Drug Misuse Nhs Choices

Date created : 24/11/2010
Drug misuse
Introduction
A drug is a chemical substance that acts on the brain and nervous system, changing a persons
mood, emotion or state of consciousness.
Drugs are often classified by the effect they have.
O Stimulants, such as cocaine, make people feel full of energy.
O Depressants (or sedatives), such as heroin, make people feel relaxed.
O Hallucinogens, such as LSD, make people see, feel or hear things that are not real.
Drug misuse is when a person regularly takes one or more drugs to change their mood, emotion or
state of consciousness.
Addiction
ne of the biggest risks of drug misuse is that you can develop a drug addiction. There are two main
types of drug addiction:
O Physical addiction, when there are withdrawal symptoms, such as nausea, vomiting or
cramping, if the supply of the drug is suddenly withdrawn.
O Psychological addiction, when there is a psychological compulsion or need to regularly use a
drug. f the drug is withdrawn, there are no physical symptoms but there may be psychological
symptoms such as depression, anxiety and irritability.
LegaI drugs
&nder British law, most drugs are illegal. However, some drugs are legal, including:
O caffeine
O alcohol
O cigarettes
f a drug is legal, that does not mean it is harmless. n England each year, cigarettes and alcohol kill
more people than all illegal drugs put together.
Prescription medication, such as strong painkillers or tranquillisers, is often misused by people who
have no clinical need for it but use it for its mood-altering effects.
n many cases, it is illegal to posses certain types of prescription medication, such as morphine or
methadone, without a valid prescription.
Risks to heaIth
As well as the danger of addiction, drug misuse has serious health risks and is associated with a
wide range of conditions and complications, both physical and psychological.
For example, cocaine can cause heart failure and heroin can cause respiratory failure (loss of normal
lung function), both of which can be fatal. Each year in England and Wales, an estimated 2,000


deaths are caused by illegal drug abuse.
f a person uses a needle to inject drugs, they have a high risk of catching a serious blood-borne
infection, such as HV or hepatitis C.
The Department of Health estimates that, in England, 90% of all cases of hepatitis C and 6% of all
HV cases are caused by injecting drugs.

Facts about drug misuse
Drugs and the Iaw
n England, the Misuse of Drugs Act is the main law that covers illegal drugs.
&nder the terms of the Misuse of Drugs Act, drugs are classified as A, B or C, with class A being the
most dangerous and class C being the least dangerous (although class C drugs can still pose a
serious risk to your health).
Examples of class A drugs include:
O heroin,
O cocaine, and
O ecstasy.
Examples of class B drugs include:
O cannabis,
O most amphetamines (see below for more information), and
O barbiturates (a type of sedative).
Examples of class C drugs include:
O ketamine,
O Gamma hydroxybutyrate (GHB), and
O tranquillisers.
The following activities are offences under the Misuse of Drugs Act:
O possessing a controlled substance (a controlled substance can either be an illegal drug or a
prescription drug, such as morphine, for which you do not have a valid prescription),
O possessing a controlled substance with intent to supply,
O supplying or offering to supply a controlled substance (even if you do not ask for any money),
and
O allowing a premises you occupy or manage to be used unlawfully for producing or supplying
controlled substances.
PenaIties
For class A drugs, the penalties are:
O For possession: up to seven years in prison or an unlimited fine, or both.
O For dealing: up to life in prison or an unlimited fine, or both.
For class B drugs, the penalties are:


O For possession: up to five years in prison or an unlimited fine, or both.
O For dealing: up to 14 years in prison or an unlimited fine, or both.
For class C drugs, the penalties are:
O For possession: up to two years in prison or an unlimited fine, or both.
O For dealing: up to 14 years in prison or an unlimited fine, or both.
Driving under the influence of drugs is illegal and carries similar penalties to drink driving.
Pattern of iIIegaI drug misuse in EngIand
llegal drug misuse is widespread in England. The Home ffice estimates that:
O one in three people have used illegal drugs at least once in their life,
O one in 10 people have used illegal drugs in the last year, and
O one in 20 people have used illegal drugs in the last month.
The most commonly misused illegal drugs in England are outlined below.
Cannabis
Cannabis comes from a plant that is found in most parts of the world. t is a class B drug and it comes
in two forms:
O Herbal cannabis (often known as weed or grass) is made up of the dried leaves and buds of
the cannabis plant.
O Cannabis resin (often known as gear or hash) is a brown or black lump of resin that is taken
from the cannabis plant.
Cannabis is usually smoked, either mixed with tobacco in a hand-rolled cigarette (joint) or by itself in
a pipe.
&sing cannabis can make you feel relaxed and happy and many users feel that they have a
heightened sense of awareness. Adverse reactions associated with cannabis use include:
O paranoia, and
O anxiety.
Amphetamines
Amphetamines are a group of synthetic (artificial) drugs that are powerful stimulants. They are often
known as speed, billy or wizz.
Amphetamines usually come as a powder, which can be snorted through the nose, rubbed into the
gums or wrapped in a cigarette paper and swallowed (speedbomb).
Some amphetamines are available in tablet form. There is also a very strong smokeable form of
amphetamine known as crystal meth. Amphetamines can be injected.
Shortly after taking amphetamines, you will experience a rush (a sudden energy boost) and feel very
energetic, talkative and excited. This rush, or high, will usually last between four and eight hours,
depending on the amount of amphetamines taken.
nce the effects of the amphetamines have worn off, you will experience what is known as a crash,
or comedown, and will feel:


O very tired but unable to sleep,
O anxious,
O irritable, and
O depressed.
These effects can last for several days.
Most amphetamines are class B. Crystal meth and amphetamines that have been prepared for
injection are class A.
Cocaine
Cocaine is a stimulant that is extracted from the coca plant. t is often known as coke or charlie.
Cocaine comes in powder form and can be snorted or rubbed into the gums. There is a form of
smokable cocaine that is often called crack. Crack is also known as rocks or base.
People who take cocaine will experience an intense feeling of wellbeing, self-confidence and energy.
These feelings may only last for 20 to 30 minutes, which often leads people to take more cocaine.
The effects of crack are more intense than cocaine, but they do not last as long. Typically, a crack
high will only last for 10 minutes.
nce a person has used up their supply of cocaine or crack, their high will soon end and they may
feel very depressed, tired and paranoid.
Both cocaine and crack are class A drugs.
Ecstasy
Ecstasy is a class A drug. t is a synthetic (artificial) stimulant that is popular among clubbers. The
chemical name is methylenedioxymethamphetamine (MDMA). Ecstasy is often known as pills or E.
Ecstasy usually comes as a tablet. Less commonly, a powdered form of MDMA used.
People who take ecstasy often experience a rush of energy that makes them feel alert, excited and
happy. Sound, particularly music, and colours seem more intense and many people feel an
increased sense of affection for people around them.
The ecstasy high usually lasts three to six hours, after which it is replaced by a comedown similar to
that experienced after taking cocaine or amphetamines.
HaIIucinogens
n England, the two most commonly used hallucinogens are:
O magic mushrooms, and
O lysergic acid diethylamide (LSD).
Magic mushrooms grow in the wild and have hallucinogenic properties. They are sometimes known
as shrooms or mushies.
Magic mushrooms can either be eaten or boiled in liquid, which is then drunk.
LSD is a synthetic (artificial) liquid that is usually dropped on to small squares of blotting paper, which
are then swallowed. LSD is often known as acid.
The effects of magic mushrooms and LSD are similar, but LSD tends to cause more intense,


longer-lasting effects.
People who take magic mushrooms or LSD will experience a long-lasting series of hallucinations,
known as a trip.
During a trip, sounds and colours can become distorted, emotions can become heightened and time
can appear to both speed up and slow down.
A magic mushroom trip tends to last between four and 10 hours. An LSD trip lasts for about 12 hours.
Some people who take hallucinogens experience frightening and disturbing hallucinations. This is
known as a bad trip. Bad trips can be intensely unpleasant.
Both magic mushrooms and LSD are class A drugs.
TranquiIIisers
Tranquillisers are class C drugs. They are prescription medication designed to treat anxiety,
depression and insomnia.
Many people misuse tranquillisers to lessen the effects of a comedown after taking stimulants as
they can have a calming and sedating effect. Alternatively, some people may use them to ease drug
withdrawal symptoms.
Tranquillisers come as tablets, gel capsules, in injection form and as suppositories (tablets that you
insert into the anus).
Tranquillisers are often known as mazzies, benzos or jellies.
t is possible to accidentally overdose on tranquillisers, particularly if they are taken with alcohol.
SoIvents
Solvents are household chemicals. Some people, particularly teenagers, abuse them by sniffing
the fumes they give off.
There are over 200 different types of solvent. Some common household solvents include:
O glue,
O hairspray,
O lighter re-fillers,
O paint,
O deodorants, and
O cleaning fluids.
When inhaled, solvents have an effect that is similar to being drunk, such as feeling giddy,
uninhibited and giggly.
Solvent abuse is potentially very dangerous because it can cause heart failure.
Although solvents are not illegal, it is illegal to sell certain solvent products to people under 18.
Ketamine
etamine is a class C drug and a powerful synthetic anaesthetic. t comes in a powdered form that
can be snorted or as a liquid that can be injected. t is often known as special or vitamin .
People who use ketamine experience LSD-like hallucinations and often report feeling that their mind


