Alcohol consumption

Alcohol screening

• CAGE Questionnaire

Centers for Disease Control and Prevention (CDC) states:

• Moderate alcohol consumption is defined as no more than one drink per day and two drinks per day for women and men, respectively.
  •  National Institute on Alcohol Abuse and Alcoholism, “Women absorb and metabolize alcohol differently than men. In general, women have less body water than men of similar body weight, so that women achieve higher concentrations of alcohol in the blood after drinking equivalent amounts of alcohol.”
• Harmful alcohol use is defined as ≥ 2 drinks/day or ≥ 7/week in women and ≥ 3 drinks/day or ≥ 14/week in men.
• Heavy drinking is defined as ≥ 8 drinks per week for women and ≥ 15 drinks per week for men.
• Excessive alcohol use includes heavy drinking, binge drinking, and any alcohol use by people aged < 21 years or pregnant.
• Binge drinking is defined as ≥ 4 drinks within about 2 hours for women and ≥ 5 drinks within about 2 hours for men and drinking on an empty stomach.

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Applies to people over 18 years old and who are not sensitive to alcohol:

One who drinks a small amount of alcohol seem to have a lower risk of heart disease than not at all, however one recommends no more than:

How to calculate alcohol units:

• https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/

When to see an healthcare professional  if one feels they are drinking too much alcohol:

• Alcohol Use Disorders Identification Tool (AUDIT).
• If one scores above 5 in AUDIT- C then proceed further (The further assessment: The full version uses ten questions to assess frequency of drinking, dependency indicators and problems related to alcohol use)
• A score of 8–15 indicates increasing risk of alcohol misuse
• 16–19 points to a higher risk of alcohol misuse
• If one scores above 20  indicates alcohol dependency.
• Scores between 8-19 need to be discussed with a healthcare professional to look at ways to reduce alcohol consumption.
• Scores above 20 need to be seen by a Medical Doctor.

• It is advised to have an alcohol free period for two days a week.
• One cannot ‘save’ units of alcohol from one day in week and use later.
• Avoid binge alcohol drinking.
• Alcohol drinking in pregnancy is not recommended.
• Beware of Alcohol withdrawal symptoms.

• Alcohol can have a range of harmful impacts on a fetus, collectively known as fetal alcohol spectrum disorder.
• Women who are pregnant or think they could become pregnant should be advised that:
• The safest approach is not to drink alcohol at all;
• The more alcohol the mother drinks, the greater the risks to the baby;
• The risks of harm are likely to be low from drinking small amounts of alcohol before pregnancy is known.
• As alcohol can pass from the mother into breastmilk, it is safest for women who are breastfeeding not to drink alcohol.
• If they do drink, they should avoid drinking 2–3 hours before breastfeeding, or they should express milk beforehand to give to their baby later.

Department of Health. UK chief medical officers’ low risk drinking guidelines. 2016. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/545937/UK_CMOs__report.pdf (accessed June 2020)

NHS UK. Start 4 Life. Alcohol and breastfeeding. 2016. Available at: https://www.nhs.uk/start4life/baby/breastfeeding/healthy-diet/alcohol-and-breastfeeding/ (accessed June 2020)

Long term alcoholism can lead to physicals sign of:

• Boerhaave Syndrome (Medical emergency)
• CNS depression (Medical emergency)
• Gynecomastia
• Spider angiomata
• Dupuytren contractures (also may be congenital)
• Testicular atrophy (shrinking of testicles)- males
• Enlarged or shrunken liver
• Enlarged spleen
• Anaemia
• Cardiovascular disease
• Compartment syndrome
• Hypertension
• Cancer
• Gout
• Gigantomastia/Macromastia (Breast hypertrophy)
• Madelung’s disease
• Rhabdomyolysis (Crush syndrome)
• Neuropathy (numbness, tingling, muscle weakness and pain in the affected area)
• Gerstmann syndrome
• Seizures
• Serious infections
• Ludwig’s angina
• Priapism
• Subacute cerebellar degeneration

High alcohol consumption can lead to:

• Liver disease and complications:
  • Cirrhosis- scarring of the liver
  • Portal blood flow hypertension/resistance
  • Alcoholic hepatic steatosis- fatty liver disease (build up of fat inside your liver cells)
  • Hepatic encephalopathy (Medical emergency)
  • Liver cancer
  • Epiglottitis (Medical Emergency)
  • Hypothermia (Medical Emergency)
  • Oesophagus (food pipe) damage and varices (blood vessels veins around your food pipe  that are enlarged or swollen)  causing bleeding of food wipe
  • Mallory-Weiss tear
  • Oesophageal cancer
• Splenomegaly (enlargement of the spleen)
• Cardiovascular disease (Heart disease) at high alcohol consumption
  • Holiday heart syndrome – heart rhythm changed when drinking alcohol
  • Atrial fibrillation
  • Brugada syndrome
• Stroke (alcohol has a anti-clotting effect to0 much can cause bodily bleeding)
• Diverticulitis and Diverticular Disease
• Pancreatitis
• Pancreatic cancer
• Immune suppression (alcohol causes dysfunction of immune cells such as  neutrophils and anti tumour attacking cells) leading one to be prone to infections i.e. bacterial meningitis
• Foetal alcohol syndrome- (when pregnant females drink alcohol causing abnormalities to their baby especially in the first trimester).
  • Symptoms of baby include:
    • Small head
    • Flat face
    • Small eye opening
    • Epicanthal folds (skin fold of the upper eyelid covering the inner corner of the eye)
    • Short nose
    • Low nasal bridge
    • Smooth Philtrum (Flat skin surface, with no ridge formation in the central region of the upper lip between the nasal base and upper vermilion border)
    • Thin upper lip
    • Underdeveloped jaw
    • Genital malformations
    • Heart (cardiac) defects
    • Infants often experience alcohol addiction withdrawal symptoms , this  may include tremors and/or convulsions, irritability, increased muscle tone, muscle and/or whole body spasms, increased respiratory rate, abdominal swelling (distention) and/or vomiting
    • Joint abnormalities
  • Alcohol metabolite acetaldehyde- (alcohol is converted to aldehyde in our body which is toxic and cancerous)
  • Sodium deficiency (Medical emergency)
  • Vitamin B1 (thiamine) deficiency:
    • Wernicke-encephalopathy
    • Korsakoff syndrome

Driving Authority

• One should notify their driving authority if one has this condition/disease.

This condition may show similar symptoms to:

• Gut fermentation syndrome (where carbohydrates are digested by gut fungi and can cause medical and social concerns of alcoholism)
• Narcissistic Personality Disorder

Please talk to your healthcare professional (i.e. Medical Doctor/Pharmacist) for further advice