - will have cirrhosis (see above). Jaundice is the usual first symptom. In hospitalised cases, there’s a mortality rate of around 50% associated with acute alcoholic hepatitis. Liver transplants are usually not an option, partly because of the history of recent alcohol abuse.

From the second you take your first sip, alcohol starts affecting your body and mind. After one or two drinks you may start feeling more sociable, but drink too much and basic human functions, such as walking and talking become much harder. You might also start saying things you don’t mean and behaving out of character. Some of alcohol’s effects disappear overnight – while others can stay with you a lot longer, or indeed become permanent.

Diseases and cancers

Experts estimate alcohol is responsible for at least 33,000 deaths in the UK each year. While rates of liver disease are falling in the rest of Europe, they are rising in the UK . A 2006 Lancet study found that liver cirrhosis death rates are already around twice as high in Scotland as they are in other European countries.

Liver disease used to affect mainly drinkers in middle age, but now sufferers are getting younger. Up to one in three adults in the UK drinks enough alcohol to be at risk of developing alcohol-related liver disease.

Alcohol misuse is an important factor in a number of cancers, including liver cancer and mouth cancer, both of which are on the increase. Alcohol is second only to smoking as a risk factor for oral and digestive tract cancers.

Evidence suggests that this is because alcohol breaks down into a substance called acetaldehyde, which can bind to proteins in the mouth. This can trigger an inflammatory response from the body – in the most severe cases, cancerous cells can develop.

Chronic pancreatitis is another disease associated with heavy drinking. It’s caused when your pancreas becomes inflamed and cells become damaged. Diabetes is a common side effect of chronic pancreatitis. There’s evidence that heavy drinking can reduce the body’s sensitivity to insulin, which can trigger type 2 diabetes. 

While studies suggesting that alcohol can help heart disease often hit the headlines, the reality is that the jury’s still out on the extent of any benefits. And it is clear that any benefits which there may be are limited to very low levels of consumption – probably no more than 1 unit alcohol per day.

Mental health

Alcohol alters the brain’s chemistry and increases the risk of depression. It is often associated with a range of mental health problems A recent British survey found that people suffering from anxiety or depression were twice as likely to be heavy or problem drinkers.

Extreme levels of drinking (defined as more than 30 units per day for several weeks) can occasionally cause ‘psychosis’, a severe mental illness where hallucinations and delusions of persecution develop. Psychotic symptoms can also occur when very heavy drinkers suddenly stop drinking and develop a condition known as ‘delirium tremens’.

Heavy drinking often leads to work and family problems, which in turn can lead to isolation and depression. For heavy drinkers who drink daily and become dependent on alcohol, there can be withdrawal symptoms (nervousness, tremors, palpitations) which resemble severe anxiety, and may even cause phobias, such as a fear of going out.

Appearance 

If you’re trying to watch your waistline, drinking too much alcohol can be disastrous! Research from the Department of Health reveals that a man drinking five pints a week consumes the same number of calories as someone getting through 221 doughnuts a year. 

Drinking too much alcohol isn’t great news for your skin either. As well as causing bloating and dark circles under your eyes, alcohol dries out your skin and can lead to wrinkles and premature aging. If you drink heavily you may develop acne rosacea, a skin disorder that starts with a tendency to blush and flush easily and can progress to facial disfiguration, a condition known as rhinophyma.

Dependence

If you drink large quantities of alcohol on a regular basis you run the risk of becoming addicted. Experts estimate that one in 17 people (6.4%) in Great Britain depend on alcohol to get through the day. This can have serious effects on their families, friends and partners, as well as their mental health.

Alcohol poisoning

Between 2007 and 2008 more than 30,000 people were admitted to hospital with alcohol poisoning. In the worst cases alcohol poisoning can cause lung damage (as you inhale your own vomit) and even lead to a heart attack.

Many traditional ‘cures’, such as drinking black coffee; just don’t work – or even make things worse.

