Serious Drinking

SERIOUS DRINKING Alcohol Made Easy

No nagging.

No moralising.

Just the hard facts about drink and its effects.

HAYNES Haynes Publishing Group is the world’s market leader in the producing and selling of car and motorcycle repair manuals.

Every vehicle manual is based on our experience of the vehicle being stripped down and rebuilt in our workshops. This approach, reflecting care and attention to detail, is an important part of all our publications. We publish many other DIY titles and books about motor sport, vehicles and transport in general.

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MEN’S HEALTH FORUM The Men’s Health Forum’s man manuals contain easy-to-read information on a wide range of men’s health subjects. Founded in 1994, the MHF is the independent voice for the health and wellbeing of men and boys in England, Scotland and Wales.

Our goal is the best possible physical and mental health and wellbeing for all men and boys.

Serious Drinking © Men’s Health Forum A full list of references is available at: menshealthforum.org.uk/MMreferences The MHF encourages your feedback at: menshealthforum.org.uk/MMfeedback All rights reserved. You must not reproduce or transmit any part of this booklet in any form or in any way without written permission from the Men’s Health Forum. This includes photocopying or scanning it.

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Drinkaware is an independent UK-wide, alcohol education charity. More on page 19.

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CONTENTS I Like A Drink

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What Happens When We Drink 6 The Long-Term Effects

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Are There Any Benefits?

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Any Tips To Cut Down?

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Am I Drinking Too Much?

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Who Can Help?

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Text by Jim Pollard & Drinkaware • Edited by Jim Pollard • Advisory Board: Dr John Chisholm for the Men’s Health Forum and the Drinkaware Medical Advisory Panel • Cartoons by John Byrne • Images: Drinkaware and creativecommons.org (Credits p34) • Supported by Drinkaware Published: December 2016 • Revision date: December 2019.

TWO-THIRDS OF ALCOHOL-RELATED DEATHS ARE MALE… This publication was produced in line with the NHS England Information Standard.

The author and the publisher do not intend this book to be used instead of advice from a medical practitioner, which you should always seek for any symptom or illness.

The authors and the publisher have taken care to make sure that the information given is correct at the time of publication.

We advise you to read and understand the information included with any medicines or treatments and to consider carefully whether a treatment is worth taking.

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MEN’S HEALTH MADE EASY I LIKE A DRINK You’re not alone.

Drinking alcohol is often associated with good times. It plays an important role in many cultures and, to most people, tastes nice. But at the same time it is a drug that can have a major impact on health and lead to dangerous behaviour and addiction.

This booklet explains how alcohol works, how to drink more safely if you do drink and what to look for if your relationship with alcohol causes you concern.

As men, we need to face up to the reality of booze because men are particularly at risk. Alcohol kills someone nearly every hour in the UK and the majority (65%) are men.

WHAT IS ALCOHOL? The alcohol we drink is actually a chemical called ethanol. It is diluted in water to make it drinkable. Sounds much less tasty.

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It is made by causing the sugars in fruit, grain or vegetables to react with yeast or bacteria. This is called fermentation. Fermentation produces two by-products: ethanol and carbon dioxide (which is responsible for the bubbles).

Wine is made from grapes, cider from apples and beer from grains (usually malted barley although wheat, corn and rice are also common).

The alcohol content depends on how much sugar there is and how long it is left to ferment. Spirits are stronger because they also go through a process called distillation which removes some of the water.

WHAT IS A UNIT? Units can be confusing as few drinks contain a nice round number of them.

But units do enable us to compare drinks of different strengths.

1 unit equals 10 ml (8g) of alcohol. But what does this look like in a drink?

The UK’s Chief Medical Officers (CMOs) say that to keep risks from alcohol low, it is safest not to drink more than 14 units a week on a regular basis.

So how many of your favourite drinks add up to 14 units?

Fourteen units is about six pints of regular strength beer, six medium glasses of regular strength wine, five pints of regular strength cider or 14 single measure shots of a spirit.

Spread your drinking. The CMOs say that if you regularly drink as much as 14 units a week, it is best to spread your drinking evenly over three or more days.

Don’t underestimate the risk. More than one man in three (39%) will develop some sort of health problem related to alcohol.

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WHAT HAPPENS WHEN WE DRINK? WHY DO WE LIKE A DRINK? Simply because, within a couple of minutes, alcohol changes our brain chemistry. Specifically it depresses the part of the brain associated with inhibition meaning that it can, in the short term, help us feel more confident and less anxious.

That’s why the first drink feels good – although even at this early stage, your reactions are slowing down, which is why it’s not a good idea to drive even if technically you’re still below the legal limit.

