alcohol

by Nicole Lee, Curtin University

With everything going on over the past couple of years, many people have changed their drinking habits.

We’ve seen an increased demand for support, suggesting more people are trying to cut back or quit.

There are so many options for cutting back or quitting alcohol it’s hard to know what will be most effective.

What works depends on how much you drink
Most people successfully quit or cut back their alcohol consumption on their own.

People who drink more frequently are much more likely to have symptoms of dependence and might find it more difficult.

You might be dependent if:

• you can’t easily go a day without drinking alcohol, or find it hard to cut back
• a lot of your social activities include or are based around drinking
• you find yourself thinking about or wanting alcohol a lot
• you find it difficult to control the amount you drink once you start
• you need to drink a lot to feel the effects
• you experience withdrawal symptoms, even mild ones, such as feeling unwell or a slight shaking in your hands when you go a day or two without alcohol.

The more of these signs you have and the more severe they are, the more dependent you’re likely to be. You can check your risk of dependence here.

If you have a mild dependence on alcohol, you may be able to cut back on your own. But if you are moderately dependent, you may need to get some kind of support.

If you are severely dependent, you should seek medical advice before you make any change to your drinking because stopping suddenly can cause severe health problems, including seizures and even death in some people.

For people who are severely dependent, the usual recommendation is to take a permanent or temporary break from alcohol. It may take six months to a year or more before you are able to start drinking again. Some people find it’s better for them not to drink again at all. With severe dependence, there’s a high risk of quickly going back to heavy drinking if you just try to cut back.

If you experience any symptoms of dependence, once you stop or cut back your drinking, you might need specialist treatment or ongoing support to prevent going back to heavy drinking.

‘Cold turkey’ or reduction?
If you’re not dependent, you should be able to either reduce the quantity or frequency of drinking or quit altogether. You may do this on your own or choose to get some support. If one method doesn’t work, try a different way.

If you experience mild to moderate dependence, every time you have a drink it can become a trigger to drink more. So it’s sometimes easier to increase drink-free days, rather than reducing the quantity on drinking days, or to quit altogether for a period of time.

People who are severely dependent usually require some kind of withdrawal support to stop drinking. It is usually better to stop altogether (“cold turkey”) as long as you have medical support. You can undertake withdrawal treatment in a hospital, at home with the help of a GP or nurse, or via telehealth. Alcohol withdrawal typically lasts about five to seven days.

Zero-alcohol drinks
Zero-alcohol drinks are alcoholic drinks with the alcohol removed but which retain a taste similar to the alcoholic version. There is now a huge variety of options for spirits, beer and wine.

If you are not dependent but are trying to reduce your alcohol intake for health or other reasons, these can be a good option. By replacing some or all of your usual alcoholic drinks with zero-alcohol drinks, you can still enjoy the social aspects of drinking without the health risks of alcohol.

If you are dependent on alcohol, the smell and taste of zero-alcohol drinks can act as a trigger for drinking alcohol. They might make it more difficult to make permanent changes to your drinking.

Treatment apps and online support
A range of computerised, web-based, and mobile apps have been developed to support people cutting back or quitting alcohol. They have shown promising results in early trials. The benefit of these apps is accessibility, but the outcomes are modest and they seem to work best in conjunction with professional support.

Hello Sunday Morning’s Daybreak program is a large online alcohol support community, accessed through a mobile and desktop app. It’s designed for moderate drinkers who want to cut back or quit. Early research suggests it’s effective in reducing drinking, as well as improving psychological well-being and quality of life.

Some previously face-to-face support groups like SMART Recovery and Alcoholics Anonymous have moved online, which has increased accessibility. These are typically more suited to people who are dependent on alcohol.

Psychological interventions

Brief interventions: As little as five minutes of advice from a GP can reduce alcohol consumption by 30%, especially for people who are in the mild to moderate dependence category. So it’s worth chatting to your doctor if you need a little help getting started.

Counselling and psychological therapy: The main treatment type to help with alcohol issues is counselling. Sessions are usually once a week with a qualified professional, such as a psychologist. Sometimes they are delivered in group settings. Counselling is suitable for any level of drinker who is trying to make changes.

Some of the main evidence-based counselling treatments in Australia are behavioural and cognitive therapies, such as cognitive behavioural therapy and mindfulness-based relapse prevention. These types of treatments have been shown to be at least as effective as medication

Intensive group programs
A number of more intensive group programs are suited to people who are dependent on alcohol or who are having significant problems, including:

• residential rehabilitation, which is usually for people who have tried other treatments unsuccessfully or who may be unsuitable for non-residential treatment because their home life is not supportive of making changes. It has been shown to be effective in increasing abstinence in dependent drinkers
• day programs, which are similar to residential rehabilitation programs but participants live at home and go in each day. These are a relatively new treatment type and there is limited good quality research on their outcomes.

Medication
A number of medications can help people who are moderately to severely dependent on alcohol. They tend to work best in conjunction with counselling.

• disulfiram is an older medication that works on the alcohol metabolism system and induces nausea and vomiting if alcohol is taken at the same time
• acamprosate can help prevent relapse in people who have already been through withdrawal
• naltrexone reduces cravings in heavy drinkers.