is floating outside their body.
etamine abuse has been linked to an increased risk of depression, panic attacks and bladder
problems, such as having to pass urine every 15 minutes.
Heroin
Heroin is a class A drug. t is a powerful painkiller and sedative that is derived from the opium poppy.
Drugs, such as heroin and codeine, that are derived from the opium poppy are called opiates.
Heroin comes as a powder and can be smoked or dissolved in water and injected. t is often known
as brown, smack or skag.
People who use heroin experience an intense feeling of relaxation and wellbeing. Heroin is highly
addictive, both physically and psychologically.
Heroin carries a high risk of overdose. This is because the purity of heroin can vary dramatically
between different batches of the drug, so people often take a stronger dose of heroin than their body
can cope with.
Other drugs
For more information about drugs that are not included in this section, visit the FRAN website.
Risks of drugs misuse
Drug misuse can be dangerous for three main reasons:
O you could become addicted to the drug,
O the drug could cause physical and psychological harm, and
O drug abuse can have a negative effect on your quality of life.
Addiction
How addictive a drug is likely to be is determined by two things:
O how pleasurable taking the drug is, and
O how quickly the drug reaches your brain.
Drugs that are smoked, injected or snorted can reach the brain very quickly and are usually more
addictive than drugs that are swallowed.
n 2007, the medical journal The Lancet commissioned a number of drug experts to asses how
potentially addictive the most popular illegal drugs are. The results, in order of addictiveness with the
most addictive at the top, were:
O Heroin.
O Cocaine.
O Tranquillisers.
O Amphetamines.
O etamine.
O Cannabis.
O Hallucinogens.
O Ecstasy.


PhysicaI and psychoIogicaI harm
Cannabis
The short-term effects of cannabis include:
O dizziness and sickness,
O dry mouth, lips and tongue,
O panic and paranoia (when you are suspicious of people and situations),
O feeling hungry, and
O loss of co-ordination.
Long-term effects of regular cannabis use include:
O lung disease and lung cancer,
O respiratory problems, such as bronchitis and asthma,
O high blood pressure (hypertension), and
O infertility.
There is some evidence that long-term cannabis use can increase your risk of mental health
conditions, such as depression and schizophrenia.
Amphetamines
Amphetamine use can lead to:
O short-term dizziness,
O hallucinations,
O burst blood vessels that, in very rare cases, can lead to paralysis (muscle weakness) and may
be fatal,
O insomnia, and
O depression.
As your body becomes more tolerant to the drug, larger amounts are needed to get the same effect.
This increases both the risks to your health and the chance of becoming addicted.
Cocaine and crack
Cocaine raises blood pressure, causes the heart to beat irregularly and increases body temperature.
As well as causing heart failure when taken in large doses, the long-term use of cocaine can lead to:
O depression,
O insomnia,
O extreme paranoia,
O extreme weight loss and malnutrition,
O impotence in men, and
O serious damage to the nasal passages.
Because cocaine is so addictive, users experience withdrawal symptoms, such as intense irritability
and restlessness, if they go for longer than usual without taking it. This period of time becomes
shorter and shorter as the body becomes more tolerant to the drug, and larger quantities are required
to experience a high. As the effects of the drug wear off, users will get symptoms such as exhaustion
and depression.


Women who use cocaine while pregnant put the health of their baby at risk because the drug can
cause low birth weight and birth defects. Their baby may also be born addicted to cocaine.
Ecstasy
Very few ecstasy tablets are pure ecstasy. Most contain other substances, such as talcum powder.
Some ecstasy tablets have even been found to contain dog-worming medicine. More dangerous
substances, including anaesthetics and tranquillisers (such as ketamine), may also be added to
ecstasy tablets.

Dehydration is a major risk when taking ecstasy. Ecstasy raises your bodys temperature and the
amphetamine contained in each tablet encourages you to behave energetically for long periods of
time, for example by dancing in a club all night.
f your fluid levels drop dramatically, dehydration can cause unconsciousness, coma and even death.
n England and Wales, there are an average of 27 deaths a year from people taking ecstasy.
f you take large amounts of ecstasy, you may experience feelings of anxiety, panic and confusion
and it can be difficult for other people to calm you down. ther unpleasant side effects include:
O dry mouth,
O nausea,
O raised blood pressure, and
O depression.
Some users say that their body stiffens after taking ecstasy, often causing them to clench their jaw
and grind their teeth. Another common symptom is an increased heart rate, which can feel like your
heart is pounding or hammering in your chest.
The use of ecstasy became widespread during the late 1980s, so it is too early to know whether
regular users, or those who used to use the drug regularly, will experience long-term side effects.
TranquiIIisers
Many tranquillisers are addictive if they are used regularly. Tranquillisers are physically addictive, so
you may have withdrawal symptoms if your supply is stopped suddenly.
Withdrawal symptoms can include:
O severe headache,
O nausea,
O anxiety, and
O confusion.
Some people who abuse tranquillisers try to inject crushed-up tablets or melted-down gel
capsules to increase the potency of the drug.
This can be very dangerous because the chalk contained in many tablets can cause veins to
collapse. This can lead to serious infections and, in the most extreme cases, the death of tissue
(gangrene). Gel capsules that are melted down can sometimes solidify inside blood vessels, which
can be fatal.
SoIvents
Many solvents contain chemicals that have a toxic effect on the body, particularly the heart.


Every time you sniff a solvent, you are at risk of having a heart attack, which may be fatal. n the &,
there are an average of 50 deaths a year from solvent abuse.
ther adverse effects of solvent abuse include:
O vomiting,
O blackouts, and
O in the case of long-term abuse, liver, kidney and brain damage.
Ketamine
etamine is a powerful anaesthetic. t is possible to badly injure yourself during a ketamine high
without realising it as you will not feel any pain.
Mixing ketamine with stimulants, such as ecstasy or amphetamine, can cause a dangerous rise in
your blood pressure.
High doses of ketamine can suppress your normal brain and breathing functions and can cause you
to become unconscious. nce unconscious, there is a risk that you will choke on your own vomit.
There is an increasing amount of evidence that long-term ketamine misuse can cause serious
damage to your kidneys and bladder. This can lead to a range of unpleasant symptoms, such as:
O a frequent urge to urinate,
O pain when urinating,
O urinary incontinence, and
O blood in your urine.
HaIIucinogens
Hallucinogens are very unpredictable and it is possible to have a bad trip even if all your previous
trips have been enjoyable. A bad trip can feel like being trapped in a nightmare.
There is a risk that somebody may act irrationality or impulsively during a trip and place themselves
in physical danger, for example by suddenly running into a busy road.
While hallucinogens are not thought to cause mental heath problems, they could make an existing
mental health condition more severe.
With magic mushrooms, there is a risk that you or your supplier may mistake poisonous mushrooms
for magic mushrooms. Mushroom poisoning can be very serious and is often fatal.
Heroin
Most heroin that is bought on the street is only 1060% pure. t is usually mixed with other substances
to increase the quantity and to make it more profitable. t is often the substances that are used to bulk
up heroin that are the most harmful, causing allergic or toxic reactions. &sers can never be sure that
the heroin they buy has not been mixed with dangerous substances.
Because it is impossible to know how pure heroin is, it is easy for the user to take an overdose.
verdosing on heroin can cause heart failure, unconsciousness and coma. There is also a risk that
the user will choke on their own vomit if they are sick while unconscious.
njecting heroin has additional risks. Sharing needles increases the risk of contracting serious
diseases, such as hepatitis C and HV. Long-term injecting may cause damage to veins, serious
infections, such as abscesses (pus-filled swellings), and severe constipation.


