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Introduction

Please work through this guide at your own pace - there is no time limit.  Click on the ‘Next’ and ‘Previous’ buttons to navigate through the pages.

Throughout the guide there will be exercises where you will be able to type in your answers. Once the page is complete you will have the option to print out your answers, or to download them as a PDF file, for future reference.

Alcohol is a commonly consumed substance worldwide, but it is essential to be aware of its effects on our health and well-being. This guide aims to provide you with information on alcohol consumption, its associated risks, and guidelines for safe drinking.

You may be interested in this guide if...

  1. You want to know more about alcohol and its effects
  2. You are interested in what the current guidelines for safe limits are
  3. You think you may have a problem with your drinking
  4. People have told you that you have a drink problem
  5. You are worried about someone else’s drinking

What will this guide do?

  1. Give you more information about different types of drinking
  2. Help you recognise your own pattern of drinking
  3. Help you decide what kind of drinker you are
  4. Describe how you might change if you want to by using ideas based on evidence
  5. Suggest how you might get further help

There is a lot of information in this guide, and it may be helpful to read it several times, or to read it a bit at a time, to get the most from it.

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What is alcohol and how much is it ‘safe’ to drink?

Alcohol itself is a colourless chemical. It can be made from almost anything that has sugar in it. For example, beer is made from barley, cider from apples, wine from grapes, whiskey from grain, and vodka from potatoes. Depending on what they are made from, and how they are made, different drinks have different amounts of alcohol in them.

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Understanding alcohol consumption

Alcohol units: 

In the UK, alcohol consumption is measured in units. One unit equals 10 millilitres (8 grams) of pure alcohol. The recommended maximum weekly intake for adults is 14 units, spread out over several days.

Standard drink sizes: 

Different types of alcoholic beverages contain varying amounts of alcohol. This is measured in alcohol by volume (ABV).  A standard drink size can help you track your intake:

  • A half-pint of beer (3.5% ABV) = 1.1 units 
  • A small glass of wine (125ml, 12% ABV) = 1.5 units
  • A single measure of spirits (25ml, 40% ABV) = 1 unit
     

One alcohol unit is often referred to as one standard drink. An example of a standard drink is:

  • Half pint of regular beer, lager or cider
  • 1 small glass of wine
  • 1 single measure of spirits
  • 1 small glass of sherry
  • 1 single measure of aperitifs

The following contain more units than one standard drink...

  • Pint of regular beer, lager or cider - 2 units
  • Pint of premium beer, lager or cider - 3 units
  • Alcopop or can/bottle of regular lager - 1.5 units
  • Can of premium lager or strong beer - 2 units
  • Can of super strength lager - 4 units
  • Glass of wine (175ml) - 2 units
  • Bottle of wine - 9  units
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What does alcohol do to your body?

Alcohol dissolves quickly in the blood stream and tends to affect your judgement. It can cause unsteadiness and loss of balance, slurred speech, and blurred vision. It can even lead to unconsciousness and death in extreme situations.

The reason why you shouldn’t drive or operate machinery after drinking alcohol is because it affects your judgement. It also affects your co-ordination – that is, your ability to control your body, and your reaction time slows down. It often does all this without you realising that it is affecting you in these ways. You may do things you wouldn’t do if you hadn’t drunk alcohol, and some of these things you may later regret

Your body treats alcohol as a poison. It works hard to get rid of it. But it takes a healthy liver about one hour to get rid of one unit of alcohol. Fresh air, black coffee, and cold showers won’t help to get alcohol out of your system.

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The impact of alcohol abuse

  1. Alcohol misuse graphic with health risks associated with different parts of the bodyHealth risks: Excessive alcohol consumption can lead to a range of health issues, including liver disease, heart problems, mental health disorders and recent evidence suggests that any level of alcohol consumption puts us at risk of developing certain cancers. Alcohol can also affect our mental health. Sometimes people drink to help with symptoms of anxiety or depression, but unfortunately any relief is temporary, and alcohol only tends to make things worse in the longer term. Alcohol has also been found to be linked to suicide and self-harm.
  2. Social and economic consequences: Alcohol misuse can have significant social and economic implications, including relationship problems, financial strain, and reduced work productivity.
  3. Moral consequences: Excessive alcohol use can contribute to situations where individuals may engage in behaviours that conflict with their moral values, leading to feelings of guilt, shame, or remorse.
  4. Drink driving: Driving under the influence of alcohol is illegal and greatly increases the risk of accidents, injuries, and fatalities on the road.
     