It’s important to understand that alcohol is a depressant so while you might get a nice buzz at first, the returns diminish quickly as recall, reactions, decision-making skills and concentration all slow down making us more likely to lose the pub quiz, do daft things and take needless risks.

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WHAT HAPPENS IF I CARRY ON DRINKING? After about two drinks, the negative effects really begin to kick in. Alcohol depresses the production of the hormones that keep you hydrated so that when you pee, you don’t just pee the pint of lager, you pee a lot more too.

You’re becoming dehydrated. Dehydration is one of the main reasons you feel hung over (so drink some water).

After three drinks, bits of your brain are starting to let you down including those that detect danger and let us read others’ body language. Result: squabbles, misunderstandings and worse. Sexual desire may increase but not performance (and the booze is actually depressing testosterone production).

Result: a good night out can turn sour. Not convinced? Check the stats: >> half of all violent crimes (53%) are alcohol-related including nearly two-thirds of violent crime with male victims (62%) >> more than a third of domestic violence incidents (36%) are alcohol-related.

WHAT IS BINGE DRINKING? The NHS defines binge drinking as about eight units of alcohol for men, and six units for women in a single session. For men, that’s around three pints of beer; for women, it’s around two and a half glasses of wine.

All the bad stuff mentioned above will happen. Minimise the risk by drinking slowly, drinking soft drinks and water, eating some food and planning ahead.

ONE UNIT = ONE HOUR TO PROCESS

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Your liver can process about one unit of alcohol an hour. If you drink any more than that (and the average pint is over 2 units), the alcohol will stay in your system until the liver can process it. That’s why if you drink a lot, you can still be unsafe to drive or operate machinery next morning.

True, men tend to process alcohol more quickly than women. It also depends on what you’ve eaten, your normal body metabolism and the state of your liver but there is nothing you can do to speed up the rate at which your body processes alcohol. Cold showers, coffee, a fry-up – none of these work.

If you are in any doubt at all, don’t drive. The combination of slower reactions and increased risk-taking is potentially lethal.

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HOW DOES DRINKING AFFECT SLEEP? Even a couple of drinks can interfere with the normal sleep process. Alcohol can send you straight into deep sleep meaning you miss the first stage of sleep called rapid eye movement (REM) sleep which is essential for memory, creativity and learning. Usually, you’ll have six or seven cycles of REM sleep a night and wake up feeling refreshed. If you've been drinking you'll typically have only one or two.

WHAT ABOUT HANGOVERS? That headache, nausea and tiredness is usually caused by dehydration. It’s a good idea to drink water and soft drinks in the course of the evening and have a big glass of water before bed. This won’t beat the hangover completely, of course – only drinking less will do that.

DOES ALCOHOL CAUSE MEMORY LOSS? It can.

As your brain slows down, it can, if you drink a lot, stop laying down new memories. That’s why you can wake up the next day with a ‘blank’ about what you said, did and even where you were. Frequent heavy sessions can damage the brain so don’t ignore black-outs. They are one very clear sign that you may have a drinking problem.

What’s the point of a weekend that you can’t remember?

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THE LONG-TERM EFFECTS Because alcohol enters the blood, it gets carried to all parts of the body and can affect any or all of them.

For example, it can contribute to the development of a number of major cancers including bowel cancer, liver cancer, breast cancer and cancers throughout the digestive system including the mouth, throat and oesophagus.

Any drink of any sort increases your cancer risk, especially if you smoke.

Tobacco and alcohol are even more dangerous together than separately.

DOESN’T DRINK MAINLY AFFECT THE LIVER? The liver is in the front line. It processes every drop we drink. But other parts of the body are affected too, mostly the brain, heart, stomach and pancreas.

The liver works hard to deal with our drinking and, over time, drinking will take its toll. There are three stages of liver disease caused by alcohol.

First you get alcoholic

fatty liver disease. This occurs when the liver is 9

spending so much time processing alcohol it hasn’t time for its other functions and you get a build-up of fat and fatty acids. It depends on the individual but if you’re regularly drinking more than 7.5 units a day, you’re at real risk.

Breaking down alcohol produces some nasty, toxic chemicals. Over time, these damage the liver. It becomes more inflamed. The gut may become less effective as a barrier to bacteria and viruses which can increase inflammation.

This is called alcoholic hepatitis. Healthy cells are replaced by scar tissue which block the flow of blood, making the liver less and less effective.