The wider impact of drug misuse
As well as the impact on your health, drug misuse can have a negative effect on your quality of life
and relationships with others.
Many drug abusers find that they lose touch with their family and friends or that their family and
friends lose patience with them due to their unreasonable behaviour.
Hobbies, interests and ambitions can be forgotten as drugs become more and more important. t can
become increasingly difficult to hold down a job if you have a drug problem.
People with a serious drug addiction, such as a heroin, cocaine or crack addiction, often resort to
desperate, illegal and dangerous activities to find money to pay for their drugs. Examples include:
O begging,
O burglary,
O shop-lifting,
O street crime, such as mugging or bag snatching, and
O prostitution.
Getting heIp for drug misuse
Getting heIp in an emergency
f a drug user is showing unusual symptoms or seems to be in distress, they may have had an allergic
reaction to a drug or they may have overdosed. Symptoms to look out for include:
O dizziness,
O sickness or nausea,
O sudden tiredness,
O headaches,
O muscle cramps and aches,
O irregular breathing,
O heavy slurring of speech,
O convulsions, and
O paralysis (muscle weakness).
f you think someone is having a reaction to a drug or has overdosed, take the following actions:
O f you are in a club or pub, get help from the staff straight away. Tell them what drugs have or
may have been taken. Most clubs and pubs have a member of staff who is trained in first aid.
They should stay with the person until medical help arrives.
O Call 999 and ask for an ambulance. Speak clearly and calmly. Tell the operator exactly where
the person is, what drugs they have taken and what symptoms they have. Listen carefully to
any advice given by the operator. You may need to give mouth-to-mouth resuscitation, put the
person into the recovery position or give other forms of life-saving treatment. You will need to
stay calm and keep a clear head.
O Make sure the persons airways are not obstructed. Look out for vomit blocking the airway and
check that the person has not swallowed their tongue.
O Collect evidence of any drugs that have been taken. This is vital to help doctors make a quick
diagnosis and provide the best possible treatment. Collect containers that drugs have been


kept in, including wrappers, packets, cling film, tin foil and syringes. f the person has been
sick, try to collect a small sample of vomit for analysis at the hospital.
HeIping yourseIf
The first and most difficult step for people who misuse drugs is to recognise that they have a problem,
and then admit that they need help to deal with it.
Some people realise that they have a problem but find it hard to stop taking the drug, even though
they are aware of the consequences. thers may need someone else to help them realise that they
have a problem.
Signs that a person may have a drug problem or addiction include:
O continually increasing the dose of drugs to get the same effect,
O a feeling of dependency on drugs or a fear of stopping using drugs,
O withdrawal symptoms if they stop taking the drug for a short time,
O sudden mood changes,
O a negative or changed outlook on life,
O a loss of motivation,
O poor performance at work or college,
O problems with personal relationships,
O borrowing or stealing money from friends and family, and
O being secretive about activities and actions.
Next steps
See your GP as soon as you recognise you have a drug problem. They can give you advice and
support and refer you for specialist treatment. Be honest with your GP about your drug use and your
reasons for wanting to give it up. You may also want to tell close family and friends about your
decision and ask them for their support.
There are a number of organisations that offer information and advice, such as details of support
groups and meetings in your area. FRAN provides a free, confidential helpline that offers
information about drugs and drug abuse and is open 24 hours a day, seven days a week. Call 0800
776600 or go to the FRAN website.
Who to caII
The National Drugs Helpline is a free and confidential telephone helpline, offering information about
drugs and drug abuse. pen 24 hours a day, 7 days a week. Tel. 0800 77 66 00.
Recovering from drug misuse
There are two types of treatment for drug misuse:
O pharmacological treatment, where medication is used to ease drug withdrawal symptoms, and
O psychological treatment, where a range of different therapies are used to help you stay off
drugs.
PharmacoIogicaI treatments
Pharmacological treatments are only available for people with a heroin or tranquilliser addiction.
There are currently no pharmacological treatments for other types of drug.


Heroin
f you have a heroin addiction, there are two different medications that can ease your withdrawal
symptoms. These are:
O methadone, and
O buprenorphine.
Both medications are synthetic (artificial) opiates that replicate some of the effects of heroin on the
brain. The brain is tricked into thinking that it is receiving a dose of heroin, so you do not have
Methadone and buprenorphine can be used in two ways:
O withdrawal therapy, where the doses of medication are gradually reduced over time before the
treatment is withdrawn, and
O maintenance therapy, where you receive regular doses of medication on a long-term basis.
Many people choose to have maintenance therapy for several months so that their health and
general wellbeing can improve. nce they are physically and psychologically stronger, they choose
to withdraw from the treatment.
Because there is a possibility that a person may not use the medication as directed (for example, by
selling their methadone to others), you may have to take the medication under supervision. You may
also be required to have regular urine tests to check that you are not taking heroin.
NaItrexone
Naltrexone is a medication that can be used when you have not taken heroin for several weeks but
are worried that you may relapse and take heroin again.
Naltrexone blocks the effects of heroin on your brain, so even if you take heroin you will not
experience a high.
TranquiIIisers
Depending on how addicted you are, you may be prescribed a course of tranquillisers to ease your
withdrawal symptoms. The dose will gradually be reduced over time until treatment is withdrawn.
PsychoIogicaI treatments
SeIf-heIp groups
Many people who have a drug misuse problem join a self-help group, such as Narcotics Anonymous.
Most of these groups are based on a 12-step programme to overcome addiction (created by
Alcoholics Anonymous), which includes the following points:
O You admit that you are unable to control your addiction or compulsion.
O You recognise that you need a power greater than yourself to restore your strength.
O You examine past errors in your life with the help of a sponsor (an experienced member of the
group).
O You make amends for those errors.
O You learn to live a new life with a new code of behaviour.
O You help others who have the same addiction or compulsion.
Contingency management


Contingency management uses a series of techniques to change a persons behaviour. You will be
offered incentives, in the form of shopping vouchers, if you manage not to take drugs.
You will usually be given a 2 shopping voucher if urine tests show that you have not taken drugs for
a week. The longer you stay free from drugs, the more vouchers you will receive.
'It took a breakdown to reaIise I needed to stop the drugs'
Smoking cannabis can lead to cannabis psychosis, which causes you to lose touch with reality. Two
men describe how it happened to them.
'I'd snort cocaine before I got out of bed in the morning'
Even casual use of cocaine can soon lead to dependence. Two people describe how the drug nearly
ruined their lives.
AIcohoI misuse - information prescription
Introduction
Many people are able to stick to the recommended levels of alcohol consumption (see box) so that
drinking does not pose a threat to their health.
However, for some people, the amount of alcohol they drink means that they face a real risk of
developing alcohol-related problems. These problems may be:
O physicaI - such as heart disease
O psychoIogicaI - such as depression
O sociaI - such as committing domestic abuse or acts of violence
Drinking levels of alcohol that can cause these types of problems is known as alcohol misuse.
Signs of misuse
Signs that you may be misusing alcohol include:
O you have felt that you should cut down on your drinking
O other people have annoyed you by criticising your drinking
O you have felt guilty or bad about your drinking
O you have needed a drink first thing in the morning to steady your nerves or get rid of a
hangover
Signs that someone you know may be misusing alcohol include:
O they regularly exceed the recommended daily amount for alcohol
O they have been unable to remember what happened the night before as a result of their
drinking
O they have failed to do what was expected of them because of their drinking - for example,
missing an appointment because they were drunk or hungover


See Alcohol misuse - diagnosis for more information and an interactive screening tool.
Getting heIp
Treatments that can help people with an alcohol misuse problem include:
O counselling
O medication, which can help to reduce cravings for alcohol
O self-help groups - where people with alcohol misuse problems share their experiences with
each other in a supportive environment
f you are concerned about your level of drinking, or someone elses, a good first step is to visit your
GP, who will be able to discuss the services and treatments that are available.
The &s leading charities and support groups for people with alcohol misuse problems will also be
able to provide you with support and advice. For example, you may want to contact:
O Alcoholics Anonymous - their helpline number is 0845 769 7555
O Alcohol Concern - who run the national drink helpline called Drinkline; their number is 0800
917 8282
See Alcohol misuse - treatment for more information and advice.
How common is aIcohoI misuse in EngIand?
Alcohol misuse is widespread in England. ne third of men and one sixth of women drink alcohol at
a level that is dangerous to their health.
n 2007 in England, there were 863,000 alcohol-related hospital admissions and 6,541 deaths that
were directly related to alcohol misuse. Most of these deaths were a result of alcoholic liver disease.
The actual number of deaths caused by alcohol misuse is much higher than those reported. This is
because alcohol misuse is a major risk factor for a range of life-threatening diseases such as:
O heart disease
O stroke
O cancers, such as liver cancer and bowel cancer
OutIook
More than half of people who receive treatment for alcohol misuse will either reduce their drinking to
a safer level than what is was previously, or give up drinking altogether.
AIcohoI units
Alcohol is measured in units. The recommended daily limits for alcohol consumption are:
O no more than three to four units a day for men
O no more than two to three units a day for women
A unit of alcohol is roughly half a pint of normal-strength lager, a small glass of wine or a single
measure (25ml) of spirits.
For more information on alcohol units see Alcohol misuse definition
Defining a drink probIem


Recommended amount of aIcohoI
The amount of alcohol contained in any alcoholic drink is measured in units. A unit is equivalent 10ml
of pure alcohol.
The recommended daily limits for alcohol consumption are:
O no more than 3-4 units per day for men
O no more than 2-3 units per day for women
f you regularly exceed the recommended daily limits, you are putting your health at risk.
Pregnant women and women trying to conceive should avoid drinking alcohol. f they do choose to
drink, they should not drink more than 1-2 units of alcohol once or twice a week and should avoid
getting drunk.
How to measure units
Any drink that you buy will contain a measurement of its alcohol by volume (ABV). ABV is a
measurement of how much of that drink is made up of pure alcohol.
The easiest way to work out how many units of alcohol a drink provides is:
O find out what the drinks ABV is
O then multiply that by how many millilitres of liquid are in the drink
O then divide that by 1,000
So for a standard pint of strong lager:
O its ABV would be 5%
O a pint contains 568ml
O 5 times 568 equals 2,840
O divide that by 100, to give a measurement of 2.8 units
The units found in some standard drink sizes are listed below:
O a can of standard lager, beer, bitter 1.8 units
O a can of strong lager, beer, bitter 2.2 units
O a pint of standard lager, beer, bitter 2.3 units
O a pint of strong lager, beer, bitter 2.8 units
O a small glass of wine (125ml) 1.5 units
O a large glass of wine (250ml) 3 units
O a bottle of alcopops 1.4 units
O a glass of spirits (25ml) 1 unit
O a bottle of wine 9 units
O a one litre bottle of standard cider 4 units
O a one litre bottle of strong cider 9 units
O a 700ml bottle of spirits 27-28 units
Types of aIcohoI misuse
There are three main types of alcohol misuse:
O hazardous drinking


