Know your limits: UK alcohol consumption raises alarm bells


After what seems like an eternity of black clouds and rainfall, many of us are finally venturing into the garden to shake the cover off the barbeque when the drier weather allows us some respite. With the alluring idea of al fresco dining and all the tasty foods that go with it, it’s not surprising that many a household sit down to dinner with wine or beer… but at what point does our leisurely consumption of alcohol overstep the mark and go beyond moderation?

Over half of respondents scored positive for a suspected Alcohol Use Disorder

The potential harmful consequences of drinking ‘one too many’ may be more significant than many adults are aware of or acknowledge, with many people simply not knowing how much is safe compared to how much they actually drink.  In a recent survey looking at the drinking habits of 294 UK adults,  just over half reported exceeding the government recommendations for sensible drinking,  and furthermore  may be misusing alcohol to the point that concerns are raised as to the long term health impact if these patterns continue.

Identifying individuals with early alcohol problems using self-report questionnaires

The use of questionnaire studies offer a valuable method for the collection of information that may help to define alcohol drinking behaviour in relation to the incidence of alcohol-related disease or harm.  This study comprised a cross-sectional open-survey posted on the social networking site ‘Facebook’ using the Alcohol Use Disorders Identification Test (AUDIT).  The AUDIT is a simple 10-question test developed by the World Health Organization (WHO) designed as a screening tool with the purpose of identifying individuals with early alcohol problems.  Scores for each question range from 0 to 4 and give rise to a final score ranging from 0 to 40.  A cut-off score of ≥ 6 in women and ≥ 8 for men gives a positive screen and is positive indicator of alcohol misuse i.e., the likely presence of an Alcohol Use Disorder (AUD).

How much is too much?

Recommendations for ‘sensible’ weekly consumption (up to 21 units in men and 14 units in women) were first proposed by the Royal College of Physicians over twenty years ago (Royal College of Physicians, 1987), and yet exceeding these guidelines is now commonplace practice within the UK.  Until the mid-1990s, UK guidelines for safe consumption of alcohol were based around these weekly unit limits. Concern regarding the differing effects of large amounts of alcohol being consumed in a single drinking occasion versus the potential benefits of drinking a small amount daily over a week for certain groups led the UK Government to introduce ‘sensible drinking guidelines’, with daily maximum recommended units of alcohol consumption of no more than 3–4 units for men and 2–3 units for women (Department of Health, 1995).   Given that a medium glass (175 ml) of 12% alcohol by volume (ABV) wine contains around two units of alcohol and a pint of beer with 3.5% ABV contains almost two, it is easy to see how many people may easily and unwittingly exceed these guidelines.

Study findings

A standard ‘drink’ was considered to be eight grams of pure alcohol equating to one unit. For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent one standard drink.

The AUDIT score was used to classify the respondents into four groups; non-drinkers and/or low-level drinker; hazardous or moderate-level problem drinker; harmful or high level problem drinker; and very high risk or probably dependent drinkers as outlined in Table 1.

 

AUDIT score

 

Risk

 

Representation

Male

Female

 

 

0-7

0-5

Minimal concern

Represents low risk drinking or abstinence

8-15

6-12

‘Hazardous’ drinking

Represents a medium level of alcohol problem

16-19

13-19

‘Harmful’ drinking

Represents a high level of alcohol problem

20-40

20-40

‘Possibly dependent’

Warrants further diagnostic evaluation for alcohol dependence

Table 1.  Risk domains of the Alcohol Use and Disorders Identification Test.

Overall, 52.6% of respondents scored positive for a suspected AUD with 32.3% of respondents identified as hazardous drinkers, 12.3% as harmful and 7.1% had an AUDIT score of more than 20, indicating possible dependence.   There were no significant differences between male and females in regards to positive scores for AUD, or scores for any of the four scoring domains.     Interestingly, although the proportion of men who identified as possibly dependent was double that of women [11.5% vs. 5.5%], overall these gender differences did not reach significance (p = 0.065).

Binge drinking behaviour and gender

Binge drinking is defined as drinking more than twice the recommended maximum daily units on the heaviest drinking day in the last week (more than 8 units for men and more than 6 for women), and  is a habit normally associated with males.  In this study, whilst the amount of men who identified as binge drinkers was higher than women [26.6% vs. 18%], these figures failed to reach significance (p = 0.092) indicating that, overall, women’s binge drinking behaviour was similar to that of males.