The morning after

If you’ve drunk heavily the night before, you’ll almost certainly wake up with a hangover. Alcohol irritates the stomach, so heavy drinking can cause sickness and nausea and sometimes diarrhoea. Alcohol also has a dehydrating effect, which is one reason why excessive drinking can lead to a thumping headache the morning after.

Alcohol is a depressant, not a stimulant. This means that it slows down the brain and the central nervous system’s processes. You may wonder what you did the night before, feel guilty, low or lethargic.

Women and alcohol

These days women are just as likely as men to make alcohol a major part of their social lives. The problem is that many women regularly drink more than the Government’s daily recommended guidelines of 2-3 alcohol units, with around one in 14 drinking alcohol every day.

Women respond to alcohol differently from men, so the recommended levels are lower than for their male counterparts.

Recent research such as Oxford University ’s Million Women Study highlight the links between moderate drinking and increased risks of breast cancer.

Alcohol is a poison and too much of it can kill you.

Acute alcohol poisoning is usually a result of binge drinking. Your body can process about one unit of alcohol an hour. If you drink a lot in a short space of time, the amount of alcohol in your bloodstream (blood alcohol concentration or BAC) may become dangerously high.

This can stop your body from working properly. In extreme cases, alcohol poisoning could stop you breathing, your heart could stop beating or you could choke on your own vomit.

Many of the traditional ‘cures’ for alcohol poisoning – giving someone black coffee, making them sick, leaving them to sleep it off – can do more harm than good. By recognising the signs of alcohol poisoning and knowing how to respond, you could save someone’s life.

Alcohol poisoning: Facts and figures

• Alcohol is a depressant, which means it slows down your brain’s functions. You might lose your inhibitions and your sense of balance. But it also affects the nerves that control your heartbeat, breathing and gag reflex (which is what stops you choking).
• Alcohol irritates the stomach, which causes vomiting – dangerous if somebody’s gag reflex isn’t working properly. People die from choking or accidentally inhaling vomit into their lungs.
• Someone’s BAC continues to rise even after they’ve stopped drinking, as alcohol in the digestive system will continue to be absorbed into the bloodstream. This means you should never leave someone to ‘sleep it off’, as their condition could still be getting worse.
• There is no minimum dose for acute alcohol poisoning to take effect – it depends on your age, sex, size, weight, how fast you’ve been drinking, how much you’ve eaten, your general health, other drugs you might have taken…
• More than 30,000 people were admitted to hospital with alcohol poisoning in England in 2007-08 (13,400 men and 16,700 women) – that’s more than 500 every week.(1)
• 157 people died from accidental alcohol poisoning in England in 2007.(2)

Progression of alcohol poisoning

Be alert for signs that somebody has progressed from being stupidly drunk to dangerously intoxicated:

• Confusion
• Loss of coordination
• Vomiting
• Seizures
• Irregular or slow breathing (less than eight breaths a minute)
• Blue-tinged or pale skin
• Low body temperature (hypothermia)
• Stupor (being conscious but unresponsive)
• Unconsciousness (passing out)

In the worst cases, alcohol poisoning can lead to comas, brain damage and even death. After an alcohol overdose, you could:

• Choke on your vomit
• Stop breathing
• Have a heart attack
• Inhale vomit, leading to fatal lung damage
• Experience severe dehydration, which can cause permanent brain damage in extreme cases
• Get hypothermia
• Suffer seizures because of lowered blood sugar levels.

Alcohol poisoning: Getting advice and help

Someone who’s suffering from acute alcohol poisoning will be in no state to help themselves, so it’s important to look out for your friends.
What to do if someone is showing signs of alcohol poisoning:

DO

• Try to keep them sitting up and awake
• Give them water if they’re able to drink it
• Lie them on their side in the recovery position if they’ve passed out. Check they’re breathing properly
• Keep them warm
• Stay with them and monitor their symptoms.