O harmful drinking
O dependent drinking
Hazardous drinking
Hazardous drinking is defined as when a person drinks over the recommended weekly limit (21 units
for men and 14 units for women).
t is also possible to drink hazardously by binge drinking, even if you stick within your weekly limit.
Binge drinking is when you drink an excessive amount of alcohol in a short space of time eight units
in a day for men, six units in a day for women. For more information, see the Live Well section on
binge drinking
f you are drinking hazardously, you may not yet have any health problems directly related to alcohol,
but you are increasing your risk of experiencing problems in the future.
Hazardous drinking, especially binge drinking, also carries additional risks such as:
O being involved in an accident
O becoming involved in an argument or fight
O taking part in risky or illegal behaviour when drunk such as drink driving
HarmfuI drinking
Harmful drinking is defined as when a person drinks over the recommended weekly amount and has
experienced health problems directly related to alcohol.
n some cases, these problems may be obvious, such as:
O depression
O alcohol-related accident
O acute pancreatitis (inflammation of the pancreas)
Many of the health problems caused by harmful drinking do not cause any symptoms until they reach
their most serious stages, such as:
O high blood pressure
O cirrhosis (scarring of the liver)
O some types of cancer, such as mouth, liver, bowel and breast cancer
O heart disease
So it can be easy to underestimate the levels of physical damage caused by harmful drinking.
Harmful drinking can also cause related social problems such as:
O difficulties with your partner or spouse
O difficulties with family and friends
O problems at work or college
Dependent drinking
Alcohol is both physically and psychologically addictive and it is possible to become dependent on
alcohol.
Dependent means that a person feels that they are unable to function without alcohol and the
consumption of alcohol becomes an important or sometimes the most important factor in their life.


Depending on the level of dependence, a person can experience withdrawal symptoms if their supply
of alcohol is suddenly stopped. Withdrawal symptoms can be both physical and psychological.
Physical withdrawal symptoms include:
O hand tremors (the shakes)
O sweating
O nausea
O visual hallucinations (seeing things that are not actually real), and, in the most serious of
cases
O seizures (fits)
Psychological withdrawal symptoms include:
O depression
O anxiety
O irritability
O restlessness
O insomnia
Moderately dependent drinkers do not usually experience withdrawal symptoms, or withdrawal
symptoms are mild to moderate.
Severely dependent drinkers do experience withdrawal symptoms, which are usually severe. Most
severely dependent drinkers fall into a pattern of relief drinking, where they drink to avoid or counter
Severely dependent drinkers usually have an extremely high tolerance to alcohol, and are able to
drink amounts that would incapacitate or even kill most other people.
Diagnosing aIcohoI misuse
f you visit your GP because you are concerned about your drinking, or you come into contact with
another health professional due to an alcohol-related injury or illness, it is likely that they will want to
assess the extent and pattern ofyour alcohol abuse.
This is usually done by using a screening test that consists of a series of questions. t is important to
be truthful when responding to the questions. Your GP and/or other health professionals are not
trying to judge you, they are simply trying to ensure you receive the appropriate treatment.
AIcohoI Use Disorders Identification Test (AUDIT)
ne widely used screening test is the Alcohol &se Disorders dentification Test (A&DT). There is an
interactive version of the A&DT test on the left of this page that you may wish to try.
Fast AIcohoI Screening Test (FAST)
A simpler test that you can use to check if your drinking has reached hazardous levels is known as
the Fast Alcohol Screening Test (FAST).
FAST consists of four questions, which are reproduced below.
1. How often do you drink eight or more units (men) or six or more units (women) on one occasion:
O never if this is your answer you can stop the test


O less than monthly score 1
O monthly score 2
O weekly score 3
O daily or almost daily score 4
2. How often during the last year have you been unable to remember what happened the night before
because you had been drinking:
O never 0
O less than monthly 1
O monthly 2
O weekly 3
O daily or almost daily 4
3. How often during the past year have you failed to do what was normally expected of you because
you had been drinking:
O never 0
O monthly 2
O weekly 3
4. n the last year has a relative or friend, or a doctor or other health worker been concerned about
your drinking or suggested that you cut down:
O no 0
O yes, on one occasion 1
O yes, on more than one occasion 2
A FAST score of 3 or more would usually suggest that you are drinking at a hazardous level.
Risks of aIcohoI misuse
Alcohol is a powerful chemical that can have a wide range of effects. As alcohol can easily pass
through the walls of human cells, once it is in your blood it can reach almost every part of the body,
from your brain to your bones to your heart.
The effects of alcohol can be both short term and long term. Similarly, the risks of alcohol can also be
both short and long term.
Short-term effects of aIcohoI
The short-term effects of alcohol are described below. This information is based on the assumption
that you have a normal tolerance for alcohol. Dependent drinkers with a higher tolerance to alcohol
can often drink much more without experiencing any noticeable effects.
1-2 units
After drinking 1-2 units of alcohol, your heart rate will speed up and your blood vessels will expand,
giving you the warm, sociable up and talkative feeling that is associated with moderate drinking.
4-6 units


After drinking 4-6 units of alcohol, your brain and nervous system will start to be affected. t will start
to dampen the part of your brain that is associated with decision making and judgement, making you
more reckless and uninhibited.
The alcohol will also impair the cells in your nervous system, making you feel lightheaded while also
adversely affecting your reaction time and co-ordination.
-9 units
After drinking 8-9 units of alcohol, your reaction times will be much slower, your speech will begin to
slur, and your vision will begin to lose focus. Your liver (which the body uses to filter alcohol out of the
body) will be unable to remove all of the alcohol overnight, so it is likely you will wake with a
hangover.
10-12 units
After drinking 10-12 units of alcohol, your co-ordination will be seriously impaired, placing you at high
risk of having an accident. The high levels of alcohol will have a depressant effect on your body and
mind, making you feel drowsy.
f you have this amount of alcohol in your body, it will begin to reach toxic levels. Your body will
attempt to quickly pass out the alcohol with your urine. However, this will leave you feeling badly
dehydrated in the morning, which, in turn, may cause a severe headache.
The excess amount of alcohol in your system can also upset your digestive system, leading to
symptoms of nausea, vomiting, diarrhoea, and indigestion.
More than 12 units
Drinking more than 12 units of alcohol will place you at a high risk of developing alcohol poisoning,
particularly if you are drinking lots of units in a short space of time. t usually takes the liver about one
hour to remove one unit of alcohol from the body.
Alcohol poisoning occurs when excessive amounts of alcohol begin to interfere with the automatic
functions of your body such as:
O your breathing
O your heart rate
O your gag reflex which prevents you from choking
Alcohol poisoning can result in coma and death.
Short-term risks of aIcohoI misuse
The short-term risks of alcohol misuse include:
O accidents and injury it is estimated that 70% of all visits to accident and emergency (A&E)
departments at peak times are due to alcohol misuse
O invoIvement in vioIence and antisociaI behaviour in England each year, around 1.2
million violent incidents are linked to alcohol misuse
O practicing unsafe sex which can lead to unplanned pregnancies and sexually transmitted
infections (STs)
O Ioss of personaI possessions many people lose personal possessions, such as their wallet
or phone, when they are drunk


O unscheduIed time off work or coIIege which could put your education, or job, at risk
Long-term effects of aIcohoI misuse
f you drink hazardous amounts of alcohol for many years, the cumulative effect of the alcohol will
have a toxic effect on many of your bodys organs, which may result in organ damage.
The organs that are known to be damaged by long-term alcohol misuse include:
O the brain
O the liver
O the pancreas
Heavy drinking can also increase your blood pressure and your blood cholesterol levels, both of
which are major risk factors for heart attacks and strokes.
Long-term alcohol misuse can weaken your immune system, making you more vulnerable to serious
infection. t can also weaken your bones, placing you at greater risk of fracturing, or breaking, them.
Long-term risks of aIcohoI misuse
The long-term health risks of alcohol misuse include:
O high blood pressure (hypertension)
O stroke
O heart disease
O pancreatitis
O liver disease
O liver cancer
O cancer of the mouth or neck
O breast cancer
O bowel cancer
O depression
O dementia
O sexual problems, such as impotence or premature ejaculation
O infertility
The long-term social risks of alcohol misuse include:
O divorce
O family break-up
O domestic abuse
O unemployment
O homelessness
O financial problems
AIcohoI poisoning
The symptoms of alcohol poisoning include:
O confusion
O vomiting
O seizures (fits)


