Many people are able to keep their drinking within the recommended limits of alcohol consumption, so their risk of alcohol-related health problems is low. However, for some, the amount of alcohol they drink could put them at risk of damaging their health.

Alcohol misuse is drinking more than the recommended limits of alcohol consumption.

There are three main types of alcohol misuse:

• hazardous drinking: drinking over the recommended limits
• harmful drinking: drinking over the recommended limits and experiencing alcohol-related health problems
• dependent drinking: feeling unable to function without alcohol

Many people who have alcohol-related health problems aren't alcoholics.

Read more about the different types of alcohol misuse.

Units of alcohol

Alcohol is measured in units. A unit of alcohol is equivalent to 10ml of pure alcohol, which is roughly half a pint of normal strength lager, a small glass of wine or a single measure (25ml) of spirits.

The recommended daily limits for alcohol consumption are:

• no more than three to four units a day for men
• no more than two to three units a day for women

For both men and women, it is also recommended to include some alcohol-free days each week. You are putting your health at risk if you regularly exceed the recommended daily limits.

Am I drinking too much alcohol?

Some signs that you could be misusing alcohol include:

• feeling that you should cut down on your drinking
• other people have been criticising your drinking, which may annoy you 
• feeling guilty or bad about your drinking
• needing a drink first thing in the morning to steady your nerves or get rid of a hangover

Some signs that someone you know may be misusing alcohol include:

• if they regularly exceed the recommended daily limit for alcohol
• if they are sometimes unable to remember what happened the night before because of their drinking 
• if they fail to do what was expected of them due to their drinking – for example, missing an appointment or work because they were drunk or hungover

Risks of alcohol misuse

Over 2009 and 2010, around one million hospital admissions were due to an alcohol-related condition or injury.

The short-term risks of alcohol misuse include:

• alcohol poisoning, which may include vomiting, seizures (fits) and unconsciousness
• accidents and injuries requiring hospital treatment, such as a head injury 
• violent behaviour that might lead to being arrested by the police
• unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs)
• loss of possessions, such as a wallet, keys or phone, leading to feelings of anxiety 

Long-term alcohol misuse is a major risk factor for a wide range of serious conditions, such as:

• heart disease
• stroke
• liver disease
• liver cancer and bowel cancer

As well as health problems, long-term alcohol misuse can lead to social problems such as unemployment, divorce, domestic abuse and homelessness.

Read more about the risks of alcohol misuse.

Alcohol assessment

If you visit your GP because you're concerned about your drinking, or you receive treatment due to an alcohol-related injury or illness, your alcohol intake may be assessed.

The two most common tests used are an Alcohol Use Disorders Identification Test (AUDIT) or a Fast Alcohol Screening Test (FAST).

It is important to be truthful when answering the questions in the tests so that you receive the right treatment to help you.

Read more about diagnosing alcohol misuse.

Treating alcohol misuse

How alcohol misuse is treated will depend on how much a person is drinking. Treatment options include:

• detoxification: this involves drinking less alcohol or stopping completely, and may take place in a clinic if you are dependent on alcohol
• counselling: including self-help groups and talking therapies such as cognitive behavioural therapy (CBT)
• medication: such as acamprosate which can help reduce the cravings for alcohol

Read more about the options for treating alcohol misuse.

Getting help

If you are concerned about your drinking, or someone else's, a good first step is to visit your GP. They will be able to discuss the services and treatments available.

As well as the NHS, there are leading charities and support groups across the UK that provide support and advice for people with an alcohol misuse problem.

You may want to contact:

• Alcoholics Anonymous: the helpline number is 0845 769 7555
• Alcohol Concern: which runs the national drink helpline (Drinkline) on 0800 917 8282

Alcohol and pregnancy

The Department of Health recommends that pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink, they should not drink more than one to two units of alcohol once or twice a week and they should avoid getting drunk.

There are three main types of alcohol misuse – hazardous, harmful and dependent drinking. This is determined by the amount of alcohol consumed.

Hazardous drinking

Hazardous drinking is defined as when a person drinks over the recommended weekly limit of alcohol (21 units for men and 14 units for women).

It is also possible to drink hazardously by binge drinking, even if you are within your weekly limit. Binge drinking involves drinking a large amount of alcohol in a short space of time – eight units in a day for men and six units in a day for women.

If you are drinking hazardously, you may not yet have any health problems related to alcohol, but you are increasing your risk of experiencing problems in the future.

Hazardous drinking, particularly binge drinking, also carries additional risks such as:

• being involved in an accident
• becoming involved in an argument or fight
• taking part in risky or illegal behaviour when drunk, such as drink-driving

Harmful drinking

Harmful drinking is defined as when a person drinks over the recommended weekly amount of alcohol and experiences health problems that are directly related to alcohol.