Cirrhosis is the third stage of liver disease. If alcoholic hepatitis is not

treated, the scarring becomes so widespread, the liver can no longer do its job of removing toxins from the blood. This means every organ in the body receives toxic blood. Cirrhosis is the main cause of alcohol-related deaths.

Other organs are affected. Drinking even a little alcohol can cause your stomach to produce too much acid. This can lead to gastritis – inflammation of the stomach lining – and eventually to the lining being worn away to cause internal bleeding.

ALCOHOL ALSO MAKES YOU FAT, RIGHT? There are a lot of calories in alcohol, even those drinks that don’t taste sweet.

A gram of alcohol contains seven calories. Like other calories from sugar, they’re often called empty calories because they have no nutritional value.

What’s more, after you drink alcohol, your body prioritises getting rid of it.

This means it slows down other processes such as fat-burning. So you’re taking on more calories at the same time as reducing the body’s ability to get rid of those it already has.

Make sure you know how fattening your favourite drink is. A pint of cider, for example, contains as many calories as a sugar doughnut. Make a bottle of cider last by filling your glass with ice.

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WON’T EXERCISE HELP? Up to a point. But you need to be well-hydrated to exercise effectively and safely whereas drinking alcohol will leave you dehydrated and more likely to overheat. Plus, if your liver is breaking down alcohol, it can’t produce so much glucose, which will leave you with low levels of blood sugar and again affect performance.

Result: you’ll be slower, have lower energy and strength, less coordination and power, reduced dexterity and poorer concentration and reactions.

Add in a hangover too and you’re not going to be on your game at all.

For all of these reasons, experts suggest avoiding alcohol the night before exercise regardless of whether that’s a trip to the gym, a kick-around with your mates or a big match.

The long-term benefits of exercise are reduced by drinking too. For example, it’s far harder to build muscle as alcohol slows down the synthesis of proteins.

HOW DOES DRINKING AFFECT YOUR SEX-LIFE? Not well. The more you’ve drunk on the night, the less likely you are to be able to get an erection or sustain one like you normally do.

Long-term, alcohol reduces the release of testosterone and other sex hormones, makes your testicles smaller, reduces healthy sperm production and increases your risk of longer-term sexual problems. Heavy drinkers are 30% more likely to have erection problems lasting a month or more.

WHAT ABOUT THE HEART? Alcohol narrows your arteries meaning the blood has a smaller space to get through and your heart has to work harder. This increases the blood pressure.

Reducing the amount you drink will reduce your blood pressure.

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Because alcohol increases blood pressure, it makes a haemorrhagic stroke more likely. A haemorrhagic stroke is a particularly dangerous, possibly fatal, type of stroke caused by bleeding in or around the brain.

The heart can also be directly affected. The toxicity of alcohol weakens heart muscle over time making it more difficult for the heart to pump blood. As a result, the heart starts to expand to hold the extra blood. It becomes thinned, enlarged and eventually stops beating properly. As blood collects in the heart’s chambers, the risk of a clot increases. Blood clots can cause breathing problems, inconsistent blood supply, dizziness, weakness, and even a stroke.

I DON’T EVEN KNOW WHERE THE PANCREAS IS. Sitting behind the stomach, the pancreas is a large gland involved in digestion and the production of hormones including insulin. Painful inflammation of the pancreas – pancreatitis – is closely linked to alcohol.

People who drink more than 35 units/week are four times more likely to have a flare-up of acute pancreatitis than those who never drink. Over time, this will cause permanent damage to your pancreas: chronic pancreatitis.

I SOMETIMES FEEL DEPRESSED AFTER DRINKING. That’s common. At the time, alcohol might make you feel less stressed but the following morning and long term it can make things worse. Drinking can cause depression and depression can cause drinking.

Regular drinking lowers levels of serotonin in your brain – the chemical that helps to regulate your mood. It also affects your brain’s thinking abilities so you’re more likely to forget, make mistakes and be snappy or short-tempered.

Depressing for you and the people around you. People who experience anxiety or depression are twice as likely to be heavy or problem drinkers.

Drinking can affect your relationships with your partner, family and friends and impact on your performance at work. All these can contribute to depression.

If you use drink to try to improve your mood or mask your depression, you may be starting a vicious circle.

It’s great to wake up and not feel like death.

I’m better at my job too.

Heavy drinking is closely linked to suicide so if you’re feeling down, a drinking session is the last thing you need.

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ARE THERE ANY BENEFITS? Alcohol was believed to have a protective effect against heart disease.

However, the Chief Medical Officers’ recent review of the evidence found that the protective effects were not so strong. In fact, they were significant only for women over 55.