O slow breathing (less than eight breaths a minute)
O pale, bluish skin
O cold and clammy skin
O unconsciousness (from which the person cannot be roused)
If you suspect aIcohoI poisoning, you shouId diaI 999 and ask for an ambuIance.
While you are waiting for the ambulance to arrive you should:
O not try to make the person vomit, as their gag reflex will be impaired, which means that they
could choke on their own vomit
O turn the person on to their side and place a cushion under their head in order to help prevent
them choking on their own vomit
If someone Ioses consciousness after drinking aIcohoI, you shouId never Ieave them aIone
to sIeep it off, even if they appear to be breathing normaIIy. The IeveIs of aIcohoI in a persons
bIood can continue rising for up to 30-40 minutes after a persons Iast drink, and this couId
cause their symptoms to suddenIy worsen.
What happens with a hangover?
Alcohol has a diuretic effect, which means that the body loses too much water and causes
dehydration. This effect can be made worse by congeners (substances that are found in all alcoholic
drinks to give a distinct flavour, but which can be more concentrated in dark drinks). Alcohol also
stimulates the production of insulin, which reduces blood sugar levels and causes drowsiness,
weakness, trembling, faintness and hunger.
Treating aIcohoI dependency
Hazardous drinking
f you are concerned that you are drinking hazardous amounts of alcohol it is likely that you will be
referred to a short counselling session, known as a brief intervention.
You may also be invited to a brief intervention if you experience an alcohol-related injury or illness,
which could suggest your drinking is at hazardous levels.
A brief intervention lasts around 10-15 minutes and usually consists of a series of steps.
Firstly, the counsellor will provide feedback on the short-term and long-term risks associated with
your individual pattern of drinking, while emphasising that it is your responsibility to reduce that risk.
Then the counsellor will provide advice on ways you can reduce your alcohol consumption. For
example, you may be told to keep a drink diary so you can accurately record how many units of
alcohol you drink a week, and then try to lower the amount.
f most of your drinking is done on a social basis, the counsellor can provide advice on how you can
continue to socialise while reducing your alcohol consumption, such as alternating alcohol with soft
drinks, or choosing low-alcohol drinks such as spritzers or low-strength lager.
Then the counsellor will discuss what additional support is available for you if you require it, such as
self-help groups or specialist alcohol services.
The session will end with the counsellor discussing any emotional issues you may feel about trying to
reduce your drinking, such as apprehension or anxiety, while providing support about how to cope


better with these emotions.
HarmfuI drinking
f you are drinking harmful amounts of alcohol you will first have to make the decision whether you
want reduce your alcohol intake to a moderate level (moderation) or quit alcohol altogether
(abstinence).
bviously, abstinence will have a greater health benefit, though often moderation is a more realistic
goal, or at least, a first step on the way to abstinence.
&ltimately the choice is yours, though there are circumstances where abstinence is strongly
recommended. These are:
O if you have liver damage
O if you have other medical problems that can be made worse by drinking, such as heart trouble
O if you are taking medication that can react badly or unpredictably with alcohol, such as
antipsychotics
O if you are pregnant or are planning to become pregnant
Abstinence may also be recommended if you have previously tried to achieve moderation and failed.
f you do choose moderation as a treatment goal you will usually be referred to a counselling session
that is known as an extended brief intervention. This is similar to a brief intervention, but slightly
longer and more in-depth.
You will probably be asked to attend further sessions so your progress can be monitored and further
treatment and advice provided if necessary.
You may also receive regular blood tests so the state of your liver can be carefully monitored.
See below for information on available treatments to achieve abstinence.
Dependent drinking
As with harmful drinking, you will need to choose between moderation and abstinence.
Moderation may be a realistic goal for people with mild to moderate dependency. Abstinence would
usually be recommended for people with moderate to severe dependency.
Treatment to achieve moderation is carried out in much the same way as for harmful drinking.
Whatever your level of dependency, it is recommended that you spend a period of time free from
alcohol, so your body can recover from its effects, and, in cases of moderate to severe dependency,
you can break the cycle of drinking alcohol to avoid withdrawal symptoms. This is known as
detoxification or detox.
Detoxification
How and where you attempt detoxification will be determined by your level of alcohol dependency.
f your level of dependency is low to moderate you should be able to detox at home without the use of
medication, as your withdrawal symptoms should be mild.
f your level of dependency is moderate to severe and your consumption of alcohol is high (over 20
units a day) and/or you have previously experienced withdrawal symptoms, you should be able to
detox at home though you will be given the option of taking medication to help ease withdrawal


symptoms. A tranquiliser called chlordiazepoxide is usually used for the purpose.
f your levels of dependency are severe it is usually recommended that you are admitted to a hospital
or clinic to detox. This is because there is a risk you could experience more-severe withdrawal
symptoms, such as seizures and hallucinations, and may require specialist treatment.
You will find that the withdrawal symptoms are at their worst for the first 48 hours. The symptoms
should then gradually improve as your body begins to adjust to being without alcohol. This usually
takes between three and seven days from the time of your last drink.
You will also find that your sleep is disturbed you may wake often during the night, or have problems
going to sleep. This is to be expected, and your sleep patterns should return to normal within a
month.
During detox you should drink plenty of fluids approximately three litres a day. Avoid drinking
excessive amounts of tea or coffee as this can make sleep problems worse and cause feelings of
anxiety. Water or fruit juice would be a better choice.
You should try to eat regular meals even if you are not feeling hungry. Your appetite will return
gradually.
f you are taking medication to ease withdrawal symptoms, then you should not drive or operate
heavy machinery as the medication will probably make you feel drowsy. nly take your medication
as directed.
Detox can be a stressful time. Ways you can try to relieve stress include listening to music, going for
a walk or taking a bath.
f you are detoxing from home you will receive regular visits from a health visitor, and be given the
relevant contact details for other support services, should you require additional support.
Abstinence
There are a number of different treatment options available to help you achieve abstinence.
Treatment options often differ in effectiveness depending on the individual, so if you feel that a
certain treatment option is not working for you, then you should discuss alternative options with your
care team and/or your GP.
Medication
There are currently two licensed medications that can be used in the treatment of alcohol misuse:
O acamprosate
O disulfiram
Acamprosate
Acamprosate (brand name Campral) is used to help prevent relapse in people who have successfully
achieved abstinence from alcohol. Acamprosate is usually used in combination with counselling.
Acamprosate works by affecting levels of a chemical in the brain known as gamma-amino-butyric
acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.
Side effects of acamprosate include:
O nausea
O vomiting


O itchy skin
DisuIfiram
Disulfiram (brand name Antabuse) is a medication that can be used if you are trying to achieve
abstinence but are concerned that you may relapse, or have experienced previous relapses.
Disulfiram works by causing a series of extremely unpleasant physical reactions if you drink any
alcohol, such as:
O nausea
O chest pain
O vomiting
O dizziness
The unpleasantness associated with these reactions should deter you from drinking any more
alcohol.
Aside from alcoholic drinks, it is important to avoid all sources of alcohol as these could also induce
an unpleasant reaction. Products that may contain alcohol include:
O aftershave
O mouthwash
O some types of vinegar
O perfume
You should also steer clear of substances that give off alcoholic fumes, such as paint thinners and
solvents.
You will continue to experience unpleasant reactions if you come into contact with alcohol for a week
after you finish taking disulfiram, so it is important to maintain your abstinence during this time.
Side effects of disulfiram include:
O drowsiness
O fatigue
O nausea
O bad breath
CounseIIing
SeIf-heIp groups
Many people with a dependence on alcohol find it useful to attend self-help groups, the best known of
which is Alcoholics Anonymous.
Alcoholics Anonymous believes that alcoholic dependence is a chronic and progressive incurable
disease for which total abstinence is the only solution.
Alcoholics Anonymous is based on a programme of 12 steps designed to help overcome addiction,
and which include the following points:
O you admit that you are powerless over alcohol and your life has become unmanageable
O you recognise that you need a power greater than yourself to restore your strength
O you examine past errors in your life with the help of a sponsor (an experienced member of the
group)


O you make amends for those errors
O you learn to live a new life with a new code of behaviour
O you help others who have an alcohol dependence
For a full list of useful organisations, see Alcohol support
TweIve-step faciIitation therapy
Twelve-step facilitation therapy is based on the programme devised by Alcoholics Anonymous,
except you work through the stages one-on-one with a counsellor, rather than as a group.
Twelve-step facilitation therapy may be a preferred treatment option if you feel uneasy or unwilling to
discuss your problems in a group setting.
Cognitive behaviouraI therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy that emphasises a problem-solving
approach to alcohol dependence.
CBTs approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs
that may be contributing towards your alcohol dependence, such as:
O ' cannot relax without alcohol
O My friends would find me boring if was sober
O Just drinking one pint cant hurt
nce such thoughts and beliefs are identified, you will be asked to base your behaviour on more
realistic and helpful thoughts, such as:
O Lots of people have a good time without alcohol, and can be one of them
O My friends like me for my personality, not for my drinking
O know cannot stop drinking once start
CBT also helps you identify triggers that can cause you to drink such as:
O stress
O social anxiety
O being in high-risk environments such a pub, club or restaurant
The therapist will then teach you how to avoid those triggers that can be avoided, and cope
effectively with triggers that are unavoidable.
FamiIy therapy
Alcohol dependence does not just impact on an individual, it can also affect a whole family.
Family therapy provides the opportunity for family members to:
O learn about the nature of alcohol dependence
O provide support to the family member who is trying to abstain from alcohol
Tips
O Replace some of your drinks with non-alcoholic or low alcohol drinks
O f you drink mainly when you go out, try going out later or having your first drink later
O f you drink mainly at home, trying buying non-alcoholic alternatives
O Buy smaller glasses and watch how much you pour


