6.1.3 Alcohol

Cause, Consequences and Recognition of Heavy Drinking: the Concept of ‘Problem Drinking’

Heavy drinking, or the consumption of alcohol at levels above recommended guidelines, is a significant public health issue in the UK and Europe. The causes of heavy drinking are complex and multifactorial, including individual and environmental factors such as genetics, social norms, and the availability of alcohol. Heavy drinking can have numerous consequences, including physical health problems, mental health issues, and social and economic problems.

Problem drinking is a term used to describe individuals who drink at levels that are harmful to their health, relationships, or work. It is important to recognize problem drinking early on as it can lead to more severe alcohol use disorders such as alcohol dependence. However, recognizing problem drinking can be challenging, as many individuals with alcohol use disorders may not seek help or may not realize the extent of their drinking.

In the UK and Europe, various interventions are available to address problem drinking, including brief interventions, medication-assisted treatments, and specialized addiction services. These interventions aim to reduce harmful drinking behaviours and improve overall health and well-being.

The recommended guidelines for alcohol consumption in the UK:

*Group*	*Recommended weekly limit*	Additional notes
Men and Women	No more than 14 units	It is recommended to spread the units across the week and have several alcohol-free days.
Pregnant Women	No more than 1-2 units, once or twice per week	Pregnant women should avoid alcohol if possible. If they do choose to drink, they should not have more than 1-2 units of alcohol once or twice per week.
Young people under 18	Not applicable	Young people under 18 should not drink alcohol.

Note: One unit of alcohol is equal to 10 millilitres (ml) or 8 grams of pure alcohol.

(Department of Health, 2016)

Alcohol dependence syndrome:

The alcohol dependence syndrome is characterized by a cluster of physiological, behavioural, and cognitive symptoms that indicate a person’s dependence on alcohol. The components of the alcohol dependence syndrome include tolerance, withdrawal, preoccupation with drinking, loss of control over drinking, continued use despite negative consequences, and neglect of other interests or obligations.

Tolerance refers to the need to consume increasing amounts of alcohol to achieve the desired effect, while withdrawal is the occurrence of physical and psychological symptoms when alcohol use is reduced or stopped. Preoccupation with drinking involves a persistent desire to consume alcohol and spending a significant amount of time obtaining, consuming, and recovering from its effects.

Loss of control over drinking is characterized by the inability to control the amount and frequency of alcohol use, while continued use despite negative consequences refers to the persistence of drinking despite adverse health, social, and legal consequences. Neglect of other interests or obligations involves giving up important activities, social or occupational, to drink alcohol.

The presence of two or more of these components indicates the diagnosis of alcohol dependence syndrome, which is a severe form of alcohol use disorder (WHO, 2018).

The nature of alcohol-related disabilities:

Alcohol-related disabilities can be wide-ranging and can affect both physical and mental health. Long-term heavy drinking can lead to liver disease, heart disease, pancreatitis, and various types of cancer. It can also cause neurological damage and impair cognitive function, resulting in memory loss and difficulty with problem-solving and decision-making. Furthermore, alcohol misuse can have a negative impact on mental health, leading to depression, anxiety, and other psychological disorders. These disabilities can have a significant impact on individuals, their families, and society as a whole.

Detoxification procedures for inpatients and outpatients:

Detoxification procedures for substance misuse in the UK vary depending on the setting and severity of the addiction. In-patient detoxification, typically offered in a hospital or residential setting, involves a medically supervised withdrawal from the substance, followed by support and monitoring to manage withdrawal symptoms and prevent relapse. Out-patient detoxification, on the other hand, involves the provision of medication and support in a community setting, allowing the individual to continue with their daily life. Out-patient detoxification is often reserved for individuals with less severe addiction and a strong support network.

How Does Alcohol Work?

Low molecular weight + low potency means very high concentrations are needed to investigate molecular targets in vitro –difficult in practice, thus a detailed mechanism of action is not known
However –a consensus does exist where alcohol’s primary effect is as a positive allosteric modulator of the GABA-A receptor
It also contributes as a negative allosteric modulator of the NMDA system
The two together give the biological basis of physical withdrawal
It also affects the dopamine reward pathway (meso-limbic system –a ‘biological’ basis of craving/addiction)

Thiamine:

Vitamin B1
Dependent on exogenous sources
Several functions in metabolism
In brain health, it is a key part of oxidative metabolism, particularly in the mid-brain and cerebellum.
Absorption is in the digestive system, and stores are limited and typically protein bound.
In dependent drinkers, nutrition is already poor, absorption is less efficient and hepatic dysfunction limits stores.
Without it, indirect neuronal cell death occurs.

References:

Anderson, P., de Bruijn, A., Angus, K., Gordon, R., & Hastings, G. (2009). Impact of alcohol advertising and media exposure on adolescent alcohol use: A systematic review of longitudinal studies. Alcohol and Alcoholism, 44(3), 229-243.
European Monitoring Centre for Drugs and Drug Addiction. (2019). European drug report 2019: Trends and developments. Publications Office of the European Union.
National Institute for Health and Care Excellence. (2010). Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence. Clinical guideline [CG115]. https://www.nice.org.uk/guidance/cg115
Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. The Lancet, 365(9458), 519-530.
World Health Organization. (2018). Global status report on alcohol and health 2018. WHO Press.
Department of Health (2016). UK Chief Medical Officers’ Alcohol Guidelines Review: Summary of the Proposed New Guidelines. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/489795/summary.pdf
World Health Organization. (2018). International classification of diseases for mortality and morbidity statistics (11th Revision). Chapter 6: Mental, behavioral or neurodevelopmental disorders. Substance use disorders. Alcohol use disorders. https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1448597234
Rehm, J., Shield, K. D., Rehm, M. X., Gmel, G., & Frick, U. (2017). Alcohol consumption, alcohol dependence, and attributable burden of disease in Europe: potential gains from effective interventions for alcohol dependence. The Lancet Public Health, 2(1), e81-e92. https://doi.org/10.1016/S2468-2667(16)30045-8
National Institute for Health and Care Excellence. (2007). Drug misuse: psychosocial interventions. https://www.nice.org.uk/guidance/cg51/chapter/1-Guidance#detoxification-procedures-for-inpatients-and-outpatients.