Lifestyle

Alcohol is a drug. Its effects are mood altering. As drinking makes people feel relaxed, happy and even euphoric, many find it surprising to learn that alcohol is in fact a depressant. Drinking switches off the part of the brain that controls judgement leading to loss of inhibitions. As most people are aware, alcohol also affects physical co-ordination. The more drinks you have the greater the effect - speech becomes slurred, vision blurred, balance is lost and movements are clumsy. Heavy drinking will depress all bodily functions, so drinking very large quantities can result in unconsciousness, coma, or even death. Vomiting while unconscious or in a heavy sleep can cause death by asphyxiation.

Some people are more vulnerable to the immediate effects of alcohol depending on their:

• Body size - because there is more blood in a large person than in a small person, the concentration of alcohol in the big person will rise more slowly, and reach a lower level, than in a small person, even if they both drink the same amount.
• Gender - women's bodies have more fat and less fluid than men's; so even if they are a similar size and weight to a man, and drinking the same amount, the concentration of alcohol in the blood will be higher in the women. Women are more sensitive to the immediate effects of drinking during ovulation (about 2 weeks before a period) and in the 2 or 3 days before a period. They are likely to feel the effects of alcohol more quickly at these times than they would normally. Women using the contraceptive pill do not experience this effect, but alcohol may take longer to process.
• Age - it appears that both young people and older people may process alcohol more slowly, and so they will have alcohol in their systems for longer.
• Genetics - there may be variations in how alcohol affects people of different races. For instance, many people of East Asian origin have an enzyme, which causes a strong allergy like reaction to alcohol.

Other factors, which can vary the effects of alcohol, are:

• Eating before drinking - alcohol is absorbed more quickly on an empty stomach - hence the expression 'that drink's gone straight to my head'.
• The type of drink - some drinks are absorbed faster than others, and so their effects are felt more quickly. Wines and sherries are absorbed more quickly than neat spirits or beers; the chemicals in sparkling wines, in lagers and in fizzy mixers speed up alcohol absorption; the sugar in sweet drinks slows it down.
• Although these effects are short term, being 'under the influence' puts you at a higher risk of accidents and can cause tension in relationships with colleagues, family and friends.

Apart from cases of extreme intoxication, these effects are short-term. It is the liver which breaks down and eliminates alcohol from the body, and it takes it about an hour to deal with one unit (half a pint of beer, a small glass of wine or a pub measure of spirits). So it would take the body eight hours to eliminate all the alcohol in four pints of beer. It is important to remember this if you are planning to drive - a couple of pints at lunchtime might mean your driving is still impaired in the early evening.

Alcohol is a poisonous substance so having it frequently circulating in your body will harm your health. Regular drinking may damage internal organs even if you rarely drink to the point of intoxication. Several serious diseases occur more frequently in heavy drinkers than in the rest of the population. It is however, fair to point out that most of the problems listed below (with the exception of liver cirrhosis) are not caused by drinking alcohol alone. Unlike cigarette smoking, which directly causes most cases of lung cancer, alcohol increases the risk of developing certain diseases, rather than being the only cause. It can also make some conditions worse. Alcohol's role in ill health is often under-recognised - doctors do not routinely ask patients how much they drink, even in cases where drinking is known to be a key factor.

Heavy drinkers suffer brain shrinkage (loss of brain cells) and even moderate drinking may effect brain function.

Heavy drinking can cause fatty deposits in the liver, eventually leading to cirrhosis. A liver damaged by alcohol cannot process the nutrients in food, nor eliminate toxins from the blood.

Alcohol is a common cause of gastritis and stomach bleeding.

Alcohol is an important cause of high blood pressure (hypertension), itself a cause of stroke.

Excessive drinking doubles the risk of cancer of the gullet, trebles the risk of cancer of the throat and quadruples the risk of cancer of the voice box. There is evidence that it can increase the risk of breast cancer.

Nerve pains or drinking large amounts can cause tightening in the arms and legs.

Vitamin deficiency, obesity, sexual difficulties and infertility, muscle disease, skin problems and pancreatitis have all been linked to excess alcohol consumption.