The increase in hazardous drinking behaviour that is being observed among young women is certainly leading to suggestions that women are indeed beginning to drink more like men, with media headlines suggesting that “British women match men for binge drinking” and that “Teenage girls in Britain are more likely to be binge drinkers than anywhere else in Europe.” According to the Office for National Statistics, men are still drinking more than women but they have on average reduced their consumption frequency over the last nine years whilst women have increased consumption frequency (Statistics on Alcohol 2003; Statistics on Alcohol 2012).   These trends certainly imply that public health efforts may be needed to specifically target changes in drinking habits associated with women due to specific differences in how males and females metabolise alcohol.

Why women should be aware of just how much they drink

There are specific metabolic differences in alcohol uptake and clearance between the sexes, making women more vulnerable to the long-term damage associated with binge drinking. For example, women have a slower initial alcohol metabolism stage (first pass), resulting in high alcohol absorption in the blood. Coupled with lower alcohol-dehydrogenase enzyme levels in women’s stomachs and their lower body water content, women generally have higher blood ethanol concentrations than men after consuming comparable amounts of alcohol, even with allowance for differences in size (Frezza et al., 1990).

The long-term effects of harmful drinking behaviour

Whilst moderate alcohol, and specifically wine intake, may protect the heart and nervous systems and may even increase longevity, there is a strong adverse link between heavy drinking, poor health and disease risk.  For example, heavy drinking over many years is known to affect cardiac and neurological systems as well as gastrointestinal, immune, haematological, musculoskeletal and other organ systems (Parry et al., 2011).   Furthermore, heavy alcohol consumption and long-term binge drinking behaviour  is significantly associated with an increased risk of developing several cancers, including; oral and pharyngeal cancer (5-fold risk),  oesophageal squamous cell carcinoma (5-fold risk), laryngeal cancer (2.5-fold risk), and as much as 30% for pancreatic, and 50% for colorectal and breast cancers (Pelucchi et al., 2011).  Within western Europe, the UK has one of the highest levels of binge drinking, and in 2007 a quarter of adults aged 16 and over in England were classified as hazardous drinkers (Statistics on Alcohol: England, 2012).

Men & women reported similarly hazardous drinking behaviours

Know your limits!

Several lines of evidence suggest that women’s consumption of alcohol may be increasing and that a ‘binge’ drinking pattern of behaviour is also becoming more frequent.  This study attempted to address the hypothesis that there is a narrowing of such habits between genders and found no significant differences in hazardous and harmful drinking behaviour between the sexes.

If gender differences are truly diminishing, the concept of alcohol problems being a male dominated health outcome will need to be addressed given the gender differences in clinical outcomes and disease progression.

Many of us enjoy the odd glass of wine or gin and tonic, but many heavy drinkers may genuinely be unaware of just how much they drink, or of the potential harmful consequences of their consumption and therefore not motivated to decrease their alcohol use.   Simply by following a few sensible behaviours when drinking can help to moderate your consumption and reduce the negative health impact.

  • Avoid drinking on an empty stomach
  • Keep count of the amount of drinks you’ve had
  • Spacing your drinks over a longer period of time
  • Alternate between soft drinks and alcoholic drinks

References

DEPARTMENT OF HEALTH: Sensible Drinking: The Report of an Inter-Departmental Working Group. London: Department of Health; 1995. www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4084701

FREZZA, M., DI PADOVA, C., POZZATO, G., TERPIN, M., BARAONA, E. & LIEBER, C. S. 1990. High blood alcohol levels in women. The role of decreased gastric alcohol dehydrogenase activity and first-pass metabolism. The New England journal of medicine, 322, 95-9.

PARRY, C. D., PATRA, J. & REHM, J. 2011. Alcohol consumption and non-communicable diseases: epidemiology and policy implications. Addiction, 106, 1718-24.

PELUCCHI, C., TRAMACERE, I., BOFFETTA, P., NEGRI, E. & LA VECCHIA, C. 2011. Alcohol consumption and cancer risk. Nutrition and cancer, 63, 983-90.

STATISITICS ON ALCOHOL: England, 2003

http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/StatisticalWorkAreas/Statisticalpublichealth/DH_4080010

STATISITICS ON ALCOHOL: England, 2012 http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/Alcohol_2011/NHSIC_Statistics_on_Alcohol_England_2012.pdf

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