Experts reckon that any protective effect from alcohol – specifically red wine – is not due to the ethanol but another group of chemicals called polyphenols.

Polyphenols increase the good cholesterol in the blood which can reduce the risk of heart disease. But given the risk of the other health effects discussed in this booklet, for men the cons outweigh the pros.

The good news is that you can find polyphenols in plenty of other foods. Dark chocolate, cocoa powder, hazelnuts, blackcurrants, raspberries, chestnuts, almonds, green and black olives, sage, rosemary and thyme are all very rich in polyphenols.

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I THOUGHT MODERATE DRINKERS LIVED LONGEST? You may be thinking of a much-publicised study published in 2010. It followed a group of people over 55 for twenty years and found that light and even moderate drinkers lived longer than both heavy drinkers and those who didn’t drink at all.

But this may be more about the design of the survey. For example, it didn’t look at quality of life or at previous smoking or levels of fitness. And, of course, they missed alcohol-related deaths before 55 (and that’s about 40% of the total). A recent systematic review reanalysed the data from 87 studies on moderate alcohol and mortality and found that any protective effect disappeared once they corrected for the quality of the studies.

So it’s probably fair to say that the Chief Medical Officers’ recent study is the best guidance currently available: any protective effect from alcohol only applies to women over 55.

Sorry, gents.

My body can’t take it like it could. I accepted it, cut back and I feel great.

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ANY TIPS TO CUT DOWN? If you want to manage your intake of alcohol, here is our six-point plan.

All these tips have been road-tested by men and have worked for someone somewhere. They’ll help you figure out what works best for you.

1. Keep track of the alcohol you’re drinking using a diary or the Drinkaware app (see page 19). Just seeing it in black and white will help.

2. Set clear goals. Don’t vaguely say that you want to drink less, set a specific maximum for specific days or events.

3. Team up. Cut down on drinking with your partner or a

group of mates. You can support each other and develop your relationships around other activities.

4. Know your motivations. Make a list of the reasons why

you’re cutting back. Improved health, more energy, better sex, saving money, being fitter – the exact reason will depend on you but whatever your reasons are, keep focussed on them.

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I feel better and more alert since I cut down the booze.

5. Know your triggers – and figure out how to beat them.

People, places, times. These could all be triggers to drinking alcohol. If, for example, you always have one after work, give yourself a distraction (a walk, exercise, computer game, whatever) to break the association. Miss the company? Go for a coffee instead.

6. Do the easy stuff >> Managing your drinking begins in the supermarket. If you buy less, you’ll drink less. Think about sizes and containers. If you tend to feel the urge to finish any open bottle, perhaps buy something smaller. >> Read the labels. Know exactly how much alcohol is in the drinks you buy. >> If you drink spirits at home, an alcohol measure will help you see how much you’re drinking. Easier still, try no alcohol at home. Or no beer in the fridge.

It puts you in control. You need to choose to have a drink – not just have one because it’s there. >> Don’t get into rounds – they’re an easy way to drink more than you intend. (Try saying: ‘I’m only stopping for one so I’ll get it myself to make it easier.’) >> Drink water to keep you hydrated and remove the excuse that you need a drink because you’re thirsty. >> Make your first drink a soft one. >> Drink something less strong.

TAKE A TIME OUT Alcohol may be a bigger part of your life than you realise. Stop drinking for a week. How difficult is that? Stop for a month. How difficult is that?

Giving up for a period will help you better understand how alcohol fits into your life. It will also reset your tolerance level. (Like all drugs, we find that over time we need to take more and more alcohol to achieve the same effect. A time out will reset your tolerance levels.)

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AM I DRINKING TOO MUCH? Now you’ve read the booklet, you probably know the answer to this.

But you need to be honest with yourself and that’s not always easy. Have you tried our tips for cutting down? How easy did you find them? Only you know.

I DON’T HAVE A PROBLEM. I STOP EVERY JANUARY. Alcohol can be doing you a lot of harm even if you’re able to stop for a time.

You may have noticed your tolerance going up (taking longer to feel the effects). You may have noticed more empties in the recycle bin. Perhaps someone has commented on your drinking. Or you’ve noticed your work is being affected. All are warning signs. You may not think you have a problem.

Quite possibly you have drinking friends saying there’s no problem either.

But just because you can stop for a while doesn’t mean you are drinking safely. Far from it. Ask yourself the questions on page 18.

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BUT I DON’T EVEN DRINK MUCH. It’s not simply about the amount. Only you know how much you need a drink.

The questions below and Drinkaware’s confidential Alcohol Self-Assessment Test (see page 19 opposite) can help.