Women are more susceptible to some of the long-term effects of alcohol, and can develop liver disease at lower levels of drinking than men.

Despite initially helping to relieve tension, alcohol can actually heighten anxiety. It is a factor in many cases of depression too, and it is estimated that alcohol has been involved in about 65% of suicide attempts.

Taken often and in large quantities, alcohol is addictive - that is a person needs to drink to prevent unpleasant and occasionally dangerous withdrawal symptoms.

The government's advice on sensible drinking has in recent years been for men to drink no more than 21 units, and women no more than 14 units, a week. It is now considered more helpful to view this guidance in daily terms and is therefore recommended that men should drink no more than three to four units a day and women no more than two to three units a day. Men consistently drinking four units a day and women consistently drinking three units a day incur a progressive health risk.
A unit of alcohol is equivalent to:

• Half a pint of average strength beer (approx. 250ML)
• a glass of wine (125ML)
• a standard pub measure of spirits/ fortified wine such as sherry or port (25ML)

These are measures of alcohol as might be bought in a restaurant or pub. Many drinks poured at home will be more generous and so contain more units of alcohol.

The first thing to consider is how much you actually drink. Try to compile a drinking diary of what you had last week. Be careful to include all the drinks and remember that at home a glass of wine or spirits is often bigger than a pub measure! Was this a typical week? If you are drinking above the recommended limits you should think about cutting down. However don't worry! On special occasions such as the Christmas and New Year period we all over indulge. Drinking a little bit extra at these times is unlikely to have a long-term health effect.

• Being drunk more often, particularly when needing to be on good form the next day.
• Taking the day off because of a hangover.
• Having accidents, domestic arguments or injuries because of drink.
• Getting into trouble because of drinking - fights, drinking and driving.
• Doing something you would not otherwise have done after drinking and regretting it.
• Drinking more than you planned to in an evening.

If these are only isolated incidents you may just need to think more carefully about reducing the number of drinks you have and when you decide to have them. However if many of the other signs given below apply, you may be getting into a pattern of problem drinking.

• Thinking a lot about when you can next have a drink
• Gulping your first drink quickly.
• Being conscious of how often you are the first person to finish a drink.
• Having more than the occasional hangover.
• Needing to have a drink before doing things or facing certain situations.
• Feeling sick, having the shakes, sweating in the morning or middle of the night.
• Spending more than you can afford on alcohol.
• Ordering doubles when it's your round.
• Often feeling that you need a drink.
• Increase in arguments and rows at home over drink.
• Being annoyed if others mention your drinking or your behaviour when you were drunk.
• Other people telling you that they are worried about your drinking.
• Feeling secretly uncomfortable about your drinking.
• Drinking when alone.
• Deliberately hiding the evidence of your drinking (lying about money, hiding drink and empty alcohol containers).
• Starting to drink at times when you didn't before and earlier in the day.

• Have to increase the amount you drink to maintain the same effect.
• Always wake up with the shakes and feeling sweaty.
• Need a drink to start the day.
• Drink large quantities over the course of the day without it making you drunk.
• Feel uncomfortable if you don't have a drink at hand.
• Lie about your drinking.
• Are covering up your drinking and the costs of it.

First start by working out what you drink in a week by reviewing the last week. If it is difficult to remember keep a daily note for the next week. Note all the drinks, how many units in each, the times of day and where you were. If this is a typical week, your notes should give you a good idea about whether you are drinking too much and, importantly, the situations in which you drink and whether it's going to be hard to cut down.

• Going out a bit later or just having your first drink later
• Replacing some of your drinks with non-alcoholic or low alcohol drinks.
• Switching your usual drink to one with less alcohol in it.
• Avoiding the quick drink situation - missing out the one at lunchtime or after work can make a huge difference over the week.
• Having at least two alcohol free days - taking up a new interest, sport or just going to the cinema if you find most of your social life is involved around the pub.
• Drinking longer drinks - beer rather than spirits and drinking more slowly.
• If you drink at home, buying beers and wines with lower alcohol content could make a great difference.
• Decide a limit of no more than, say, 5 units on any one occasion.
• Buy smaller glasses for the home or buy a drinks measure.
• Keep a supply of non-alcoholic alternatives for drinking at home and entertaining.
• Tell others you are cutting down and avoid rounds.
• Finding other ways of relaxing - exercise or relaxation techniques for example.
• If you anticipate a heavy evening, avoid drinking on an empty stomach and make sure someone else is driving.

