Alcohol misuse


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 poisoningcirrhosis of the liver, inability to work and socialise and destructive behaviours, such as drink-driving.

Am I at risk?

Your risk of developing problems increases with the amount of alcohol you drink. The different risk categories are described below.

Lower-risk drinking

Lower-risk drinking is regularly drinking 21 units of alcohol a week or less (adult men) or 14 units a week or less (adult women). It’s also known as 'sensible' or 'responsible' drinking.

Increased-risk drinking

Increased-risk drinking is regularly drinking 22-50 units of alcohol a week (adult men), or 15-35 units a week (adult women). It’s also known as ‘hazardous’ drinking.

It's possible to drink hazardously by binge drinking, even if you're within your weekly limit. Binge drinking involves drinking a large amount of alcohol in a short space of time - eight units in a day for men and six units in a day for women.

If you're drinking hazardously, you may not have any alcohol-related health problems at the moment, but you're increasing your risk of experiencing problems in the future.

Hazardous drinking, particularly binge drinking, also carries additional risks such as:

  • being involved in an accident
  • becoming involved in an argument or fight
  • taking part in risky or illegal behaviour while drunk, such as having unprotected sex or drink-driving

Higher-risk drinking

Higher-risk drinking is regularly drinking over 50 units of alcohol a week (adult men) or over 35 units a week (adult women). It’s also known as ‘harmful’ drinking.

Harmful drinking means drinking over the recommended weekly amount of alcohol and experiencing health problems directly related to alcohol.

In some cases, harmful drinking may cause obvious problems such as:

Many health problems that occur as a result of harmful drinking don't cause any symptoms until they reach their most serious stages. These include:

This means it can be easy to underestimate levels of physical damage caused by harmful drinking.

Harmful drinking can also cause social problems, such as relationship difficulties with your partner or family and friends, as well as problems at work or college.

Dependent drinking

Alcohol is both physically and psychologically addictive. It’s therefore possible to become dependent on it.

Being dependent on alcohol means you feel unable to function without it, and drinking becomes an important (or sometimes the most important) factor in your life.

One way to think about whether you're dependent on alcohol is to ask, “Do I carry on drinking even though I know it’s harming me or upsetting my family?”

Depending on your level of dependence, you can experience withdrawal symptoms if you suddenly stop drinking alcohol. These can be both physical and psychological.

Physical withdrawal symptoms include:

  • hand tremors ('the shakes')
  • sweating
  • nausea
  • visual hallucinations (seeing things that aren’t real)
  • seizures (fits) in the most serious cases

Psychological withdrawal symptoms include:

  • depression
  • anxiety 
  • irritability
  • restlessness
  • 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

Alcohol assessment

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.

Getting help

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:

Last updated: 12 August 2014

Continue to next section: Diagnosing alcohol misuse