Blog: What does Alcohol Harm mean?

David Henstock – Public Health Lead (Clinical – substance use) 

1^st – 7^th of July is Alcohol Awareness Week, which is managed and hosted by Alcohol Change UK  Alcohol Awareness Week | Alcohol Change UK. This year the Alcohol Awareness Week theme is “understanding alcohol harm”. What does Alcohol Harm mean to Derbyshire, and what does it mean to us as individuals? Alcohol is one of those topics that we all know something about but perhaps harms related to alcohol isn’t something we think too much about, or is it?

It’s probably fair to say that most people know that alcohol can cause harms, but when you stop and think about it, the harms related to alcohol are substantial and quite sobering! Alcohol is a well-established poison and there is no such thing as 100% safe drinking, even small amounts can cause harm, especially if we are taking certain medications, or have some other type of illness, or are undertaking certain activities. The UK Chief Medical Officer guidance on alcohol consumption recognises that many people enjoy a drink and recommends that if alcohol consumption is kept to no more than 14 units per week then the risks of harm are low. We now tend to advise that the more one drinks over the 14 units, then the greater the risk of harm, and a man that drinks more than 50 units of alcohol per week, or a woman that drinks more than 35 units per week is considered to be at high risk of developing a health problem, if you want to know more about units – see here:  Alcohol units | Alcohol Change UK.

So, what are alcohol harms? Drinking too much can itself be a harm, as alcohol dependence can develop and is a serious health condition. But did you know that most of the harms caused by alcohol are not related specifically to alcohol dependence? Scarily, alcohol either causes, or contributes to 200 different medical conditions, ranging from high blood pressure and heart problems to dementias and even some cancers. When we explore alcohol harms in healthcare, we often look at a body map and can identify harms caused by alcohol in almost every part of the body, from dementias, sleep and mood problems at the top, to gout and peripheral neuropathy at the toe. Alcohol harms also include such things as hangovers and not getting to work the next day.  

Perhaps the most well-known serious consequence of alcohol is so called Alcohol Related Liver Disease, which can range from a mild inflammation to serious scarring, otherwise known as cirrhosis. The scary thing about liver disease is that a person typically doesn’t know they have it until it is at a serious stage. But we now have ways to look for that with new scanning technology, usually called a Fibroscan. The good news is, for most people stopping drinking, or cutting down to lower risk drinking levels, can stop the damage to the liver from getting any worse and can often, but not always, completely reverse the damage. One of the scariest things I have seen in my career is that liver disease is becoming more common, in fact the rate has increased by 400% since 1970! Back in the 1990s when I first started in this line of work, liver disease was thought of as a disease that middle aged men get, but we are now more likely to encounter liver disease in younger people and in females. 

Alcohol is not only a health issue though. Alcohol also contributes to a range of other harms, such as accidents, fires, violence, and antisocial behaviour. Alcohol makes significant impacts on emergency services such as ambulances and emergency department. If we look at our hospitals, we know that more people are being admitted to hospital due to alcohol than at any other time in the past. If you are interested to know more about alcohol harms, the Joint Strategic Needs Assessment for Derbyshire is a good place to start Derbyshire Joint Strategic Needs Assessment – Alcohol Misuse.

Thankfully there are some simple ways we can all help to reduce the harms associated with alcohol. If your employment role means that you have conversations with the public about their health, then simply encouraging them to consider their drinking is worthwhile and is effective in reducing harm. Of course, some people need more help than others. If that’s something you want to do more, you can get guidance here: Alcohol Identification and Brief Advice – elearning for healthcare (e-lfh.org.uk). If the person you are talking to might be alcohol dependent though, it’s important they don’t cut down too quickly and getting them to accept and access specialist help should be the goal. Information on how to access specialist help for Derby City can be seen here, Derby Drug and Alcohol Recovery Service :: Derbyshire Healthcare NHS Foundation Trust, and for the rest of Derbyshire here:  Derbyshire Recovery Partnership :: Derbyshire Healthcare NHS Foundation Trust (derbyshirehealthcareft.nhs.uk)

If you are perhaps drinking a bit too much yourself and want to cut back, then the good news is, that it has never been easier and lots of people are now drinking less than before. It is now much easier to find low-alcohol or no-alcohol alternatives, either those that taste like alcohol or a wide range of alternatives. A common method used by those that want to continue to enjoy a drink but are keen to keep those units low is to “tiger stripe” which is a term that refers to alternating one alcohol containing drink with one that is alcohol free. Some people need a little help to cut down, and there are a range of options, if you live in Derbyshire you can gain free access to the discrete and confidential app Lower My Drinking – Derbyshire County Council (orchahealth.com) , or  Support for people who want to cut down on their drinking (drinkwisederby.org.uk) which will give you practical tips and encouragement to help you to make some positive changes.  

David Henstock  is a Public Health Lead (Clinical- substance use) for Derbyshire and has over 20 years of experience of working on the front line of dealing with alcohol harms, where he has been the lead clinical nurse specialist running specialist alcohol services in acute hospitals and communities in various parts of the East Midlands.