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Guidelines for safe drinking

  1. Know your limits: Understand the recommended guidelines for alcohol consumption and stick to them. Keep track of how much you're drinking and avoid exceeding the recommended limits.
  2. Stay hydrated: Alternate alcoholic drinks with water or non-alcoholic beverages to stay hydrated and reduce the risk of alcohol-related harm.
  3. Plan ahead: If you're going out, plan how you'll get home safely beforehand. Consider using public transportation, designated drivers, or taxi services.
  4. Look out for others: If you notice someone showing signs of intoxication or alcohol poisoning, don't hesitate to seek help. It's essential to look out for each other's well-being.
     
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Weekly drinking guidelines

The Chief Medical Officers’ guideline for both men and women is that: 

  • You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level
  • If you do drink as much as 14 units per week, it is best to spread this evenly over 3 days or more. If you have one or two heavy drinking sessions, you increase your risks of death from long term illnesses and from accidents and injuries 
  • The risk of developing a range of illnesses (including, for example, cancers of the mouth, throat and breast) increases with any amount you drink on a regular basis
  • If you wish to cut down the amount you’re drinking, a good way to help achieve this is to have several drink-free days each week.
     
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Single occasion drinking episodes

This applies to drinking on any single occasion (not regular drinking).

The Chief Medical Officers' advice for men and women who want to keep their short term health risks from single occasion drinking episodes to a low level is to reduce them by:

  • limiting the total amount of alcohol you drink on any single occasion
  • drinking more slowly, drinking with food, and alternating with water
  • planning ahead to avoid problems by making sure you can get home safely or that you have people you trust with you. 

The sorts of things that are more likely to happen if you do not understand and judge correctly the risks of drinking too much on a single occasion can include:

  • accidents resulting in injury; causing death in some cases
  • misjudging risky situations, and
  • losing self-control (e.g. engaging in unprotected sex)
     
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Pregnancy and drinking

The Chief Medical Officers' guideline is that:

  • If you are pregnant or think you could become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum.
  • Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk. The risk of harm to the baby is likely to be low if you have drunk only small amounts of alcohol before you knew you were pregnant or during pregnancy. 
  • If you find out you are pregnant after you have drunk alcohol during early pregnancy, you should avoid further drinking. You should be aware that it is unlikely in most cases that your baby has been affected. If you’re worried about alcohol use during pregnancy, do talk to your doctor or midwife.
     
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How do people use alcohol?

Some people choose not to drink alcohol at all. Of those people who drink alcohol, most people in this country (55-65%) drink at low risk levels.

What’s everyone else like? (% of population)

graph showing alcohol usage between male and females

This graph shows that:

  • 13.4% of men and 19.9% of women abstain from drinking alcohol. 
  • 53.9% of men and 63.8% of women drink alcohol at a lower risk level
  • 27.4% of men and 12.6% of women drink alcohol at an increasing risk level
  • 5.4% of men and 3.7% of women drink alcohol at a higher risk level

But different people use alcohol in different ways. These are some of the different ways people use alcohol.

Which of these people are you most like, in the way you use alcohol?

AJ is typical of the majority of people in Britain. He enjoys a pint or two a couple of times a week. He tends to do this either with his mates at the local pub in the evening, or at family celebrations such as birthday parties. He and his partner like to organise a baby sitter once in a while and treat themselves to a meal with wine at a restaurant. It is the company of his friends and family that AJ enjoys. He’s not that bothered about the alcohol, although he enjoys it when he does have a drink.

If you are like AJ, then probably you are drinking at what health guidelines call a low risk level. If you are otherwise in good health, then the alcohol you drink should cause you no harm. But you may still find this guide helpful to you. You will be able to check that you really are a low-risk drinker. It will also help you understand how and why it is important not to increase your drinking.
 

AK likes to go out with her friends about twice a week. She usually just has one or two drinks but sometimes finds she drinks a bit more than this. This tends to happen when she drinks with her friends in rounds or during “happy hour” or promotions when the drinks are cheaper. She does not feel she drinks too much.

She accepts the occasional hangover without concern. Recently, she has started having a glass of wine at home most evenings.

If you are like AK then you might be surprised to learn that you are drinking at a level which health guidelines call increasing risk. This means that while you are unlikely to be actually causing harm to yourself right now, you are putting yourself at risk. Your drinking is at a level where you may be putting yourself at risk of having an accident or having serious health problems in the long term. In fact, if you drink like AK, then probably there are days when you feel tired or hung-over because of the way you use alcohol. If you feel you may be drinking at increased risk, then using this guide will help you return to being a low risk drinker. You will then avoid the long-term risks to your health that too much alcohol can cause.