O f you use alcohol to wind down after a hard day, find alternatives such as exercise classes or
relaxation techniques
O Avoid drinking on an empty stomach
O Avoid mixing different alcoholic drinks
Keep a drinking diary
n a daily basis, make a note of:
O all the alcoholic drinks you had
O how many units you drank (visit www.drinkaware.co.uk for a unit calculator)
O what time you had them
O where you were
This should give you a good idea of how much you're drinking, the situations in which you drink and
where you could start to cut down
Expert view
Dr Michelle Butterworth, specialist registrar in addiction psychiatry at South London and Maudsley
NHS Trust, suggests some of the questions that you might want to discuss with your doctor.
What is aIcohoI misuse?
Alcohol misuse is using alcohol in such a way that it causes harm to you and to those close to you -
physically, psychologically and socially.
Can drinking too much harm my heaIth?
Definitely. At the lower end of the spectrum, simply overdoing it causes a hangover, which is a result
of dehydration and low blood sugar levels. A hangover also alters the way the brain cells work,
causing tremors and sleep disruption. Moving up the scale, drinking too much can cause accidents,
violence and reckless or dangerous behaviour. f you drink heavily, you're at risk of alcoholic hepatitis
(when the liver becomes inflamed), cirrhosis and damaging the ability of your brain to work
effectively.
How do I know I have a probIem?
ts not just about what or how much you're drinking. You have a problem with alcohol if:
O You want to drink at a time when its not appropriate.
O You have difficulty controlling or limiting what you drink.
O Your judgment is affected.

What are the signs I couId be aIcohoI dependent?
O f you wake up sweating and shaking.
O f you drink every day.
O f you need increasing quantities to get the same effect.
O f you crave alcohol.
O f your drinking starts to take over other areas of your life.

I onIy drink a Iot on Friday and Saturday night. That cant hurt, can it?
t depends on how much you're drinking. f you're saving up your units or drinking more than twice the


maximum recommended units of alcohol per day in one session, then it is harmful to your health and
possibly to others.
Can I cut down on my own?
f you're drinking heavily but not alcohol dependent, you may be able to cut down on your own. f,
however, you are physically dependent on alcohol, trying to stop on your own can cause serious
health problems. n both cases, it's best to talk to your GP or a drug and alcohol advisor.
Ask your doctor

O How much alcohol is safe?
O Why am drinking too much?
O What will happen if carry on drinking?
O What support are you able to give me?
O Should give up drinking totally?
O How do give up alcohol?
O Are support groups can use for help?

AdditionaI information
UsefuI organisations
AIcohoI Concern
64 Leman Street, London, E1 8E&
Tel : 020 7264 0510
http://www.alcoholconcern.org.uk/home
AIcohoIics Anonymous
The General Service Board of Alcoholics Anonymous, P Box 1, 10 Toft Green, York, Y1 7NJ
Tel : 0845 769 7555
http://www.alcoholics-anonymous.org.uk/

AIcohoI misuse - information prescription
Introduction
Many people are able to stick to the recommended levels of alcohol consumption (see box) so that
drinking does not pose a threat to their health.
However, for some people, the amount of alcohol they drink means that they face a real risk of
developing alcohol-related problems. These problems may be:


O physicaI - such as heart disease
O psychoIogicaI - such as depression
O sociaI - such as committing domestic abuse or acts of violence
Drinking levels of alcohol that can cause these types of problems is known as alcohol misuse.
Signs of misuse
Signs that you may be misusing alcohol include:
O you have felt that you should cut down on your drinking
O other people have annoyed you by criticising your drinking
O you have felt guilty or bad about your drinking
O you have needed a drink first thing in the morning to steady your nerves or get rid of a
hangover
Signs that someone you know may be misusing alcohol include:
O they regularly exceed the recommended daily amount for alcohol
O they have been unable to remember what happened the night before as a result of their
drinking
O they have failed to do what was expected of them because of their drinking - for example,
missing an appointment because they were drunk or hungover
See Alcohol misuse - diagnosis for more information and an interactive screening tool.
Getting heIp
Treatments that can help people with an alcohol misuse problem include:
O counselling
O medication, which can help to reduce cravings for alcohol
O self-help groups - where people with alcohol misuse problems share their experiences with
each other in a supportive environment
f you are concerned about your level of drinking, or someone elses, a good first step is to visit your
GP, who will be able to discuss the services and treatments that are available.
The &s leading charities and support groups for people with alcohol misuse problems will also be
able to provide you with support and advice. For example, you may want to contact:
O Alcoholics Anonymous - their helpline number is 0845 769 7555
O Alcohol Concern - who run the national drink helpline called Drinkline; their number is 0800
917 8282
See Alcohol misuse - treatment for more information and advice.
How common is aIcohoI misuse in EngIand?
Alcohol misuse is widespread in England. ne third of men and one sixth of women drink alcohol at
a level that is dangerous to their health.
n 2007 in England, there were 863,000 alcohol-related hospital admissions and 6,541 deaths that
were directly related to alcohol misuse. Most of these deaths were a result of alcoholic liver disease.


The actual number of deaths caused by alcohol misuse is much higher than those reported. This is
because alcohol misuse is a major risk factor for a range of life-threatening diseases such as:
O heart disease
O stroke
O cancers, such as liver cancer and bowel cancer
OutIook
More than half of people who receive treatment for alcohol misuse will either reduce their drinking to
a safer level than what is was previously, or give up drinking altogether.
AIcohoI units
Alcohol is measured in units. The recommended daily limits for alcohol consumption are:
O no more than three to four units a day for men
O no more than two to three units a day for women
A unit of alcohol is roughly half a pint of normal-strength lager, a small glass of wine or a single
measure (25ml) of spirits.
For more information on alcohol units see Alcohol misuse definition
Defining a drink probIem
Recommended amount of aIcohoI
The amount of alcohol contained in any alcoholic drink is measured in units. A unit is equivalent 10ml
of pure alcohol.
The recommended daily limits for alcohol consumption are:
O no more than 3-4 units per day for men
O no more than 2-3 units per day for women
f you regularly exceed the recommended daily limits, you are putting your health at risk.
Pregnant women and women trying to conceive should avoid drinking alcohol. f they do choose to
drink, they should not drink more than 1-2 units of alcohol once or twice a week and should avoid
getting drunk.
How to measure units
Any drink that you buy will contain a measurement of its alcohol by volume (ABV). ABV is a
measurement of how much of that drink is made up of pure alcohol.
The easiest way to work out how many units of alcohol a drink provides is:
O find out what the drinks ABV is
O then multiply that by how many millilitres of liquid are in the drink
O then divide that by 1,000
So for a standard pint of strong lager:
O its ABV would be 5%
O a pint contains 568ml


O 5 times 568 equals 2,840
O divide that by 100, to give a measurement of 2.8 units
The units found in some standard drink sizes are listed below:
O a can of standard lager, beer, bitter 1.8 units
O a can of strong lager, beer, bitter 2.2 units
O a pint of standard lager, beer, bitter 2.3 units
O a pint of strong lager, beer, bitter 2.8 units
O a small glass of wine (125ml) 1.5 units
O a large glass of wine (250ml) 3 units
O a bottle of alcopops 1.4 units
O a glass of spirits (25ml) 1 unit
O a bottle of wine 9 units
O a one litre bottle of standard cider 4 units
O a one litre bottle of strong cider 9 units
O a 700ml bottle of spirits 27-28 units
Types of aIcohoI misuse
There are three main types of alcohol misuse:
O hazardous drinking
O harmful drinking
O dependent drinking
Hazardous drinking
Hazardous drinking is defined as when a person drinks over the recommended weekly limit (21 units
for men and 14 units for women).
t is also possible to drink hazardously by binge drinking, even if you stick within your weekly limit.
Binge drinking is when you drink an excessive amount of alcohol in a short space of time eight units
in a day for men, six units in a day for women. For more information, see the Live Well section on
binge drinking
f you are drinking hazardously, you may not yet have any health problems directly related to alcohol,
but you are increasing your risk of experiencing problems in the future.
Hazardous drinking, especially binge drinking, also carries additional risks such as:
O being involved in an accident
O becoming involved in an argument or fight
O taking part in risky or illegal behaviour when drunk such as drink driving
HarmfuI drinking
Harmful drinking is defined as when a person drinks over the recommended weekly amount and has
experienced health problems directly related to alcohol.
n some cases, these problems may be obvious, such as:
O depression
O alcohol-related accident