The bottom line is this: if you’ve tried to give up for a while and can’t, that is a sign that you need to do something about your drinking. Even if you can give up for a bit, ask yourself honestly the questions below.

Don’t underestimate alcohol. It is a powerful drug costing England around £21 billion a year (about half goes on alcohol-related crime). An estimated 7.5 million people are unaware of the damage their drinking could be causing.

Alcohol dependence or alcoholism can affect any of us. If it happens to you, it’s not your fault any more than getting any other disease is your fault.

But it is your responsibility to do something about it. Is your drinking costing you more than the price of the alcohol?

IS DRINK IN CHARGE? ASK YOURSELF… >> Have you ever decided to stop drinking for a week or so, but only lasted for a couple of days? >> Do you wish people would mind their own business about your drinking and stop telling you what to do? >> Have you ever switched drinks hoping this would stop you getting drunk? >> Do you need to have a drink to get yourself going when you wake up? >> Do you envy people who can drink without getting into trouble? >> Have you had problems connected with drinking during the past year – at home, at work, when out? >> Have you missed days of work or school because of drinking? >> Do you have ‘blackouts’? >> Do you tell yourself you can stop drinking any time you want to, even though you keep drinking or getting drunk when you don't mean to? >> Have you ever felt that your life would be better if you did not drink?

If you’re answering ‘yes’ to a few of these, you should probably talk to someone about it.

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WHO CAN HELP? Your GP can help you figure out if you should make any changes in your drinking, and offer help and advice along the way.

Men’s Health Forum www.menshealthforum.org.uk Health information from the Men’s Health Forum beatstress.uk Email/text chat with a stress expert.

NHS Choices Online ‘front door’ to NHS www.nhs.uk www.nhs.uk/lifecheck www.nhs.uk/change4life apps.nhs.uk Call 111 (24 hour) for nonemergency medical advice. http://tinyurl.com/oohNHS for more on NHS out of hours.

NHS Choices has an excellent section on alcohol support at: www.nhs.uk/ Livewell/alcohol/Pages/ Alcoholsupport.aspx including a search facility to find Sometimes local services.

you think that drinking is the answer but it never is.

PHOTO CREDITS: Thanks to Drinkaware plus sridgway, bareknuckleyellow, Patrik Nygren, HealthAliciousNess,Guian Bolisay and Rene Schweitzke who were all

Text Units to 64746 to access the NHS alcohol units calculator on any smartphone.

Drinkaware www.drinkaware.co.uk The Drinkaware Track & Calculate Units App and MyDrinkaware online tracking tool can both help you to monitor your intake.

Alcoholic Anonymous 0845 769 7555 www.alcoholics-anonymous.co.uk If you need help with a drinking problem you can phone the national helpline on 0845 769 7555 or email help@ alcoholics-anonymous.org.uk Addaction www.addaction.org.uk For all general enquiries and concerns, you can email info@addaction.org.uk.

To find your nearest service in England or Scotland, visit the Service Finder section of the website www.addaction. org.uk Mental Wellbeing www.mentalhealth.org.uk www.time-to-change.org.uk

kind enough to make their images available through the Creative Commons. (If this is not the case, please contact us.)

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Drinkaware is an independent UK-wide, alcohol education charity with the objective of positively changing public behaviour and the national drinking culture.

We aim to reduce alcohol misuse and minimise alcohol-related harm by helping people make better choices about their drinking.

We achieve this by: • providing impartial, evidence-based information, advice and practical resources; • raising awareness of alcohol and its harms, and • working collaboratively with partners (including the medical community, public health, third sector organisations, local authorities, police and the drinks industry).

FEELING DESPERATE? Samaritans 08457 90 90 90 Emotional support 24/7 www.samaritans.org Calm 0800 58 58 58 www.thecalmzone.net Full credits, links and licences at: menshealthforum.org.uk/ MMreferences

SERIOUS DRINKING Many of us enjoy alcohol and there’s nothing wrong with that. This booklet explains how alcohol works, how it affects our bodies and how you can drink more safely.

But alcohol is also a powerful drug that kills someone nearly every hour in the UK, the vast majority of them men. So this booklet also includes tips for controlling your drinking and what to look for if your relationship with alcohol is causing you concern.

• Units and limits • Processing alcohol • Sleep, driving and hangovers • Effects on the body and mind • Our six-point plan for cutting down

At last, a health booklet I can read cover to cover. Great stuff.

• How you know when you’ve got a drink problem.

WARNING: Reading this booklet could seriously improve your health.

ISBN: 978-0-85761-014-0 www.menshealthforum.org.uk