DON’T

• Give them coffee – it will make them more dehydrated
• Leave them alone, even if they’re asleep, or leave them lying on their back
• Walk them around
• Put them under a cold shower
• Let them drink any more alcohol.

DON’T wait for all the symptoms to be present before getting help.
DO DIAL 999 to call an ambulance if you’re in any doubt.

Hospital treatments for acute alcohol poisoning

Every weekend, hundreds of people are taken into hospital with acute alcohol poisoning. In less severe cases, the medical staff will monitor them closely until they’re in a fit state to be taken home. This may involve an overnight stay.

In more severe cases, the medical staff may:

• Insert a tube into their trachea to help them breathe
• Fit an intravenous drip to top-up the body’s water, blood sugar and vitamin levels
• Fit a catheter (a tube that goes up the urethra, so the bladder empties straight into a bag)
• Pump the stomach by flushing fluids through a tube inserted into the nose or mouth.

Around 40% of patients admitted to A&E are diagnosed with alcohol-related injuries or illnesses, many of which result from binge drinking.

What is binge drinking?

The NHS definition of binge drinking is drinking heavily in a short space of time to get drunk or feel the effects of alcohol. 

The amount of alcohol someone needs to drink in a session for it to be classed as ‘bingeing’ is less clearly defined but the marker used by the NHS and National Office of Statistics is drinking more than double the daily recommended units of alcohol in one session.  

The Government guidelines state that men should not regularly drink more than three to four units a day, and women should not regularly exceed more than two to three units daily.

Binge drinking for men, therefore, is drinking more than eight units of alcohol – or about three pints of strong beer. For women, it’s drinking more than six units of alcohol, equivalent to two large glasses of wine.  

What’s the difference between drinking normally and binge drinking?

Two large glasses of wine may not seem like very much. But drinking six units of alcohol in a short space of time – an hour, say – will raise your blood alcohol concentration (BAC) and could make you drunk very quickly. Drinking the same amount over several hours, and accompanied by food for example, will not have the same effect on your BAC.

What are the effects of binge drinking?

Some studies show that drinking a large amount of alcohol over a short period of time may be significantly worse for your health than frequently drinking small quantities.

Getting very drunk can affect your physical and mental health:

• Accidents and falls are common because being drunk affects your balance and co-ordination. You’re also more likely to suffer head, hand and facial injuries. Binge drinking has also been linked to self-harm .
• In extreme cases, you could die. Overdosing on alcohol can stop you breathing or stop your heart, or you could choke on your vomit.
• Nearly a third (29%) of alcohol related deaths are a result of alcohol related accidents. These deaths are more common among 16–34-year-olds.
• Binge drinking can affect your mood and your memory and in the longer term can lead to serious mental health problems.

More commonly, binge drinking can lead to anti-social, aggressive and violent behaviour.

Alcohol is a factor in:

• One in three (30%) sexual offences
• One in three (33%) burglaries
• One in two (50%) street crimes.

Binge drinking is most common among 16–24-year-olds , and is more common among men than women. The General Lifestyle Survey 2008 showed that 21% of men and 14% of women drank more than double their recommended units on at least one day in the previous week. However, in the last decade binge drinking among young British women has increased rapidly.

And binge drinking when you’re young can become a habit. Studies have shown that those who drink a lot in their teens and early 20s are up to twice as likely as light drinkers to be binge drinking 25 years later.

Fatal alcohol syndrome (FAS) is a pattern of mental and physical defects which develops in some unborn babies when the mother drinks excessive alcohol during pregnancy.  The ingestion of alcohol does not always result in FAS, but no amount of alcohol whatsoever is proven safe for consumption during pregnancy. The current recommendation of both the Department of Health is not to drink alcohol at all during pregnancy.