In some cases, there may be obvious problems such as:

• depression 
• an alcohol-related accident, such as a head injury
• acute pancreatitis (inflammation of the pancreas)

Many of the health problems that occur as a result of harmful drinking do not cause any symptoms until they reach their most serious stages. These include: 

• high blood pressure (hypertension)
• cirrhosis (scarring of the liver)
• some types of cancer, such as mouth cancer and bowel cancer 
• heart disease

This means it can be easy to underestimate the levels of physical damage that is caused by harmful drinking. Harmful drinking can also cause related social problems, such as difficulties with your partner or spouse, family and friends or at work or college. 

Dependent drinking

Alcohol is both physically and psychologically addictive. It is possible to become dependent on it.

Being dependent on alcohol 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 their level of dependence, a person can experience withdrawal symptoms if they suddenly stop drinking alcohol. Withdrawal symptoms can be both physical and psychological.

Physical withdrawal symptoms include:

• hand tremors ("the shakes")
• sweating
• nausea
• visual hallucinations (seeing things that are not actually real)
• seizures (fits) in the most serious cases

Psychological withdrawal symptoms include:

• depression
• anxiety 
• irritability
• restlessness
• insomnia (difficulty sleeping)

Severely dependent drinkers usually experience severe withdrawal symptoms. They often fall into a pattern of "relief drinking", where they drink to avoid withdrawal symptoms.

Severely dependent drinkers are often able to tolerate very high levels of alcohol, and they are able to drink amounts that would incapacitate, or even kill, most other people.

Read more about the risks of alcohol misuse.

If you visit your GP because you are concerned about your drinking, or you receive treatment for an alcohol-related injury or illness, they are likely to assess the extent of your alcohol misuse.

This is usually done by using a screening test that consists of a series of questions. It is important to be truthful when you answer the questions so that you can receive the right treatment. Your GP will not judge you.

Alcohol Use Disorders Identification Test (AUDIT)

One widely used screening test is the Alcohol Use Disorders Identification Test (AUDIT). This test involves answering 10 short questions about your drinking habits to help assess the effects it could have on you.

Fast Alcohol Screening Test (FAST)

The Fast Alcohol Screening Test (FAST) is a simpler test that you can use to check whether your drinking has reached hazardous levels.

FAST consists of four questions which are listed below. The number after each answer is that answer's score.

1. How often do you drink eight or more units (men) or six or more units (women) on one occasion?

• never – if this is your answer you can stop the test
• less than monthly – 1
• monthly – 2
• weekly – 3
• daily or almost daily – 4

2. How often during the last year have you been unable to remember what happened the night before because you had been drinking?

• never – 0
• less than monthly – 1
• monthly – 2
• weekly – 3
• 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?

• never – 0 
• less than monthly – 1
• monthly – 2
• weekly – 3
• daily or almost daily – 4

4. In 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?

• no – 0
• yes, on one occasion – 1
• yes, on more than one occasion – 2

A FAST score of three or more would usually suggest that you're drinking at a hazardous level.

Alcohol is a powerful chemical that can have a wide range of effects on almost every part of your body, including your brain, bones and heart.

Alcohol and its associated risks can have both short-term and long-term effects. In 2009-10, there were around 1 million hospital admissions due to an alcohol-related injury or condition.

Short-term effects of alcohol

The short-term effects of alcohol are described below. This information is based on the assumption that you have a normal tolerance to 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 speeds up and your blood vessels expand, giving you the warm, sociable and talkative feeling that is associated with moderate drinking.

4-6 units

After drinking 4-6 units of alcohol, your brain and nervous system starts to be affected. It will start to affect 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 light-headed while also adversely affecting your reaction time and co-ordination.

8-9 units

After drinking 8-9 units of alcohol, your reaction times are much slower, your speech will begin to slur and your vision will begin to lose focus. Your liver, which filters alcohol out of your 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 is highly impaired, placing you at serious risk of having an accident. The high level of alcohol has a depressant effect on both your mind and body which makes you drowsy.

This amount of alcohol will begin to reach toxic (poisonous) levels. Your body will attempt to quickly pass out the alcohol with your urine. This will leave you feeling badly dehydrated in the morning, which 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 places you at a high risk of developing alcohol poisoning, particularly if you are drinking lots of units in a short space of time. It 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:

• your breathing
• your heart rate
• your gag reflex – which prevents you from choking

Alcohol poisoning can result in a person falling into a coma and could lead to their death.