AL likes to have a drink on a regular basis. He goes to the pub most nights and has at least 3 to 4 pints. Recently he has been having arguments with his partner. She is not happy, both with the amount of time he spends in the pub and the amount of money he spends when he’s in there. Also, recently, he has had to take time off work when he has been hung-over the following day. He is now finding it difficult to fall asleep unless he has had a drink. He also finds he has to drink more to get the same effect he once had from smaller amounts. His partner thinks he has a problem and that it is getting worse and it continues to be a source of arguments.

If you are like AL then you could be damaging your health right now. Probably, you are drinking more alcohol than your body can cope with. If that is the case, then you are probably drinking at what health guidelines call a higher level of risk.

Over time your body will have more and more difficulty dealing with the alcohol you are drinking. Your health will suffer. It might even be, looking back to how you used to be when you drank less than you do now, that you do notice some differences. You may feel bloated or have ‘tummy troubles’. Perhaps you don’t feel as energetic as you used to. You may not sleep as well or wake feeling as rested. Possibly you feel less happy, even low in mood some days. If this sounds like you, then you should use this guide to help you cut down both how much and how often you drink. You’ll be surprised how much better you feel if you do.
 

AM feels she needs to drink every day. If she does not have a drink she suffers from shaking, feeling sick, feeling anxious and sweating. She recently lost her job due to her drinking and can only afford to drink the cheapest brands. She drinks a bottle of vodka most days. She has tried putting her first drink of the day off for as long as possible, but now finds it is getting earlier each day and is sometimes as soon as she gets up. She thinks she is drinking too much and would like to change but is afraid of the feelings she has when she tries to cut down. She knows she needs to talk to someone about her drinking and has thought of making an appointment to see her doctor, but hasn’t yet done so.

If you are like AM then you may find it difficult to stop drinking alcohol. You may begin to feel more unwell if you don’t drink than if you do. If that is the case then you could be what health guidelines call a dependent drinker.

Even if you are a dependent drinker, don’t worry. There is help available. You can find out how to get help later in this guide.

Urgent help

If you think you may be physically dependent on alcohol then it is very important that you see your doctor before you stop drinking. The reason for this is that it can be harmful to stop suddenly and the effects of sudden withdrawal can be very severe and possibly life threatening.

To understand more about your relationship with alcohol read more of this guide and do one or two of the exercises. This may help you be more clear what type of drinker you are. More importantly, you’ll discover what you want to do about it and what you can do.

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What kind of drinker are you?

To find out what kind of drinker you are, think about the amount of alcohol you drink and also the pattern of your drinking. The pattern of your drinking is made up of the times when you drink alcohol and the times when you do not, and who you drink alcohol with.

Think about how you used alcohol in the last week. Now fill out the diary. Perhaps you cannot remember exactly what you had to drink last week, or when. In that case, keep a diary in the coming week. Each day, record on the sheet where, what, why and with whom you were drinking. In the small boxes, put the number of units consumed.

Drinking diary

AM/PM/Eve Where and with whom/alone Type of drink Units £ spent
Mon
Tue
Wed
Thu
Fri
Sat
Sun
Total

How much money did you spend on alcohol in the week?

When you have completed your Drinking Diary, use it to help you answer the following questions.

Questions Scoring System Your score
0 1 2 3 4
How often do you have a drink that contains alcohol?
How many standard alcoholic drinks (i.e.units) do you have on a typical day when you are drinking?
How often do you have six or more standard drinks (units) on one occasion?
How often in the last year have you found you were not able to stop drinking once you had started?
How often in the last year have you failed to do what was expected of you because of drinking?
How often in the last year have you needed an alcoholic drink in the morning to get you going?
How often in the last year have you had a feeling of guilt or regret after drinking?
How often in the last year have you not been able to remember what happened when drinking the night before?
Have you or someone else been injured as a result of your drinking?
Has a relative/friend/doctor/health worker been concerned about your drinking or advised you to cut down?
Add up the numbers in the right hand column. What is the total?

