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About alcohol and alcohol-related problems

   How can you tell if someone has an alcohol problem?

The most obvious way of identifying a person who might have an alcohol problem would be by looking at the amount of alcohol they drink. However, regardless of how much is or is not drunk, a person has a problem with alcohol if his or her drinking is negatively affecting their overall wellbeing, their work, their personal finances and/or relationships with their family and friends.

People who:- drink less than the recommended levels (3-4 units* a day for men and 2-3 units a day for women) and do not regularly become intoxicated, and whose presenting problems have no association with alcohol misuse.	No alcohol problem indicated
People who:- men who drink up to 35 units per week and women who drink up to 28 units a week; or anyone who drinks double the recommended limit more than once a week who become intoxicated sometimes, but not frequently, but whose presenting problem has no strong association with alcohol misuse. For example someone with problems relating to employment, housing or family relationship who does drink and occasionally becomes drunk but whose problems are not associated with their drinking pattern.	No alcohol problem indicated but at risk of damage to health In such cases, general advice about the health effects of alcohol and sensible drinking advice (brief intervention) would be recommended.
People who:- regularly drink significantly more than the recommended levels and up to 50 units per week for men and 35 units per week for women, and those who become regularly intoxicated, with this contributing to the presenting problem (family troubles, loss of work and financial difficulties, problems in taking action to alleviate other difficulties)	Alcohol problem requiring intervention indicated. This needs to aim, at least, towards reducing consumption and controlled drinking, as well as consideration of the underlying reasons for misusing alcohol. Referral to an alcohol advice and counselling service should be considered.
People who:- regularly drink at or above the dangerous levels (50 units per week for men and 35 units per week for women), or whose health is affected by their alcohol consumption, or who are alcohol dependent irrespective of the nature of the presenting problem. * a unit is roughly half a pint of normal strength beer or lager, a glass of wine (although traditional sized wine glass are now rare, so beware..), a pub measure of spirits.	Serious alcohol problem indicated. They will require specialist help and detoxification may be needed prior to referral to a day programme or residential rehabilitation centre.

There are a number of problems in relying on assessment of drinking levels alone to ascertain whether someone has an alcohol problem:-

1. People with alcohol problems tend to under-report the number of drinks they have.
2. Calculating units can be difficult as the strength of drinks vary considerably, as does the size of ‘one’ drink - especially if poured and drunk at home.
3. It requires the client to remember a lot of information in detail, which is difficult on initial assessment.
4. It rarely helps a person see for them self that their drinking is getting out of hand.

However the table above can be a useful aid especially if combined with the signs given below that indicate a problem with alcohol.

Early warning signs can be:-

• Being drunk more often, particularly when needing to be on good form the next day
• Taking the day off because of a hangover
• Having accidents, domestic arguments or injuries because of drink
• Getting into trouble because of drinking - fights, drinking and driving
• A person doing something they would not otherwise have done after drinking and regretting it
• Drinking more than was planned to in an evening.

If these are only isolated incidents a person may just need to think more carefully about reducing the number of drinks they have and when they decide to have them.

Using a drink diary can help identify drinking patterns and habits, giving pointers as to what can be changed.

www.howsyourdrink.org.uk is a useful self-evaluation tool of drinking habits and includes signs of hazardous, harmful and dependent drinking, advice on getting help and tips for safer drinking.

However if many of the other signs given below apply, a person may be getting into a pattern of problem drinking.

Signs of problem drinking:

• Thinking a lot about when they can next have a drink
• Gulping the first drink quickly
• Being conscious of how often they are the first person to finish a drink
• Having more than the occasional hangover
• Needing to have a drink before doing things or facing certain situations
• Feeling sick, having the shakes, sweating in the morning or middle of the night
• Spending more than they can afford on alcohol
• Ordering doubles when it’s their round
• Often feeling that they need a drink
• Increase in arguments and rows at home over drink
• Being annoyed if others mention their drinking or their behaviour when they were drunk
• Other people telling them that they are worried about their drinking
• Feeling secretly uncomfortable about their drinking
• Drinking secretly
• Deliberately hiding the evidence of drinking (lying about money, hiding drink and empty alcohol containers)
• Starting to drink at times when they didn’t before, and earlier in the day.

Signs of definite alcohol dependency

A person is likely to have a definite problem with alcohol or have become addicted if they:

• Require an alcoholic drink to complete tasks, function normally or manage strong emotions
• Have to increase the amount they drink to maintain the same effect
• Always wake up with the shakes and feeling sweaty
• Need a drink to start the day
• Drink large quantities over the course of the day without it making them drunk
• Feel uncomfortable if they don’t have a drink at hand
• Lie about their drinking
• Are covering up their drinking and the costs of it.

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