How much alcohol is too much?

Alcohol is a fact of life in the UK, and many people are unsure if their level of drinking is safe. While the NHS has guidelines on low-risk drinking, the reality is that assessing safe levels of alcohol consumption is complicated.

What is a unit?

A unit is also known as a standard drink. One unit is 10ml or 8g of pure alcohol. In the UK, NHS guidelines set recommended drinking limits as 14 units or less per week.

Assessing if your drinking is within or exceeding the NHS guidelines is made trickier by the fact it uses units of alcohol – and many of us need to view drinks in a different way. The NHS states that 14 units are about six medium glasses of wine or 6 pints of beer, but this will vary depending on the strength of the drinks. This means that the only way to be certain of how many units you’re drinking is to check the back of the bottle – but this is not possible when buying drinks out of the home.

Units and guidelines in different countries

Different countries have different safe drinking recommendations – and unit sizes differ too. The UK’s closest neighbour, Ireland, sets upper drinking limits as 17 units per week – and units are 10g of pure alcohol, not 8g. In Basque country, people are recommended not to exceed 70g of alcohol per day – meaning the guidance allows people to exceed the NHS levels of safe drinking in just two days. In Italy, a standard drink is even bigger – 12g of pure alcohol.

Some countries have different guidelines for men and women, while the UK does not. In the US, a standard drink is defined as 14g of alcohol, and the upper limit for safe consumption is one drink for women and two drinks for men per day. Italy recommends a maximum of 2-3 drinks for men and 1-2 for women. Some countries recommend a certain number of drink-free days per week, while others don’t.

Having different guidelines for men and women is slightly controversial. It recognises that women could be more vulnerable to certain harms of alcohol when it’s consumed at higher levels, such as the risk of breast cancer. However, some countries state that alcohol is equally risky for men and women, and this is reflected in their guidelines.

Different guidelines for men and women in some countries also raises the question of whether there should be different guidelines depending on age. Drinking is prohibited for people under a certain age in all countries – but older people are frailer. Should there be stricter guidelines for them?

Why do guidelines differ between countries?

While the evidence they’re basing their advice on remains the same, countries have different health authorities that take different factors into account. Australia calibrated their guidelines by setting them at a level where you have less than a 1% chance of dying of alcohol-related

causes. Canada has taken into account research that suggests drinking at very low levels has benefits for the heart – but this evidence is controversial. The Netherlands has the strictest guidelines possible – it suggests drinking no alcohol at all. However, many countries recognise that as drinking is so culturally embedded, it isn’t realistic to recommend people abstain entirely and set levels where the risk is as low as possible. Guidelines are in place to reduce, not eliminate risk.

What level of drinking is the safest?

Based on the latest evidence, the Netherlands’ guidance is correct. The World Health Organisation states that no form of alcohol consumption is risk-free.

This is mainly because alcohol is a powerful carcinogen. Cancer risk increases in proportion to the amount consumed – but even very low levels increase cancer risk.

This partially explains why guidelines differ between countries. They aren’t attempting to measure a level of alcohol consumption that is risk-free, as that doesn’t exist. What they are trying to do is lower the risk as much as possible, accepting that in most countries, alcohol consumption is a fact of life while attempting to keep the risk of alcohol consumption as low as possible.

Health risks of excessive alcohol consumption

Guidelines are an attempt to curb the risks of excessive alcohol consumption – and at high levels, alcohol is seriously detrimental to health. Individual risks include increased susceptibility to certain cancers, cardiovascular disease and heart attacks, strokes, liver disease, pancreatitis, nervous system damage and mental health problems. Excessive consumption also increases the risk of accident or injury, involvement in violent crime as both perpetrator and victim, self-harm and suicide.

UK guidelines for lower-risk drinking don’t differ for men and women – but they do for riskier levels of drinking. Increasing risk is defined as 15-34 units a week for women and 15-49 units for men, and higher risk is defined as drinking above these levels.

Why is alcohol addictive?

If alcohol is so harmful, why is it addictive?

One reason that alcohol is addictive actually comes from how harmful it is to the body. The unpleasant effects of a hangover are one part of the cycle of alcohol addiction – people will consume more alcohol to stave off the feeling of acute withdrawal. There is even a word for this negative physical and emotional state – hyperkatifeia.

Alcohol’s ability to both increase pleasurable feelings and blunt negative feelings makes it extremely appealing as a way of alleviating stress and anxiety. For people suffering from chronic stress, people with trauma and people with a genetic susceptibility to alcohol addiction, alcohol use can quickly slip into dangerous levels.

The changes in the brain that occur when alcohol is consumed become reinforcing over time in a process called incentive salience. This means alcohol and the cues associated with it, such as certain places, times of day, and even the sound of glassware clinking, can trigger an urge to drink. Over time, the combination of a brain that has been primed to associate alcohol with pleasure combined with the intensely unpleasant nature of withdrawal can lead to the territory of problematic drinking.

Signs of problematic drinking

Alcohol Change UK estimates that there are 600,000 dependent drinkers in the UK. Dependent drinkers can consume alcohol at much higher levels than other people due to increased tolerance and will exhibit the signs of alcohol addiction if they try to quit. These signs include tremors, sweating, hallucinations, depression, anxiety and insomnia.

Experiencing any of these symptoms is a sign that you need help with alcohol and advice on how to reduce alcohol consumption safely. When alcohol dependence has reached this level, stopping without support can be dangerous.

How to stop drinking

If you’re concerned that your alcohol consumption is too high, the safest thing to do is stop entirely. If your level of drinking exceeds the guidelines of 14 units a week by just a few units, you may not find it too difficult to cut down or stop.

However, if your level of drinking puts you in the category of dependent drinking, reducing your consumption won’t be as easy – and may not be recommended to do without help. Detox and rehab may be necessary to support you through the process of safely withdrawing from alcohol.