Your total score is: 0

You are probably drinking sensibly and with low risk. (low risk)

Your drinking is possibly becoming hazardous to your health. You are increasing the risk to your health. (increasing risk)

Your drinking is probably harmful now or in the longer term. Although you may not notice it, there is a high risk that your health is suffering because of alcohol. (higher risk)

You may be alcohol dependent. (high risk and possible dependence)

  • If you scored up to 7, you are probably drinking sensibly and with low risk. (low risk)
  • If you scored between 8 and 15, then your drinking is possibly becoming hazardous to your health. You are increasing the risk to your health. (increasing risk)
  • If you scored between 16 and 19, then your drinking is probably harmful now or in the longer term. Although you may not notice it, there is a high risk that your health is suffering because of alcohol. (higher risk)
  • If you are scoring 20 or more, then you may be alcohol dependent. (high risk and possible dependence)

Now put the information together that you have learned about yourself.

My drinking is probably

If you believe that you are a high risk and dependent drinker, then it is very important that you see your doctor before you stop drinking.

If you are unhappy with the amount you drink, and believe you may be an increasing or higher risk drinker then you should find help in the following pages.
 

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How can you control your drinking?

The way you drink alcohol now is in part a habit. It is a habit that took time to develop. Now you should take time to make new habits in the way you use alcohol.

Planning

  • Begin to take control of your drinking by planning when and how much you will drink
  • Use your drinking diary to plan when you will drink alcohol and how much you will drink
  • Use your diaries to work out habits in your drinking. Do you drink while eating snacks, or watching TV, or while cooking? If so, try to break these habits by setting yourself new rules and not drinking at these habitual times
  • Identify high-risk times i.e., times when you know that you might drink too much e.g., on a night out with friends, at home after a hard day, on Friday or Saturday nights, and have a plan to deal with this
  • Pick at least two days a week when you will not drink any alcohol
  • On days when you plan to drink, pick the time when you will stop drinking and leave the pub or bar, or the time when you will go to bed
  • On the days when you plan to drink alcohol, write down what types of drinks you will have and how many. Try to work out how many units of alcohol you will drink
  • Keep track of how much you really drink by recording what you actually had next to what you planned to have
  • Plan to eat before you start drinking, and if possible, eat while you are drinking. This can help to reduce the effect of alcohol on your body
  • Tell your friends and family if you feel they will support you
  • If you have a supportive partner or friend who also wishes to reduce, it can be really helpful to work on this together
  • Keep a record of your mood. People often find their mood is better on days when they don’t drink, and worse when they do, particularly the day after

Cutting down

Begin to reduce the amount of alcohol you actually drink by trimming back at the times you’ll least miss it.

  • If you go out to drink, don’t have a drink at home beforehand
  • If you do pre-drink before going out, try to reduce your alcohol intake once out
  • Try to eat before drinking alcohol. You will probably drink less if you are full
  • Start drinking later in the evening, whether you drink at home or go out to drink; set a time before which you won’t have an alcoholic drink
  • If you drink spirits, dilute them with a mixer (tonic, soda, ginger ale, lemonade etc.) and increase the amounts of the mixer to make them ‘long drinks’
  • If you drink wine, buy small glasses rather than large ones and try ‘spritzers’ (mixing your wine with soda or lemonade)

Try to drink lower strength wines. Sparkling wine tends to be slightly lower strength and comes in a smaller measure!

If you drink beer or lager, stick to standard strength and avoid extra-strength varieties or premium varieties.

Alternatives

Begin to reduce the time you spend drinking alcohol by looking for alternatives.

  • Pick one day a week when you usually drink alcohol and do something else instead e.g. go to the cinema, go swimming or some other activity
  • If you tend to drink alcohol at home, experiment with non-alcoholic drinks until you find one that you enjoy. These may be cold soft drinks such as fizzy drinks, cordials or fruit juices.  Or they may be hot drinks such as tea, coffee, hot chocolate, or malted drinks. Also, look for new activities at home that may interest you and don’t involve drinking e.g. crosswords, puzzles, gardening, reading
  • If you tend to drink alcohol when you are out with friends, offer to be the non-drinking driver so you have a good excuse ready for not drinking alcohol
  • If you are drinking alcohol, alternate your alcoholic drinks with non-alcoholic drinks. Remember many pubs now sell tea and coffee

Drinking due to other issues

Some people turn to alcohol to cope with their anxiety, stress, or low mood. Some people use alcohol as a means of self-medication to improve sleep or alleviate their physical pain. If you are encountering any of these challenges, it is crucial that you seek assistance from your doctor or alcohol services. 
 

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What if you are a dependent drinker?

If you are a dependent drinker, then when you are drinking this is likely to be continuous and heavy. Continuous heavy drinking can lead to a number of health problems. When you are dependent on alcohol, you may experience a strong internal drive to use alcohol along with an impaired ability to control its use, increasing priority is given to the use of alcohol over other activities and you may continue to use alcohol despite harm or negative consequences. Physical signs of dependence may also be present, including withdrawal symptoms following stopping of or reduction in use of alcohol.