Alcohol crosses the placental barrier and can stunt fetal growth and weight, create distinctive facial stigmata, damage neurons and the structure of the brain, and cause other physical, mental, or behavioral problems. Surveys found that in the United States , 10–15% of pregnant women report having recently used alcohol, and up to 30% use alcohol at some point during pregnancy. The main effect of FAS is permanent central nervous system damage, especially to the brain. Developing brain cells and structures are underdeveloped or malformed by prenatal alcohol exposure, often creating an array of primary cognitive and functional disabilities (including poor memory, attention deficits, impulsive behavior, and poor cause-effect reasoning) as well as secondary disabilities (for example, mental health problems, and drug addiction) The risk of brain damage exists during each trimester, since the fetal brain develops throughout the entire pregnancy.

Fatal alcohol exposure is the leading known cause of mental retardation in the Western world. In Europe the FAS prevalence rate is estimated to be nearly one in every 100 live births

Korsakoff's syndrome is a brain disorder usually associated with heavy alcohol consumption over a long period. Historically it has also been called 'Korsakoff's psychosis', although this can be confusing, as there are no true psychotic symptoms in the medical sense. Sometimes it is referred to as 'alcohol amnestic syndrome' − 'amnestic' meaning loss of memory − although in rare cases alcohol is not the cause. Although Korsakoff's syndrome is not strictly speaking a dementia, people with the condition experience loss of short-term memory. This factsheet outlines the causes, symptoms and treatment of the syndrome.

What causes Korsakoff's syndrome?

Korsakoff's syndrome is caused by lack of thiamine (vitamin B1), which affects the brain and nervous system. Thiamine deficiency is often seen in people who consume excessive amounts of alcohol. This is because:

• Many heavy drinkers have poor eating habits. Their nutrition is inadequate, and does not contain essential vitamins.
• Alcohol can inflame the stomach lining and impede the body's ability to absorb the key vitamins it receives.

Korsakoff's syndrome may also occur in other conditions where there is severe malnutrition, but this is extremely rare in the UK .

The pancreas is a gland that produces enzymes which help with digestion, and hormones, such as insulin and glucagon, which control blood sugar levels.

You get pancreatitis when your pancreas becomes inflamed, and its cells are damaged. There are two types of pancreatitis, acute and chronic. Both are often caused by heavy drinking.

Facts and figures

Acute pancreatitis is most commonly caused by a bout of heavy drinking or by gallstones.

The main symptom of acute pancreatitis is abdominal pain, felt just behind the ribs and spreading through to your back. The pain, which usually comes on over about an hour, can be severe. Other symptoms include nausea, vomiting and fever.

Most cases come on quickly and usually go away quickly, leaving no permanent damage.

However, one in five cases are severe. Other organs can be damaged by pancreatic enzymes getting into your bloodstream during an attack. This can lead to serious illness, such as kidney or respiratory failure, and can be fatal. About 25% of people who develop severe acute pancreatitis die.

Each year, in the UK , between five and 80 people in every 100,000 are diagnosed with acute pancreatitis.

Chronic pancreatitis is when your pancreas is constantly inflamed. Heavy drinking, usually over a period of 10 years or more, is the cause of about eight out of 10 cases of chronic pancreatitis. However, the condition can also be hereditary. Men between the ages of 40 and 50 are most commonly affected.

The main symptom of chronic pancreatitis is also abdominal pain that is felt behind the ribs and goes all the way through to your back. It is a recurrent pain, which can be mild initially, but can become severe for some people. Weight loss is common for people with chronic pancreatitis.

Approximately three to nine in every 100,000 people in the UK develop chronic pancreatitis every year.

How does alcohol cause pancreatitis?

A strong link exists between heavy drinking and pancreatitis. Alcohol can trigger the pancreas to become inflamed and its cells become damaged, impeding its digestive function and causing pain.

However, the exact process through which alcohol causes both the acute and chronic versions of the disease is unclear.
• A University of Liverpool study concluded that acute pancreatitis occurs because alcohol acts as a stimulant for the pancreas to produce fatty acids and other fatty substances. These substances can destroy cells and stop energy production in the pancreas.