Sensible Drinking

by Dr Nick Edmunds

I receive a lot of questions about a lot of topics, but a common connection often emerges: alcohol. Most of us enjoy a drink but many of us don't understand or realise how much it has become woven into our lives. The great majority don't have "a problem", and are able to take pleasure from the relaxing, sociable feel a few drinks can give us.

There can be benefits to health: a couple of drinks a day almost certainly improves our chances of staving off heart disease, strokes and circulation damage, but a little more than that has the exact opposite effect. Over the time I have spent as a doctor I have seen dozens of serious alcoholics who have suffered heart disease, and brain damage like stroke, through the effects of alcohol on the circulation and nervous system.

I'm not in a position to sermonise, but two cases I have come into contact with this month have prompted me to think about advice on sensible drinking.

A man of 33 I have known for a year was sent to me by a specialist alcohol support worker, recommending drugs to try to keep him off drink. I took this seriously; these specialists rarely recommend medication, but my patient was in rapid decline. He had been unemployed for three years, staying at home to look after the kids while his wife took a number of low-paid part-time jobs. He had taken to having a can of beer in the afternoon, and it snowballed out of contol to the point where he had to get a drink, now cheap strong cider, before he could get the kids out to school. He was well-motivated to stop, and I agreed to try disulfiram, a drug which gives nasty side effects if alcohol is taken along with it - a kind of aversion therapy. I also gave him acamprosate which helps to stave off cravings. These will only help in conjunction with much support and encouragement from family and friends, and from specialist psychiatric and counselling services.

A lady in her forties contacted me from Portugal, where she had gone to meet her partner, who was there building up his business while they prepared to move there permanently. They have a successful shop in Yorkshire, but had bravely decided to relocate to the sun. She was shocked to see him and to discover he had been to a doctor because friends said he was turning yellow. He'd been told he had liver damage to the extent where he had become jaundiced, a sure sign that his liver was very badly affected. Over the years they had both enjoyed a nightly bottle of wine and a couple of night-caps. In the three months he had been in the Algarve he had increased his consumption enough to tip the scales, and his liver had become no longer able to cope with the daily onslaught of the toxic effects of ethanol.

Both of these young men were tragic victims of the gradual damage we are all susceptible to if we are unable to keep our drinking in check. It's great to have a few drinks, but the following tips might be of help to some:

Eat something with alcohol - it slows you down and adds to the pleasure
Don't drink every day - have a few days in the week when you avoid it altogether
Set a weekly limit and try to stick to it
Avoid getting into 'rounds' of drinks - remember if you say no, you will be admired and envied by those who can't
Alternate with soft drinks
Don't drink on your own

If you do think you have a "problem", ask for help, from a doctor, a counselling service, a voluntary agency - they can all help confidentially.

Dr Nick Edmunds, General Practitioner, Scotland.