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There are roughly four ‘levels’ of alcohol drinking - social, heavy, problem and dependent. As a rule, each level increases the risk to your health and safety.

Social drinking

Most people drink some alcohol. However, even a small amount of alcohol can be dangerous if you drive, operate machinery, or take some types of medication.

Heavy (hazardous) drinking

This is drinking above the recommended ’safe’ limits which are:

* Men should drink no more than 21 units of alcohol per week, and no more than four units in any one day.
* Women should drink no more than 14 units of alcohol per week, and no more than three units in any one day. (Pregnant women should not drink at all.)

One unit of alcohol is in about half a pint of beer, or two thirds of a small glass of wine, or one small pub measure of spirits. See separate leaflet called ‘Alcohol and Sensible Drinking’ for details.

Drinking above the recommended safe limit is hazardous. That is, it increases your risk of developing diseases such as cirrhosis (liver damage), damage to the pancreas, certain cancers, heart problems, sexual problems, and other conditions. About 1 in 3 men, and about 1 in 7 women, drink more than the safe limit. In general, the more you drink, the greater the risk.

For example, if a man drinks five units each day (not greatly over the recommended limit) then, on average, he doubles his risk of developing liver disease, raised blood pressure, some cancers, and of having a violent death.
Problem (harmful) drinking

This is where you continue to drink heavily even though you have caused harm, or are causing harm or problems to yourself, family, or society. For example, you may:

* Have cirrhosis or another alcohol related condition.
* Binge drink and get drunk quite often. This may cause you to lose time off work, or behave in an antisocial way when you drink. But note: not everybody with problem drinking binges or gets drunk. Many people with an alcohol related condition such as cirrhosis drink small amounts frequently, but do not get drunk.
* Spend more money on alcohol than you can afford.
* Have problems with your relationships or at work because of your drinking.

Many problem drinkers are not dependent on alcohol. They could stop drinking without withdrawal symptoms if they wanted to. But, for one reason or another, they continue to drink heavily.
Alcohol dependence (addiction)

This is a serious situation where drinking alcohol takes a high priority in your life. You drink every day, and often need to drink to prevent unpleasant withdrawal symptoms (see below). In the UK about 2 in 100 women and about 6 in 100 men are alcohol dependent.
What are the symptoms of alcohol dependence?

If you are alcohol dependent you have a strong desire for alcohol. Sometimes the desire is overwhelming. You have great difficulty in controlling your drinking. In addition, your body becomes used to lots of alcohol. Therefore, you may start to develop ‘withdrawal’ symptoms 3-8 hours after your last drink as the effect of the alcohol wears off. So, even if you want to stop drinking, it is often difficult because of the withdrawal symptoms.

Withdrawal symptoms include: feeling sick, trembling, sweating, craving for alcohol, and just feeling awful. Convulsions occur in a small number of cases.

As a result, you drink alcohol regularly and ‘depend’ on it to prevent withdrawal symptoms. If you do not have any more alcohol, withdrawal symptoms usually last 5-7 days, but a craving for alcohol may persist longer. The severity of dependence can vary. It can develop gradually and become more severe. You may be developing alcohol dependence if you:

* Often have a strong desire to drink alcohol and need a drink every day.
* Drink alone often.
* Need a drink to stop trembling (the shakes).
* Drink early, or first thing in the morning (to avoid withdrawal symptoms).
* Spend a lot of you time in activities where alcohol is available. For example, if you spend a lot of time at the social club or pub.
* Neglect other interests or pleasures because of alcohol drinking.

If you are alcohol dependent you are usually ‘tolerant’ to the effect of alcohol. This means that you need more alcohol to notice any effects and to become drunk. This can make things worse as it tends to make you drink even more.

If you are alcohol dependent you may get drunk regularly. However, you may not get drunk. You may drink small amounts regularly to keep any withdrawal symptoms away. You may then be able to ‘hide’ your problem from others. However, you are still at serious risk of developing conditions due to heavy drinking (liver damage, cancers, etc). Delirium tremens (’DTs’)

Problems with drinking alcohol - Part 2