Alcohol misuse means drinking excessively - more than the recommended limits of alcohol consumption (see below).
This can lead to a number of harmful physical and psychological effects, such as alcohol poisoning, cirrhosis of the liver, inability to work and socialise and destructive behaviours, such as drink-driving.
Your risk of developing problems increases with the amount of alcohol you drink. The three main risk categories based on how much you drink, that can be used to help judge your own level of risk, are lower-risk, increasing-risk and higher-risk.
Lower-risk drinking is drinking at a level associated with a low risk of future harm to your health.
For men, lower-risk is drinking no more than 3-4 units of alcohol a day on a regular basis. For women, it’s lower risk if they drink no more than 2-3 units of alcohol a day on a regular basis.
Sensible' or 'responsible' drinking are sometimes used to mean lower-risk drinking.
Increasing-risk drinking is drinking associated with an increased risk of future harm to your health, with the risk increasing the more you drink.
For men, this riskier level of drinking is drinking more than 3-4 units of alcohol a day on a regular basis. For women, it's drinking more than 2-3 units a day on a regular basis.
Higher-risk drinking is drinking at such a high level that you’re at particularly high risk of harming your health.
For men, higher-risk drinking is regularly drinking over over 50 units a week (eight units of alcohol a day). For women, it’s regularly drinking over 35 units a week (over six units of alcohol a day).
Other categories of alcohol misuse
The term 'binge drinking' usually refers to an episode of heavy drinking over a short period of time, such as over the course of an evening or over an hour or two. It also refers to an episode of drinking to intoxication or to drunkenness.
Binge drinking can affect your health in a number of ways. For example, it can increase your immediate risk of being in an accident, becoming involved in an argument or fight, or taking part in illegal or risky behaviour, such as drink-driving or unsafe sex.
Different people are affected differently by how much they drink. Alcohol can also affect a person differently at different times. Some people will be at risk of the immediate harms to their health even if they don’t think they’re getting drunk.
Hazardous drinking usually refers to drinking above the recommended lower-risk levels but without, yet, showing evidence of harm to health.
Harmful drinking refers to those already experiencing or showing evidence of health harms (but not if just showing evidence of alcohol dependence).
Dependent drinking refers to having developed alcohol dependence, which is a specific health harm where the person affected has started to have an excessive desire to drink, or is showing some loss of control over their drinking.
This has usually started to affect the person’s quality of life and relationships, but they may not always find it easy to see this or to accept it.
For someone with severe alcohol dependence who experiences physical alcohol withdrawals when they cut down or stop drinking, suddenly cutting down or stopping can be dangerous without seeking medical advice.
Physical withdrawal symptoms include:
- hand tremors ('the shakes')
- visual hallucinations (seeing things that aren’t real)
- seizures (fits) in the most serious cases
Psychological withdrawal symptoms include:
- 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, amounts that would incapacitate or even kill some people.
Risks of alcohol misuse
The short-term risks of alcohol misuse include:
- alcohol poisoning - this may lead to vomiting, seizures (fits) and falling unconscious
- accidents and injuries requiring hospital treatment, such as a head injury
- violent behaviour that might lead to being arrested by police
- unprotected sex that could potentially lead to unplanned pregnancy or sexually transmitted infections (STIs)
- loss of personal possessions, such as wallets, keys or mobile phones, leading to stress and anxiety
Long-term alcohol misuse is a major risk factor for serious conditions including:
As well as causing serious 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.
Units of alcohol
Alcohol is measured in units. A unit of alcohol is 10ml of pure alcohol, which is about half a pint of normal strength lager or a single measure (25ml) of spirits. A small glass (125ml) of wine contains about one-and-a-half units of alcohol.
Men should not regularly drink more than 3-4 units of alcohol a day, and women should not regularly drink more than 2-3 units a day.
'Regularly' means drinking this amount every day or most days of the week.
It's also recommended that both men and women should have at least two alcohol-free days each week. Your health is at risk if you regularly exceed recommended daily limits.
Am I drinking too much alcohol?
You could be misusing alcohol if:
- you feel you should cut down on your drinking
- other people have been criticising your drinking
- you feel guilty or bad about your drinking
- you need a drink first thing in the morning to steady your nerves or get rid of a hangover
Someone you know may be misusing alcohol if:
- they regularly exceed the recommended daily limit for alcohol (see above)
- they are sometimes unable to remember what happened the night before due to their drinking
- they fail to do what was expected of them as a result of their drinking - for example, missing an appointment or work due to being drunk or hungover
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 the:
- Alcohol Use Disorders Identification Test (AUDIT)
- Fast Alcohol Screening Test (FAST)
It's important to be truthful when answering the questions in these tests. The doctor or nurse is asking these questions to ensure you get the best possible advice and treatment.
For example, they might want to start you on a medicine that will either not work properly if you drink, or may even be dangerous to take with alcohol.
Read more about diagnosing alcohol misuse.
Treating alcohol misuse
How alcohol misuse is treated depends on how much alcohol a person is drinking. Treatment options include:
- detoxification - involves a nurse or doctor supporting you to safely stop drinking; this can be done by helping you slowly cut down over time or by giving you medicines to prevent you experiencing withdrawal
- counselling - including self-help groups and talking therapies, such as cognitive behavioural therapy (CBT)
- medication - there are two main types of medicines to help people stop drinking; the first is to help stop withdrawal symptoms and is given in reducing doses over a short period of time; the most common medicine that’s used in this way is called chlordiazapoxide (Librium); the second is a medication to reduce any urge you may have to drink; the most common medications used for this are acamprosate and naltrexone; these medicines are given at a fixed dose and you'll usually be on them for 6-12 months
Read more about the treatment options for alcohol misuse.
If you're 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 a number of charities and support groups across the UK that provide support and advice for people with an alcohol misuse problem.
For example, you may want to contact:
Alcohol and pregnancy
The Department of Health recommends pregnant women and women trying to conceive should avoid drinking alcohol. If they do choose to drink, they should not drink more than 1-2 units of alcohol once or twice a week and should avoid getting drunk.