Short-term risks of alcohol misuse

The short-term risks of alcohol misuse include:

• 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
• violence and antisocial behaviour:   each year, in England, around 1.2 million violent incidents are linked to alcohol misuse
• unsafe sex: this can lead to unplanned pregnancies and sexually transmitted infections (STIs)
• loss of personal possessions: many people lose personal possessions, such as their wallet or phone, when they are drunk
• unscheduled time off work or college: this could put your job or education, at risk

Long-term effects of alcohol misuse

If you drink hazardous amounts of alcohol for many years, it will take its toll on many of your body’s organs and may cause organ damage.

The organs that are known to be damaged by long-term alcohol misuse include the brain and nervous system, heart, liver and pancreas. Heavy drinking can also increase your blood pressure and your blood cholesterol levels, both major risk factors for heart attacks and strokes.

Long-term alcohol misuse can weaken your immune system, making you more vulnerable to serious infection. It can also weaken your bones, placing you at greater risk of fracturing or breaking them.

Long-term risks of alcohol misuse

There are many long-term health risks associated with alcohol misuse. They include:

• high blood pressure (hypertension)
• stroke
• heart disease 
• pancreatitis 
• liver disease 
• liver cancer 
• cancer of the mouth 
• head and neck cancer 
• breast cancer 
• bowel cancer 
• depression 
• dementia 
• sexual problems, such as impotence or premature ejaculation
• infertility 

As well as having a significant impact on your health, alcohol misuse can also have long-term social implications. For example, it can lead to:

• divorce
• family break-up
• domestic abuse
• unemployment
• homelessness
• financial problems

The treatment options available for alcohol misuse depend on whether your drinking is hazardous, harmful or dependent, and whether you are trying to drink less or give up drinking completely.

Hazardous drinking

If 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. This may be following an alcohol-related accident or injury.  

A brief intervention lasts around 10 to 15 minutes and covers the risks associated with your pattern of drinking, advice on reducing the amount of alcohol you drink, alcohol support networks available to you and any emotional issues around your drinking.

You may be advised to keep a "drinking diary" so that you can record how many units of alcohol you drink a week. You may also be given tips on social drinking, such as alternating soft drinks with alcoholic drinks when you're out with friends.

Harmful drinking

If you are drinking harmful amounts of alcohol, you will first have to make the decision about whether you want to reduce your alcohol intake (moderation) or give up drinking alcohol altogether (abstinence).

Abstinence will obviously have a greater health benefit, although moderation is often a more realistic goal, or at least, a first step on the way to abstinence.

Ultimately, the choice is yours, although there are circumstances where abstinence is strongly recommended. These include:

• if you have liver damage, such as liver disease or cirrhosis
• if you have other medical problems that can be made worse by drinking, such as heart disease
• if you are taking medication that can react badly with alcohol, such as antipsychotics
• if you are pregnant or are planning to become pregnant

Abstinence may also be recommended if you have previously tried to achieve moderation and been unsuccessful.

If you choose moderation, you will probably be asked to attend further counselling sessions so that your progress can be monitored and further treatment and advice provided if necessary.

You may also have regular blood tests so the health of your liver can be carefully monitored.

Dependent drinking

As with harmful drinking, you will need to choose between moderation and abstinence. Abstinence will usually be recommended for people with moderate to severe dependency.

Whatever your level of alcohol dependency, it is recommended that you spend a period of time free from alcohol so that your body can recover from its effects.

Detoxification

How and where you attempt detoxification will be determined by your level of alcohol dependency. In mild cases you should be able to detox at home without the use of medication because your withdrawal symptoms should also be mild.

If your consumption of alcohol is high (over 20 units a day) or you have previously experienced withdrawal symptoms, you may also be able to detox at home with medication to help ease withdrawal symptoms. A tranquiliser called chlordiazepoxide is usually used for this purpose.

If you have severe dependency, you may go to a hospital or clinic to detox as the withdrawal symptoms will also be severe and are likely to need specialist treatment.  

Withdrawal symptoms

Your withdrawal symptoms will be at their worst for the first 48 hours. They should gradually start to 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 getting 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 – about three litres a day. However, avoid drinking a large number of caffeinated drinks, including tea or coffee, because they can make your sleep problems worse and cause feelings of anxiety. Water or fruit juice is a better choice.

Try to eat regular meals even if you are not feeling hungry. Your appetite will return gradually.

If you are taking medication to help ease your withdrawal symptoms, you should not drive or operate heavy machinery because the medication will probably make you feel drowsy. Only take your medication as directed.

Detox can be a stressful time. Ways that you can try to relieve stress include listening to music, going for a walk or taking a bath. Read more about stress management.

If you are detoxing at home you will regularly see a nurse or other health professional. This might be at home, your GP practice or at a specialist NHS service. You will also be given the relevant contact details for other support services should you need additional support.

