Family doctor

Overview:

• Alcohol may be good for your heart if taken in moderation.
• Teetotalers and heavy drinkers have higher death rates than moderate drinkers do
• There is controversy over what moderate drinking means
• More than three drinks a day for men and over two for women is considered too much
• One in 13 people are believed to be alcoholics
• Heavy drinking has been linked to suicide, fatal accidents and fatal diseases
• Alcohol can harm unborn children
• Drinkers are advised to have alcohol free days
• There is a wide range of alcohol treatment programmes available

What are the issues?

Many drinkers have been heartened in recent years by the news from several studies that alcohol may actually be good for you. However, it must be stressed that drinking alcohol is only beneficial if it's done in moderation.

The majority of the population drinks alcohol, only about 10 percent are teetotalers.

Alcohol dependency is one of the most common drug problems all over the world. One person in 13 is believed to be an alcoholic. Several million more people drink too much and are at risk of alcohol abuse.

Alcohol addiction is a serious issue. Alcohol consumption is linked to 80 percent of suicides, 50 percent of murders, 30 percent of fatal road crashes, and 15 percent of drownings. It is also a factor in one in three divorces, and one in three cases of child abuse.

Drinking alcohol can increase the likelihood of cirrhosis of the liver, harm an unborn child, and has been linked to breast cancer in women and cancer of the mouth, oesophagus, pharynx, larynx, and liver.

Heavy drinking has also been associated with poor sexual performance, dementia and muscle degeneration.

On the other hand moderate drinking in middle age has been shown to reduce deaths from heart disease by about one third. An Australian study shows the heart attack risk is lowest among men who report one to four drinks daily on five or six days a week and for women who have two standard drinks a day, five or six days a week.

Infrequent drinkers and teetotalers are not advised to drink more because they may run the risk of developing an alcohol problem.

What is moderate drinking?

There is controversy over what moderate drinking is. A common guideline is one standard drink a day for women and two for men, and no heavy drinking sessions at all. Another recommendation is three or four small drinks for men, three or four times a week and two or three small drinks for women, three or four times a week. UK health authorities suggest a limit of 14 drinks a week for women and 21drinks a week for men.

Many people fall outside these guidelines and some could have an alcohol problem.

The definition of a standard drink also varies, but a general guide is one can of beer, one small glass of wine, and one nip of spirits.

There is no strong evidence that wine drinking is any better than drinking beer or spirits.

Women need to drink less than men because they have less fluid in their bodies so alcohol has a stronger effect. They are also smaller than men.

People with low body weight and a small frame should drink less than others.

What are the warning signs of a drinking problem?

Some of the early signs of problem drinking include:

• Drinking faster than others.
• Thinking of ways to get extra drinks when socialising with others
• Spending too much money on alcohol
• Denying the problem and understating how much you are drinking
• Feeling guilt or remorse about drinking
• Memory loss while drinking
• Promising to drink less
• Drinking to cope with normal stress

The CAGE questionnaire is commonly used for people to find out if they have an alcohol problem. Answer the questions honestly:

• Have you ever felt you should Cut down on your drinking?
• Have people Annoyed you by criticising your drinking?
• Have you ever felt bad or Guilty about your drinking?
• Have you ever had an "Eye opener" - a drink first thing in the morning to steady your nerves?

Just one yes answer indicates a possible drinking problem. Yes to more than one question suggests a likely drinking problem. Even if you answered no to all the questions but your drinking is causing problems with relationships, your job, or the law, you should seek help.

When does problem drinking become alcoholism?

There is no standard definition of alcoholism. However, it is generally linked to an uncontrollable urge to drink, needing to drink more to feel the effects, and chronic intoxication.

A strong craving for alcohol, not being able to stop drinking and suffering withdrawal symptoms such as shakiness when sober are all symptoms of alcoholism.

The need for alcohol may become as strong as the desire for food or water. The majority of alcoholics cannot stop drinking without treatment and support.

People who cannot go without a drink for three days in a row may be alcoholics.

It is not unusual for heavy drinkers to deny they have problem.

Men who drink more than six drinks a day and women who have more than four drinks a day are drinking too much and run the risk of illness or alcohol-related problems.

What are the effects of alcohol on unborn children?

Women are advised to abstain from alcohol when they become pregnant or are trying for a baby.

Exposing the fetus to alcohol can cause birth defects known as fetal alcohol syndrome (FAS).

The condition is normally found in babies of mothers who drank excessively during pregnancy. However, studies have also shown it can occur with mothers having just one drink a day.

Infants with FAS may be born small, have problems with eating and sleeping, seeing and hearing, following directions, paying attention at school and making friends.

In serious cases the child may need medical care all their lives and need special-aide teachers.

What can be done to help?

If you think you drink too much try to limit your intake. Alcoholics are advised to give up drinking altogether.

Write down your reasons for cutting down. You may want to do it for health reasons, to sleep better or wake up in the morning without a hang over.

Decide before drinking how many drinks will have and stick to it. Reward yourself with a treat for keeping to your limit.

Team up with a friend and help support each other to drink less.

Avoid rounds because this can make you drink more. Put your glass down between sips to stop drinking as fast.

Pace your drinks by having a non-alcoholic drink in between alcoholic ones.

If you are worried about how much you are drinking go and do something else, go and dance or take time out for five minutes.

It may pay to avoid people and places that make you drink while you are cutting down.

Try to have three alcohol free days a week. Learn how to say no to a drink.

Don't give up if you are not successful the first time. Many people need a few trial runs before reaching their goal.

Seek help from a treatment programme. Most heavy drinkers cannot give up without professional guidance.

Medicines are also available which cause nasty side effects when alcohol is consumed.

How can alcohol abuse be prevented?

Many people are believed to inherit a drinking addiction from their parents. If your parent was or is a heavy drinker then you could be at risk. You need to watch the amount you drink.

People can control their drinking by having three alcohol free days a week, and by not drinking more than four alcoholic beverages in one sitting.

Switch to low alcohol beer and mix drinks with non-alcoholic drinks like lemonade.

Future trends

The future of alcohol use will focus on public awareness of drinking problems and highlighting safe drinking levels.

New treatment methods are also being assessed to help people with drug dependency problems.

The dangerous and social effects of drinking is likely to prevent alcohol being recommended as a health measure, despite research which shows that moderate drinking can be good for the heart.

Getting help

A large number of organisations are available in New Zealand to help people with alcohol dependency. Your doctor may be able to refer you to one of these.

Alcoholics Anonymous and the Salvation Army run programmes in most cities to help people reduce their alcohol intake.

Al-Anon groups around New Zealand run programmes to help family members of alcoholics.

Local hospitals have drug and alcohol services, look for these in your telephone book.

The private Queen Mary Treatment Center in Hamner Springs, Christchurch, runs an inpatient treatment program. Treatment is also available in Auckland.

The Salvation Army Bridge program has an inpatient treatment program in Auckland and on Rotoroa Island in the Hauraki Gulf.