O acute pancreatitis (inflammation of the pancreas)
Many of the health problems caused by harmful drinking do not cause any symptoms until they reach
their most serious stages, such as:
O high blood pressure
O cirrhosis (scarring of the liver)
O some types of cancer, such as mouth, liver, bowel and breast cancer
O heart disease
So it can be easy to underestimate the levels of physical damage caused by harmful drinking.
Harmful drinking can also cause related social problems such as:
O difficulties with your partner or spouse
O difficulties with family and friends
O problems at work or college
Dependent drinking
Alcohol is both physically and psychologically addictive and it is possible to become dependent on
alcohol.
Dependent means that a person feels that they are unable to function without alcohol and the
consumption of alcohol becomes an important or sometimes the most important factor in their life.
Depending on the level of dependence, a person can experience withdrawal symptoms if their supply
of alcohol is suddenly stopped. Withdrawal symptoms can be both physical and psychological.
Physical withdrawal symptoms include:
O hand tremors (the shakes)
O sweating
O nausea
O visual hallucinations (seeing things that are not actually real), and, in the most serious of
cases
O seizures (fits)
Psychological withdrawal symptoms include:
O depression
O anxiety
O irritability
O restlessness
O insomnia
Moderately dependent drinkers do not usually experience withdrawal symptoms, or withdrawal
symptoms are mild to moderate.
Severely dependent drinkers do experience withdrawal symptoms, which are usually severe. Most
severely dependent drinkers fall into a pattern of relief drinking, where they drink to avoid or counter
Severely dependent drinkers usually have an extremely high tolerance to alcohol, and are able to
drink amounts that would incapacitate or even kill most other people.


Diagnosing aIcohoI misuse
f you visit your GP because you are concerned about your drinking, or you come into contact with
another health professional due to an alcohol-related injury or illness, it is likely that they will want to
assess the extent and pattern ofyour alcohol abuse.
This is usually done by using a screening test that consists of a series of questions. t is important to
be truthful when responding to the questions. Your GP and/or other health professionals are not
trying to judge you, they are simply trying to ensure you receive the appropriate treatment.
AIcohoI Use Disorders Identification Test (AUDIT)
ne widely used screening test is the Alcohol &se Disorders dentification Test (A&DT). There is an
interactive version of the A&DT test on the left of this page that you may wish to try.
Fast AIcohoI Screening Test (FAST)
A simpler test that you can use to check if your drinking has reached hazardous levels is known as
the Fast Alcohol Screening Test (FAST).
FAST consists of four questions, which are reproduced below.
1. How often do you drink eight or more units (men) or six or more units (women) on one occasion:
O never if this is your answer you can stop the test
O less than monthly score 1
O monthly score 2
O weekly score 3
O daily or almost daily score 4
2. How often during the last year have you been unable to remember what happened the night before
because you had been drinking:
O never 0
O monthly 2
O weekly 3
3. How often during the past year have you failed to do what was normally expected of you because
you had been drinking:
O never 0
O monthly 2
O weekly 3
4. n the last year has a relative or friend, or a doctor or other health worker been concerned about
your drinking or suggested that you cut down:
O no 0
O yes, on one occasion 1
O yes, on more than one occasion 2


A FAST score of 3 or more would usually suggest that you are drinking at a hazardous level.
Risks of aIcohoI misuse
Alcohol is a powerful chemical that can have a wide range of effects. As alcohol can easily pass
through the walls of human cells, once it is in your blood it can reach almost every part of the body,
from your brain to your bones to your heart.
The effects of alcohol can be both short term and long term. Similarly, the risks of alcohol can also be
both short and long term.
Short-term effects of aIcohoI
The short-term effects of alcohol are described below. This information is based on the assumption
that you have a normal tolerance for alcohol. Dependent drinkers with a higher tolerance to alcohol
can often drink much more without experiencing any noticeable effects.
1-2 units
After drinking 1-2 units of alcohol, your heart rate will speed up and your blood vessels will expand,
giving you the warm, sociable up and talkative feeling that is associated with moderate drinking.
4-6 units
After drinking 4-6 units of alcohol, your brain and nervous system will start to be affected. t will start
to dampen the part of your brain that is associated with decision making and judgement, making you
more reckless and uninhibited.
The alcohol will also impair the cells in your nervous system, making you feel lightheaded while also
adversely affecting your reaction time and co-ordination.
-9 units
After drinking 8-9 units of alcohol, your reaction times will be much slower, your speech will begin to
slur, and your vision will begin to lose focus. Your liver (which the body uses to filter alcohol out of the
body) will be unable to remove all of the alcohol overnight, so it is likely you will wake with a
hangover.
10-12 units
After drinking 10-12 units of alcohol, your co-ordination will be seriously impaired, placing you at high
risk of having an accident. The high levels of alcohol will have a depressant effect on your body and
mind, making you feel drowsy.
f you have this amount of alcohol in your body, it will begin to reach toxic levels. Your body will
attempt to quickly pass out the alcohol with your urine. However, this will leave you feeling badly
dehydrated in the morning, which, in turn, may cause a severe headache.
The excess amount of alcohol in your system can also upset your digestive system, leading to
symptoms of nausea, vomiting, diarrhoea, and indigestion.
More than 12 units
Drinking more than 12 units of alcohol will place you at a high risk of developing alcohol poisoning,
particularly if you are drinking lots of units in a short space of time. t usually takes the liver about one
hour to remove one unit of alcohol from the body.


Alcohol poisoning occurs when excessive amounts of alcohol begin to interfere with the automatic
functions of your body such as:
O your breathing
O your heart rate
O your gag reflex which prevents you from choking
Alcohol poisoning can result in coma and death.
Short-term risks of aIcohoI misuse
The short-term risks of alcohol misuse include:
O accidents and injury it is estimated that 70% of all visits to accident and emergency (A&E)
departments at peak times are due to alcohol misuse
O invoIvement in vioIence and antisociaI behaviour in England each year, around 1.2
million violent incidents are linked to alcohol misuse
O practicing unsafe sex which can lead to unplanned pregnancies and sexually transmitted
infections (STs)
O Ioss of personaI possessions many people lose personal possessions, such as their wallet
or phone, when they are drunk
O unscheduIed time off work or coIIege which could put your education, or job, at risk
Long-term effects of aIcohoI misuse
f you drink hazardous amounts of alcohol for many years, the cumulative effect of the alcohol will
have a toxic effect on many of your bodys organs, which may result in organ damage.
The organs that are known to be damaged by long-term alcohol misuse include:
O the brain
O the liver
O the pancreas
Heavy drinking can also increase your blood pressure and your blood cholesterol levels, both of
which are major risk factors for heart attacks and strokes.
Long-term alcohol misuse can weaken your immune system, making you more vulnerable to serious
infection. t can also weaken your bones, placing you at greater risk of fracturing, or breaking, them.
Long-term risks of aIcohoI misuse
The long-term health risks of alcohol misuse include:
O high blood pressure (hypertension)
O stroke
O heart disease
O pancreatitis
O liver disease
O liver cancer
O cancer of the mouth or neck
O breast cancer
O bowel cancer


O depression
O dementia
O sexual problems, such as impotence or premature ejaculation
O infertility
The long-term social risks of alcohol misuse include:
O divorce
O family break-up
O domestic abuse
O unemployment
O homelessness
O financial problems
AIcohoI poisoning
The symptoms of alcohol poisoning include:
O confusion
O vomiting
O seizures (fits)
O slow breathing (less than eight breaths a minute)
O pale, bluish skin
O cold and clammy skin
O unconsciousness (from which the person cannot be roused)
If you suspect aIcohoI poisoning, you shouId diaI 999 and ask for an ambuIance.
While you are waiting for the ambulance to arrive you should:
O not try to make the person vomit, as their gag reflex will be impaired, which means that they
could choke on their own vomit
O turn the person on to their side and place a cushion under their head in order to help prevent
them choking on their own vomit
If someone Ioses consciousness after drinking aIcohoI, you shouId never Ieave them aIone
to sIeep it off, even if they appear to be breathing normaIIy. The IeveIs of aIcohoI in a persons
bIood can continue rising for up to 30-40 minutes after a persons Iast drink, and this couId
cause their symptoms to suddenIy worsen.
What happens with a hangover?
Alcohol has a diuretic effect, which means that the body loses too much water and causes
dehydration. This effect can be made worse by congeners (substances that are found in all alcoholic
drinks to give a distinct flavour, but which can be more concentrated in dark drinks). Alcohol also
stimulates the production of insulin, which reduces blood sugar levels and causes drowsiness,
weakness, trembling, faintness and hunger.
Treating aIcohoI dependency
Hazardous drinking
f you are concerned that you are drinking hazardous amounts of alcohol it is likely that you will be