For those worried about someone else's drinking a common question is - are they actually alcoholic?
The problem is that most people with a drinking problem will deny it. The question is usually paramount in the minds of those concerned because finding out by other means is difficult. The person (who is unlikely to appear completely drunk) will be resistant to any enquiries, is likely to lie about their drinking and will take a lot of trouble to cover it up. You know something is wrong and suspect alcohol, but because of the stigma attached to alcohol problems which contributes to denial (often aggressive), it is hard to find out from the person directly. In fact the question itself is rarely very useful, unless the person is willing to talk about their drinking, and when thinking about what action needs to be taken. It is likely that if you are concerned about someone and think drink is involved then it probably is. It is more useful to focus on what has changed rather than whether or not someone is `alcoholic'.

Alcoholism is a rough word to deal with. No one is too young (or too old) to have trouble with booze. Alcoholism is an illness. It can hit anyone irrespective of age, rich, poor, colour or creed. It doesn't matter how long you've been drinking or what you've been drinking. It's what drinking does to you that matters.

ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism.

• The only requirement for membership is a desire to stop drinking. There are no dues or fees for AA membership; they are self-supporting through their own contributions.
• AA is not allied with any sect, denomination, politics, organisation or institution; does not wish to engage in any controversy; neither endorses nor opposes any causes.
• AA'ss primary purpose is to stay sober and help other alcoholics to achieve sobriety.

To help you decide whether you might have a problem with your own drinking, Alcoholics Anonymous has prepared these 12 questions. The answers are nobody's business but your own. If you can answer yes to any one of these questions, it maybe time you took a serious look at what your drinking might be doing to you. If you do need help or if you'd just like to talk to someone about your drinking, call the AA -they are in the phone book under Alcoholics Anonymous.

Answer the following questions honestly and they will help you decide if you need to seriously consider the amount you drinking.

1	Do you drink because you have problems? To face up to stressful situations?
2	Do you drink when you get mad at other people, your friends or parents?
3	Do you often prefer to drink alone, rather than with others?
4	Are you starting to get low marks? Are you skiving off work?
5	Do you ever try to stop or drink less - and fail?
6	Have you begun to drink in the morning, before school or work?
7	Do you gulp your drinks as if to satisfy a great thirst
8	Do you ever have loss of memory due to your drinking?
9	Do you avoid being honest with others about your drinking
10	Do you ever get into trouble when you are drinking?
11	Do you often get drunk when you drink, even when you do not mean to?
12	Do you think you're big to be able to hold your drink?

People often don't know how best to help someone with a drink problem. If you are close to a problem drinker it can be hard because you and your family may be having to put up with difficult behaviour whilst the drinker does not recognise or admit they have a problem. Even when they do, it can be very difficult for them to stop drinking or cut down and this in itself is a source of tension for their partners and friends. How you approach the problem and respond to it is important, but it may have got beyond the resources of the people involved leading to distress and guilt as the family and friends try, but fail to help. The best thing to do in these circumstances is to get some independent advice and support, even if this is to just check out whether your suspicions are accurate.

Advice and counselling agencies exist throughout the country and the staff are more than happy to talk to friends and family members either on the phone or by appointment. They can support you; help you make decisions about what you want to do, and importantly, if you feel you can continue to help the drinker, they can offer guidance on ways that are more likely to have an effect. Talking to others in the same situation helps a lot of people and self-help groups do exist for families’ friends and partners of problem drinkers. Drinking problems are a lot more common than you may think.

Check your local phone book under Alcohol. Drinkline, can offer information on local agencies, telephone 0800 917 82 82 (Freephone). For self help groups in your area contact Al-Anon on 020 7403 0888. If you are worried about you're drinking, are finding it hard to cut down or stop, there are many agencies that offer a confidential service and will be happy to help you.