Self-help groups
Alcoholics Anonymous’s 12-step movement has a long history dating back to the 1930s, when there was very little available in the way of real alcohol treatment. There is relatively little research on AA and much of that has been conducted from within the organisation. The known outcomes are modest – the success rate is estimated to be around 10% and the dropout rate appears high.

AA can be helpful for some people and also provides a very well-established peer support network if you need support. It seems to be more effective in conjunction with professional treatment.

There are many options if you are trying to reduce your drinking and no single strategy works for everyone. The best approach is to start with something that looks appealing and feasible to get the outcomes you are looking for. If that’s not effective, try something else or seek professional help. ■

Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

So it is welcome news that the government is pressing for the official guidelines to return in September (see video), albeit two years after they were quietly dropped.

I have joined calls for official health guidelines to appear on all alcoholic drinks labels since revealing that they had been dropped from the UK’s voluntary code in my reporting in late 2017.

It seems extraordinary that robust, scientific information about the safe consumption of a product could ever omitted from packaging, so undermining our right to make informed choices as consumers.

If official health guidelines do reappear on labels in September, as the government hopes, some can be forgiven for looking back and wondering whether self-regulation is an effective way to safeguard consumers?

The responsibility for such concerns about the current system of regulation lies with the alcohol industry. ■

The challenge of changing our behaviour to slow the spread of coronavirus offers valuable clues about how we all might help reduce the harms of alcohol.

There are those aspects of coronavirus aware behaviour adults must master alone, like washing our hands or the remarkably challenging feat of not touching our faces.

But the most difficult ones for coronavirus are the social ones: turning down invitations, spurning warm hugs, gleeful handshakes, high-fives and knuckle-bumps.

Reducing alcohol use can be a personal struggle too, with the urge to use it to sooth ourselves or lift our mood often heightened by withdrawal symptoms. But the social aspects are even harder to halt.

We might need to pooh-pooh a pub visit, if the environment is hard for us. We might need to say no to a drink or, maybe, explain our choices to people doing exactly the opposite.

It is awkward and difficult, all of it, particularly to begin with, but it is possible. We may miss our old habits, but we can grow fond of alternatives which serve the same purpose.

We can see why invitations have to be declined. And we can learn to greet one with namaste, or foot-bump, bow or alcohol-free beer, or whatever other hygienic greeting we can devise.

In both cases we are adaptable creatures able to combine science, flexibility, imagination and empathy to reduce the harm we do ourselves and to others. ■

Health minister Jo Churchill chaired a meeting with alcohol industry representatives which began exploring how uptake of low-alcohol drinks might help prevent health problems on Monday.

“The roundtable was made up of representatives from the alcohol industry, trade bodies, consumer groups and retailers,” said the Department of Health and Social Care (DHSC).

The health department said the meeting “kickstarted discussions” on proposals first outlined in the Prevention Green Paper of summer 2019.

The paper suggested increasing the availability of low-alcohol products by 2025 and reviewing evidence on raising the threshold for officially using the term “alcohol-free” to 0.5% from 0.05%.

Portman Group (PG), which represents large alcohol producers and retailers, said yesterday it “co-hosted” the meeting.

At the sam e time released a poll highlighting role its members could play in weaning their customers off alcohol, noting a quarter of alcohol drinkers are regular consumers of low-alcohol drinks.

“Work will continue on developing proposals including a further meeting with public health organisations,” said the DHSC.

Many in public health complain of a chronic lack of resources for treatment services, low alcohol prices and high levels availability and advertising. ■

One in 25 cancers is linked to alcohol consumption, with men accounting for three quarters of cases, according to a global study in Lancet Oncology.

“Public health strategies, such as reduced alcohol availability, labelling alcohol products with a health warning, and marketing bans could reduce rates of alcohol-driven cancer,” says Harriet Rumgay of the International Agency for Research on Cancer, also recommending higher taxes and minimum pricing.

The estimates would mean 740,000 cancer cases globally were linked to alcohol last year, with heavy drinkers contributing bar far the most. But there is no risk-free level of alcohol drinking and cancer. Low-level drinkers were one-in-seven of alcohol-linked cancer cases.

“It is safest not to drink alcohol, but if you do, you should stick to the UK Chief Medical Officers’ low-risk guidelines which is to drink no more than 14 units a week [or 140ml of alcohol] on a regular basis,” said Professor Sir Ian Gilmore, Chair of the UK’s Alcohol Health Alliance.

Cancers of the oesophagus, liver, and breast accounted for most of the cases. Alcohol damages DNA and affects hormone production, which can contribute to cancer development, as well as worsen the cancer-causing effects of substances like tobacco.

In the UK the alcohol-lined cancer rate was the global average of 4%, with 16,800 cases; The US, 3%, with 52,700 cases; China 6%, 282,300; Germany 4%, 21,500 cases; and France 5%, 20,000 cases. The percentage of alcohol-linked cancer cases were reckoned to be highest in Mongolia, at 10%, from 560 cases, and lowest in Kuwait, where it was 0%, with just a few cases.

The study made its estimate by looking at alcohol intake in 2010 and the number of cases of cancers known to be linked to alcohol last year. Some suspect the research may underestimate alcohol’s contribution to cancer cases, because a quarter of alcohol purchases are not captured by government figures. ■