DPT-304.2-PT Essentials – Lifestyle Considerations – Alcohol

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ALCOHOL

Alcohol is produced by the fermentation of vegetables, fruits or germs. It is a drug that has positive and negative effects on the body and creates dependency in some individuals. In small quantities, alcohol may be good for your health; 1-2 units per day is believed to help protect against ischaemic strokes and heart attacks in men over 40 years and post-menopausal women (NHS, 2002). However, when consumed in larger quantities, the effects of alcohol can be detrimental to your health. One of the immediate effects of alcohol is making people feel relaxed, however alcohol is technically a depressant (BUPA, 2000a). Research has shown that a very high percentage of adults in the UK (over 90% of men and 86% of women aged 16 years or over) drink alcohol (NHS, 2002).

Alcohol is absorbed into the bloodstream from the stomach and small intestine. It circulates through the liver, heart, lungs and brain. The faster the alcohol is absorbed the higher the blood alcohol level and the greater its effect. The presence of food may slow this absorption rate down, but carbonated drinks or drinking quickly may speed the rate up. Alcohol is removed and metabolised from the bloodstream by the liver as the blood flows through it. However, this process is slow with about one unit (10ml) of alcohol eliminated per hour (BUPA, 2002) and only after blood alcohol levels reach a peak, which is usually around 1 hour after drinking begins (Tortora et al, 1996). Alcohol continues to be transported around the body, via the blood supply, resulting in a loss of co-ordination and impairment of judgement, until it is ready to be metabolised.

Units of Alcohol

Alcohol ‘units’ are used as a guide to measure intake. A unit of alcohol is 8mg or 10ml of pure alcohol (ethanol) (DOH, 2003). This is roughly equivalent to half a pint of beer, cider or lager, a 25ml (pub) measure of spirit such as vodka, whisky or gin, a 50ml (pub) measure of fortified wine such as port or sherry, or a small (125ml) glass of wine (NHS, 2002). 

The above is a good guide; however, it is not always 100% correct as many drinks contain more than this ‘guesstimated’ amount. Some containers now state the units on the label, and if not they can be easily calculated.

The UK limit for alcohol consumption and driving is 80mg%. One unit gives a peak blood level of roughly 15 milligrams in 100 millilitres of blood (15mg%) (BUPA, 2002)

Recommended intake of units:

Sensible drinking limits are defined as no more than 21 units a week for adult males and 14 units a week for adult females (NHS, 2002). In addition to this, the Department of Health (2003) advises that men should not drink more than 3 – 4 units of alcohol per day, and women should drink no more than 2 – 3 units of alcohol per day. These daily benchmarks apply whether drinking every day, once or twice a week, or occasionally. 

Pregnant women are advised not to drink any alcohol. It is also wise to avoid alcohol if trying to become pregnant or at risk of becoming pregnant. Alcohol can affect the unborn baby before a woman realises that she is pregnant (BUPA, 2002).

There are a number of factors that affect the capacities for handling alcohol including body size and the liver’s ability to break down alcohol. Women also have a lower tolerance of alcohol than men. This is because they are often smaller and lighter, their bodies contain less water and their metabolism is different (NHS, 2002).

A ‘hazardous alcohol intake’ means drinking heavily enough to cause harm in the future. ‘Harmful alcohol intake’ means that drinking is already causing harm. ‘Binge drinking’ is defined as drinking at least half of the recommended weekly units in one session (NHS, 2002) and has more health risks associated with it.

MALEFEMALE
≤ 1-2 units per dayBeneficial≤ 1-2 units per day
≤ 3-4 units per day or ≤ 21 units per weekAcceptable≤ 2-3 units per day or≤ 14 units per week
> 21 units per weekUnhealthy> 14 units per week
> 35 units per weekHarmful> 21 units per week

Health Risks of Excess Intake

In moderate amounts alcohol can reduce tension and inhibitions, enhance enjoyment and increase sexual desire. However, excessive drinking can affect physical and mental health, work, social and personal relationships. The risks of excess alcohol intake are varied and can lead to a number of physical, social and mental problems. (NHS, 2002, and BUPA, 2000):

Physical:

Some cancers, alcoholic hepatitis, cirrhosis of the liver, brain damage, alcohol-related anaemia, chronic calcifying pancreatitis, heart muscle damage (cardiomyopathy) and heartbeat irregularities (arrhythmias), malnutrition, pre-natal damage to foetus, hypertension, cerebral haemorrhage (stroke), coronary heart disease, muscle atrophy, danger to diabetics, peptic ulcers, infertility, obesity and alcohol induced accidents. 

Social:

Isolation and aggression are the most common problems and a recent report showed that a quarter of all young prisoners had been drinking when they committed their crime (NHS, 2002).

 

Mental:

Psychiatric disorders are also more common in people who drink more than 10 units a day (NHS, 2002). These include: depression, breakdown, mood swings, alcoholic dementia, suicide and attempted suicide, personality deterioration, sexual dysfunction, hallucinations without the other symptoms of memory loss and delirium tremens (psychosis caused by alcoholism).

Alcohol Dependence

The following signs may indicate that alcohol is affecting your life adversely. If you answer ‘yes’ to two or more of the following questions, you need to think about your alcohol intake (adapted from BUPA, 2000b and NHS, 2002):

  • have you ever thought you should cut down on your drinking? 
  • have other people ever annoyed you by commenting on your drinking? 
  • do you ever feel guilty about the amount of alcohol you are drinking? 
  • have you ever taken a drink in the morning to relieve the symptoms of alcohol (commonly known as ‘hair of the dog’ or an ‘eye-opener’)?
  • you find it hard to stop drinking once you have started
  • alcohol takes priority over other activities
  • you have been in trouble with the police through drinking and driving or other anti-social behaviour
  • you spend money on alcohol at the expense of other important things e.g. your family
  • there is disharmony in the family because of alcohol 
  • you turn up late for an appointment because of the previous night’s drinking
  • you need increasing amounts of alcohol to feel an effect
  • other people comment on your behaviour and alcohol consumption
  • you get angry when people make comments about your drinking
  • you feel the need to drink in the morning
  • you start to become impatient or irritable before lunch and at the end of the day because you want to have a drink

Strategies for Reducing Intake

(adapted from BUPA, 2000)

  • never drink alone
  • if you are going out, decide in advance how much you are going to drink and pace yourself
  • practise saying ‘no thanks’ to another drink
  • space alcoholic drinks with non-alcoholic drinks
  • drink more slowly – do this by consciously taking small sips
  • don’t quench a thirst with alcohol – have a glass of water or juice
  • don’t drink every day. Have two or three alcohol free days each week
  • monitor your alcohol drinking patterns
  • become aware of the consequences of drinking too much alcohol
  • take notice of times when you drink too much
  • select alternatives
  • learn from your mistakes and be prepared to start again

References

NHS (2002). Alcohol. http://www.nhsdirect.nhs.uk

Tortora, G. J. and Grabobowski, S. (2002) Principles of Anatomy and Physiology. 10th Edition. John Wiley and Sons.

BUPA (2002). Alcohol Abusehttp://hcd2.bupa.co.uk/fact_sheets/html/alcohol_abuse.html

BUPA         (2000a). Alcohol Factsheet. BUPA Hospitals ltd.

BUPA         (2000b). Cutting Down on Alcohol Factsheet. BUPA Hospitals ltd.

DOH (2003). Alcoholhttp://www.doh.gov.uk/alcohol/alcoholandhealth.htm

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