referred to a short counselling session, known as a brief intervention.
You may also be invited to a brief intervention if you experience an alcohol-related injury or illness,
which could suggest your drinking is at hazardous levels.
A brief intervention lasts around 10-15 minutes and usually consists of a series of steps.
Firstly, the counsellor will provide feedback on the short-term and long-term risks associated with
your individual pattern of drinking, while emphasising that it is your responsibility to reduce that risk.
Then the counsellor will provide advice on ways you can reduce your alcohol consumption. For
example, you may be told to keep a drink diary so you can accurately record how many units of
alcohol you drink a week, and then try to lower the amount.
f most of your drinking is done on a social basis, the counsellor can provide advice on how you can
continue to socialise while reducing your alcohol consumption, such as alternating alcohol with soft
drinks, or choosing low-alcohol drinks such as spritzers or low-strength lager.
Then the counsellor will discuss what additional support is available for you if you require it, such as
self-help groups or specialist alcohol services.
The session will end with the counsellor discussing any emotional issues you may feel about trying to
reduce your drinking, such as apprehension or anxiety, while providing support about how to cope
better with these emotions.
HarmfuI drinking
f you are drinking harmful amounts of alcohol you will first have to make the decision whether you
want reduce your alcohol intake to a moderate level (moderation) or quit alcohol altogether
(abstinence).
bviously, abstinence will have a greater health benefit, though often moderation is a more realistic
goal, or at least, a first step on the way to abstinence.
&ltimately the choice is yours, though there are circumstances where abstinence is strongly
recommended. These are:
O if you have liver damage
O if you have other medical problems that can be made worse by drinking, such as heart trouble
O if you are taking medication that can react badly or unpredictably with alcohol, such as
antipsychotics
O if you are pregnant or are planning to become pregnant
Abstinence may also be recommended if you have previously tried to achieve moderation and failed.
f you do choose moderation as a treatment goal you will usually be referred to a counselling session
that is known as an extended brief intervention. This is similar to a brief intervention, but slightly
longer and more in-depth.
You will probably be asked to attend further sessions so your progress can be monitored and further
treatment and advice provided if necessary.
You may also receive regular blood tests so the state of your liver can be carefully monitored.
See below for information on available treatments to achieve abstinence.
Dependent drinking


As with harmful drinking, you will need to choose between moderation and abstinence.
Moderation may be a realistic goal for people with mild to moderate dependency. Abstinence would
usually be recommended for people with moderate to severe dependency.
Treatment to achieve moderation is carried out in much the same way as for harmful drinking.
Whatever your level of dependency, it is recommended that you spend a period of time free from
alcohol, so your body can recover from its effects, and, in cases of moderate to severe dependency,
you can break the cycle of drinking alcohol to avoid withdrawal symptoms. This is known as
detoxification or detox.
Detoxification
How and where you attempt detoxification will be determined by your level of alcohol dependency.
f your level of dependency is low to moderate you should be able to detox at home without the use of
medication, as your withdrawal symptoms should be mild.
f your level of dependency is moderate to severe and your consumption of alcohol is high (over 20
units a day) and/or you have previously experienced withdrawal symptoms, you should be able to
detox at home though you will be given the option of taking medication to help ease withdrawal
symptoms. A tranquiliser called chlordiazepoxide is usually used for the purpose.
f your levels of dependency are severe it is usually recommended that you are admitted to a hospital
or clinic to detox. This is because there is a risk you could experience more-severe withdrawal
symptoms, such as seizures and hallucinations, and may require specialist treatment.
You will find that the withdrawal symptoms are at their worst for the first 48 hours. The symptoms
should then gradually improve as your body begins to adjust to being without alcohol. This usually
takes between three and seven days from the time of your last drink.
You will also find that your sleep is disturbed you may wake often during the night, or have problems
going to sleep. This is to be expected, and your sleep patterns should return to normal within a
month.
During detox you should drink plenty of fluids approximately three litres a day. Avoid drinking
excessive amounts of tea or coffee as this can make sleep problems worse and cause feelings of
anxiety. Water or fruit juice would be a better choice.
You should try to eat regular meals even if you are not feeling hungry. Your appetite will return
gradually.
f you are taking medication to ease withdrawal symptoms, then you should not drive or operate
heavy machinery as the medication will probably make you feel drowsy. nly take your medication
as directed.
Detox can be a stressful time. Ways you can try to relieve stress include listening to music, going for
a walk or taking a bath.
f you are detoxing from home you will receive regular visits from a health visitor, and be given the
relevant contact details for other support services, should you require additional support.
Abstinence
There are a number of different treatment options available to help you achieve abstinence.


Treatment options often differ in effectiveness depending on the individual, so if you feel that a
certain treatment option is not working for you, then you should discuss alternative options with your
care team and/or your GP.
Medication
There are currently two licensed medications that can be used in the treatment of alcohol misuse:
O acamprosate
O disulfiram
Acamprosate
Acamprosate (brand name Campral) is used to help prevent relapse in people who have successfully
achieved abstinence from alcohol. Acamprosate is usually used in combination with counselling.
Acamprosate works by affecting levels of a chemical in the brain known as gamma-amino-butyric
acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.
Side effects of acamprosate include:
O nausea
O vomiting
O itchy skin
DisuIfiram
Disulfiram (brand name Antabuse) is a medication that can be used if you are trying to achieve
abstinence but are concerned that you may relapse, or have experienced previous relapses.
Disulfiram works by causing a series of extremely unpleasant physical reactions if you drink any
alcohol, such as:
O nausea
O chest pain
O vomiting
O dizziness
The unpleasantness associated with these reactions should deter you from drinking any more
alcohol.
Aside from alcoholic drinks, it is important to avoid all sources of alcohol as these could also induce
an unpleasant reaction. Products that may contain alcohol include:
O aftershave
O mouthwash
O some types of vinegar
O perfume
You should also steer clear of substances that give off alcoholic fumes, such as paint thinners and
solvents.
You will continue to experience unpleasant reactions if you come into contact with alcohol for a week
after you finish taking disulfiram, so it is important to maintain your abstinence during this time.
Side effects of disulfiram include:


O drowsiness
O fatigue
O nausea
O bad breath
CounseIIing
SeIf-heIp groups
Many people with a dependence on alcohol find it useful to attend self-help groups, the best known of
which is Alcoholics Anonymous.
Alcoholics Anonymous believes that alcoholic dependence is a chronic and progressive incurable
disease for which total abstinence is the only solution.
Alcoholics Anonymous is based on a programme of 12 steps designed to help overcome addiction,
and which include the following points:
O you admit that you are powerless over alcohol and your life has become unmanageable
O you recognise that you need a power greater than yourself to restore your strength
O you examine past errors in your life with the help of a sponsor (an experienced member of the
group)
O you make amends for those errors
O you learn to live a new life with a new code of behaviour
O you help others who have an alcohol dependence
For a full list of useful organisations, see Alcohol support
TweIve-step faciIitation therapy
Twelve-step facilitation therapy is based on the programme devised by Alcoholics Anonymous,
except you work through the stages one-on-one with a counsellor, rather than as a group.
Twelve-step facilitation therapy may be a preferred treatment option if you feel uneasy or unwilling to
discuss your problems in a group setting.
Cognitive behaviouraI therapy (CBT)
Cognitive behavioural therapy (CBT) is a type of talking therapy that emphasises a problem-solving
approach to alcohol dependence.
CBTs approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs
that may be contributing towards your alcohol dependence, such as:
O ' cannot relax without alcohol
O My friends would find me boring if was sober
O Just drinking one pint cant hurt
nce such thoughts and beliefs are identified, you will be asked to base your behaviour on more
realistic and helpful thoughts, such as:
O Lots of people have a good time without alcohol, and can be one of them
O My friends like me for my personality, not for my drinking
O know cannot stop drinking once start
CBT also helps you identify triggers that can cause you to drink such as:


O stress
O social anxiety
O being in high-risk environments such a pub, club or restaurant
The therapist will then teach you how to avoid those triggers that can be avoided, and cope
effectively with triggers that are unavoidable.
FamiIy therapy
Alcohol dependence does not just impact on an individual, it can also affect a whole family.
Family therapy provides the opportunity for family members to:
O learn about the nature of alcohol dependence
O provide support to the family member who is trying to abstain from alcohol
Tips
O Replace some of your drinks with non-alcoholic or low alcohol drinks
O f you drink mainly when you go out, try going out later or having your first drink later
O f you drink mainly at home, trying buying non-alcoholic alternatives
O Buy smaller glasses and watch how much you pour
O f you use alcohol to wind down after a hard day, find alternatives such as exercise classes or
relaxation techniques
O Avoid drinking on an empty stomach
O Avoid mixing different alcoholic drinks
Keep a drinking diary
n a daily basis, make a note of:
O all the alcoholic drinks you had
O how many units you drank (visit www.drinkaware.co.uk for a unit calculator)
O what time you had them
O where you were
This should give you a good idea of how much you're drinking, the situations in which you drink and
where you could start to cut down

AdditionaI information
UsefuI organisations
AIcohoI Concern
64 Leman Street, London, E1 8E&
Tel : 020 7264 0510
http://www.alcoholconcern.org.uk/home
AIcohoIics Anonymous
The General Service Board of Alcoholics Anonymous, P Box 1, 10 Toft Green, York, Y1 7NJ
Tel : 0845 769 7555


http://www.alcoholics-anonymous.org.uk/
N ADDTN T DR&G AND ALCHL ADDCTN THERE ARE:-
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SPECFC TYPES F MEDCATN
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