Continuous heavy drinking

Many people who drink very heavily every day do not eat properly. In particular, they do not get enough Vitamin B. At the same time, the body needs extra Vitamin B to repair the damage caused by alcohol. It particularly needs Vitamin B to repair damage to nerve cells in the body, including the brain. Very heavy drinking flushes vitamins out of the body. So the very heavy drinker needs more Vitamin B than most people but usually gets less. This leads to nerve damage. Many very heavy drinkers first experience damage to their nerves as ‘pins and needles’ in their fingers and toes. The very heavy drinker can also be left with no ability to lay down new memories. This is a type of dementia specifically associated with very heavy drinking. It is caused by a lack of Thiamine, which is a type of Vitamin B needed by the brain to make new memories.

Very heavy drinkers may also experience being breathless when doing ordinary activities, like walking upstairs. They may feel constantly tired. And they may find that they bruise very easily. This is because the alcohol is damaging the blood cells that carry oxygen and other blood cells that help stop bleeding.

Very heavy drinkers may also get diabetes because of damage to their pancreas, which normally produces insulin. They may also damage their liver, but they are unlikely to actually feel that damage being done.

If you experience any of these symptoms it is important you this discuss this with your doctor.

Suddenly stopping very heavy drinking

The body, and especially the brain, will try to adjust to cope with large amounts of alcohol if the alcohol is present in the body all the time. That means that the body has to readjust if the alcohol is taken away.

If your body has adjusted to coping with continuous large amounts of alcohol and then the alcohol is suddenly stopped then you may experience the following:

  • Shaking or tremors all over
  • Very heavy sweating
  • Extremely high blood pressure and looking very red in the face
  • Vomiting and diarrhoea, and the only way to keep down any food will be after drinking more alcohol
  • Very tense and agitated, being unable to settle down or do anything
  • Feeling very confused, not knowing the time, or where you are and having a very poor short-term memory so that you cannot recall what happened recently
  • Hallucinating: you may just ‘sense’ that bad things are happening, or you may actually see or hear things that aren’t there; typically, people in this state ‘see’ spiders, rats or snakes
  • You may suffer ‘fits’, during which you lose control of your body, collapse, and become unconscious

These are symptoms of physical withdrawal from alcohol. The symptoms are very dangerous and can be fatal. They can also lead to permanent brain damage. Continuing to drink heavily however will eventually lead to serious health problems.  Although your body tries to adjust, it gradually gets worse rather than better at dealing with the damage alcohol causes.
 

Warning:

If you believe that you are dependent on alcohol, then it is very important that you see your doctor or a local specialist service to help you stop drinking. Remember, with the right kind of help, anybody can come off alcohol safely.
 

Alcohol can be enjoyed responsibly, but it's crucial to be aware of its potential risks and to drink in moderation. By understanding the guidelines for safe drinking and seeking support when needed, we can all contribute to healthier, happier communities.
 

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Useful organisations and information

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Useful books

  • Allen Carr's easy way to control alcohol. 2nd edition  
    Allen Carr
    Arcturus Publishing 2009
    A book that offers the solution to anyone who sincerely wants to turn their back on a problem that ruins lives, tears families apart, fuels crime and costs the economy billions of pounds every year.
  • Overcoming problem drinking
    Marcantonio Spada
    Robinsons 2009
    A self-help book aimed specifically at problem drinking uses an approach based on real clinical practice, first to recognise alcohol misuse and then, using proven Cognitive Behavioural Therapy (CBT) techniques, to show the drinker how to turn the tables and regain control of alcohol consumption.
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References

A full list of references is available on request by emailing pic@cntw.nhs.uk

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Acknowledgement

Original guide written by Dr Lesley Maunder and Lorna Cameron, Consultant Clinical Psychologists, and healthcare staff Nick Holdsworth, Pip Anslow, David Crawford, Debra Hall, Allan Jacques, Dave McNally, Susan Reynolds and Ann Widdas.

The guide was reviewed and re-written in 2024 by Dr Margaret Orange, Associate Director (Addictions Governance), Dr Sophie Quarshie, Consultant Psychiatrist and Dr Afiz Ashraf, ST6 trainee, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust has developed this resource with the support of NHS healthcare staff, service users and local voluntary sector groups.

Published by Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

2024 Copyright PIC/86/0324 March 2024 V5

Review date 2027

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