Can you imagine a Dry December? The very thought of getting through the grim, grey days, manic bouts of shopping and emotional overload of the festive holidays without a drop of alcohol is surely unbearable for many. So, is there any such thing as safe drinking? Can we ensure we don’t slide into addiction? And is it true that it is actually bad to be teetotal?
I love a drink but don’t want to end up addicted. What do you suggest?
The only way to avoid being dependent on alcohol is not to drink at all, says David Nutt, professor of neuropsychopharmacology at Imperial College London. “We talk about capture rate, the percentage of users who end up addicted to a substance. Tobacco is the most addictive, with a capture rate of about 40%, then heroin at 30%, crack cocaine about 25% and alcohol at 12%. But you can’t know if you’re going to be one of the 12% who is susceptible to becoming addicted to alcohol. And in the UK, 85% of adults drink alcohol, so that’s potentially around 4 million people who are at risk of addiction.”
So, is it really best not to drink at all?
Nutt says, at the very least, you should be aware of how much you drink, and then try to drink less. “Everyone should keep tabs on their weight, blood pressure, waist size and know how many units of alcohol they’re drinking. Try to stay within the government recommendation of 14 units a week or four units a day.”
I have heard that we should all drink a bit to stave off dementia. Is is it true?
The media have certainly embraced the idea that moderate drinkers (generally those drinking fewer than 20 units a week) are less likely to develop dementia than teetotallers. But neuropsychiatrist Killian Welch of the Royal Edinburgh hospital says the studies that seemed to show that some alcohol is better than none in terms of brain function were often flawed, and didn’t take other factors into account. “People who drink in moderation may also have a moderate approach to life in general; they may be more likely to exercise, eat a Mediterranean diet and socialise than teetotallers. And some people are teetotal because they used to be heavy drinkers, which damaged their health.” The upshot is that it is probably a myth that some drinking is better than none.
I have had a blood test that says my liver is fine. Can I carry on enjoying a few pints?
Just because your blood test is OK, that does not mean the liver isn’t becoming damaged by alcohol. And liver damage is just one of a range of harmful effects. “The only known way to reduce your risk of developing breast cancer or dementia is by cutting out alcohol,” says Nutt. Mark Leyshon, senior policy officer at Alcohol Concern, says alcohol is linked to more than 60 conditions, including liver disease and six forms of cancer: breast, bowel, liver, mouth and throat, oesophagus and stomach. The risk of developing alcohol-related health problems such as cancer relates to how much we consume: the less we drink, the lower our risk. Alcohol is thought to be responsible for about 4% of cases of cancer in the UK.
Isn’t alcohol good for the heart?
Leyshon explains: “For some groups, drinking very small amounts of alcohol has been shown to offer some protection against heart disease, but this should not be a green light to start drinking – there are more effective and less risky ways to protect yourself from heart disease, such as regularly eating fresh fruit and vegetables and taking regular exercise.” And there is no doubt that heavy drinking damages the heart muscle and contributes to high blood pressure.
What’s better for you; spirits, wine or beer?
Psychiatrist Anya Topiwala, of the University of Oxford, says: “The jury is out on whether one type of alcohol is better for you than any other. It’s the units that count; we know that drinking 0-7 units a week does not seem to damage your health. But once you get over 14 units a week, there is a dose response, so that the more you drink, the more cognitive decline you can demonstrate in memory testing and MRI studies.” Even moderate levels of alcohol are bad for the brain, including shrinkage of the area called the hippocampus. Leyshon says that whatever you are drinking, the trick is to stay well within the 14 units guideline; that is the equivalent of six glasses of wine, or six pints of ordinary-strength beer, spread out over three or more days. A large (35ml) single shot of spirits is 1.4 units.
I come from a family of drinkers and we can all hold our drink. Doesn’t that mean I can manage a bit more?
Topiwala says about half of alcohol dependence is explained by genetics, the other half by the environment. About a third of east Asians (people from Japan, Korea, Vietnam and China) have an inherited deficiency of an enzyme, which means they accumulate acetaldehyde in the bloodstream when they drink alcohol. This can cause facial flushing, nausea, headache and palpitations and may increase the risk of oesophageal cancer. People with this inherited tendency often choose not to drink because the effects are so unpleasant. Other people may have no trouble metabolising alcohol, but this means they are more at risk of drinking to excess because the biological brakes don’t kick in. And just because you don’t feel drunk, doesn’t mean the alcohol isn’t causing harm.
Does all this mean that people in the know never touch a drop?
Welch laughs when I ask him. “We all do things we probably shouldn’t, but it does seem important that people are provided with accurate information so they can make informed choices. For what it’s worth, I will be having a drink over Christmas, but my reading of the research literature would certainly encourage moderation.”
Details of Alcohol Concern’s Dry January campaign are at alcoholconcern.org.uk