Withdrawal from alcohol is an important first step to overcoming your problems with alcohol. However, withdrawal is not an effective treatment by itself. You will be advised to undergo further treatment and support to help you in the long-term.

Abstinence

Several treatment options are available for abstinence. These often differ in effectiveness depending on the individual, so if you feel that a certain treatment is not working for you, you can discuss alternatives with your care team or your GP.

Medication

There are several medications recommended by NICE to treat alcohol misuse:

• acamprosate 
• disulfiram
• naltrexone

Before being prescribed medication you will have a full medical assessment, including blood tests. These medications are discussed in more detail below.

Acamprosate

Acamprosate (brand name Campral) is used to help prevent a relapse in people who have successfully achieved abstinence from alcohol. It is usually used in combination with counselling.

Acamprosate works by affecting levels of a chemical in the brain called gamma-amino-butyric acid (GABA). GABA is thought to be partially responsible for inducing a craving for alcohol.

If you are prescribed acamprosate, the course of medication will usually start as soon as you begin withdrawal from alcohol and can last for up to six months initially.

Naltrexone

Naltrexone is also used to prevent a relapse or limit the amount of alcohol someone drinks. It is usually used in combination with other medicine or counselling. It works by blocking the opioid receptors in the body, stopping the effects of alcohol.

If naltrexone is recommended for you, you should be informed that naltrexone will stop painkillers that contain opioids, such as morphine and codeine, from working.

If you feel unwell while taking naltrexone, stop the medication immediately and seek advice from your GP or care team.

A course of naltrexone can last for up to six months although it may sometimes be longer.

Disulfiram

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 if you've had previous relapses.

Disulfiram works by causing a series of very unpleasant physical reactions if you drink any alcohol to help deter you from drinking. This can include:

• nausea
• chest pain
• vomiting
• dizziness

As well as alcoholic drinks, it is important to avoid all sources of alcohol because they could also induce an unpleasant reaction. Products that may contain alcohol include:

• aftershave
• mouthwash
• some types of vinegar
• perfume

Try to avoid 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.

When taking disulfiram you will be seen by your healthcare team about once every two weeks for the first two months and then every month for the following four months.

Counselling

Self-help groups

Many people with a dependence on alcohol find it useful to attend self-help groups, such as Alcoholics Anonymous.

Alcoholics Anonymous believes that alcoholic dependence is a long-term and progressive, incurable condition and that total abstinence is the only solution.

The treatment plan promoted by Alcoholics Anonymous is based on a 12-step programme that is designed to help you overcome addiction. It includes the following steps:

• You admit that you are powerless over alcohol and your life has become unmanageable.
• You recognise that you need a power greater than yourself to restore your strength
• You examine past errors in your life with the help of a sponsor (an experienced member of the group).
• You make amends for those errors
• You learn to live a new life with a new code of behaviour.
• You help others who have an alcohol dependence.

Read more about alcohol support.

Twelve-step facilitation therapy

Twelve-step facilitation therapy is based on the programme devised by Alcoholics Anonymous. The difference is that you work through the stages on a one-to-one basis with a counsellor, rather than as a group.

Twelve-step facilitation therapy may be your preferred treatment option if you feel uneasy or unwilling to discuss your problems in a group setting.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is a talking therapy that emphasises a problem-solving approach to alcohol dependence.

CBT’s approach to alcohol dependence is to identify unhelpful and unrealistic thoughts and beliefs that may be contributing towards your alcohol dependence, such as:

• "I can't relax without alcohol."
• "My friends would find me boring if I was sober."
• "Just drinking one pint can’t hurt."

Once such thoughts and beliefs are identified, you will be asked to base your behaviour on more realistic and helpful thoughts, such as:

• "Lots of people have a good time without alcohol and I can be one of them."
• "My friends like me for my personality, not for my drinking." 
• "I know I can't stop drinking once I start."

CBT also helps you to identify triggers that can cause you to drink, such as:

• stress
• social anxiety
• being in "high-risk" environments such a pub, club or restaurant

The therapist will teach you how to avoid certain triggers and how to cope effectively with those that are unavoidable.

Family therapy

Alcohol dependence doesn't just impact on an individual – it can also affect a whole family. Family therapy provides the opportunity for family members to:

• learn about the nature of alcohol dependence
• support the family member who is trying to abstain from alcohol

Help is also available for family members in their own right. It can be stressful living with someone who misuses alcohol and it can be helpful to receive support. Some specialist alcohol services provide support to family members as does AlAnon, an organisation affiliated to Alcoholics Anonymous.

Read more about the different types of talking therapies.