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Drink Smart. Alcohol Self-Help Guide

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Contents

Introduction . . . 3

How can this guide help me? . . . 4

What is lower risk drinking? . . . 6

Ageing well . . . . 8

One drink isn’t always One Unit . . . 10

Self-Test . . . 12

Drinking causes damage you can’t see . . . 16

The impact on children and childhood . . . . 18

How alcohol enters the body . . . 20

The intoxicating effects of alcohol . . . 21

How alcohol can affect medication . . . . 22

How alcohol leaves the body . . . 24

What is alcohol-dependency? . . . . 25

A typical week . . . 28

What do I like about drinking? . . . 30

Thinking about change? . . . 34

Do I cut down or have time off? . . . 37

Importance and confidence . . . 38

Action Plan . . . 39

Stress bucket . . . 42

Health benefits of change . . . 44

Menu of options . . . . 46

Final Tips . . . . 47

Drink Diary . . . . 48

Non-Drinking Diary . . . . 50 Where to get more help and advice . . . . Back cover

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Introduction

Drink Smart is a self-help guide designed to help you make positive choices about alcohol .

The first part of the booklet includes:

• what the lower, increasing and higher risk drinking levels are

• how many units of alcohol there are in popular drinks

• an easy self-test to check your risk category • how alcohol affects the body, the brain, and

medication

The middle part of the booklet will help you think about:

• when and where you drink in a typical week • what you like about drinking and how you feel

about change

• whether to cut down or have time off

The last part of the booklet will support you to: • make an action plan to achieve your goal • manage stress in different ways

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How can this guide help me?

Maybe your drinking no longer fits with your values and identity

Perhaps health, work, family or legal reasons are forcing you to look at your drinking

Maybe you're drinking to cope with stress or anxiety

Perhaps you are drinking more than you realise Most of us don’t start thinking about change until we really have to .

(5)

“I can handle

my drink”

“I’m a

social

drinker”

“Everyone

else drinks

as much as me”

“I’ve nothing

else to do”

You may have had similar thoughts yourself .

(6)

What is lower risk drinking?

Higher Risk Level Regularly drinking over 2-3 units in one day

More than 35 units in one week (or regularly drinking 6+ units in one day)

Lower Risk Level Regularly drinking

no more than 2-3 units in one day

Women

To help people stay safe and healthy, the NHS advises men and women not to regularly drink more than a certain amount of alcohol in one day . “Regularly” means most days of the week or every day . The risk of harm from drinking above these levels increases the more alcohol that you drink, and the more often you drink over these levels .

Pregnant women (or women trying for a baby) should avoid alcohol altogether . Never more

than 1-2 units once or twice a week

Increasing Risk Level

(7)

Higher Risk Level Regularly drinking over 3-4 units in one day

More than 50 units in one week (or regularly drinking 8+ units in one day)

Increasing Risk Level Lower Risk Level Regularly drinking no more than 3-4 units in one day

Men

It also involves a personal judgement of what else is happening at the time (or about to happen) e .g . if driving or operating machinery, if you have work or childcare responsibilities, or if you are taking medication . It is also dangerous to mix alcohol with illegal drugs or “legal highs” .

BInge DRInkIng

WOMEN = drinking more than 6 units in one session

MEN = drinking more than 8 units in one session

(8)

Ageing well

As you get older, your body becomes more sensitive to the effects of alcohol . This is because there is less water to dilute it inside the body tissues, and, it is broken down more slowly by the liver .

• Some people feel drunk at a faster rate compared to when they were younger

• Others find that it takes them a longer time to recover from the night before

Drinking less, or not drinking at all, is especially important when you feel unwell or run-down, or when taking medication.

(9)

For men over 40 and post-menopausal women, 1-2 units of alcohol per day can offer some protection against coronary heart disease . Drinking more than this does not add more health benefits .

It can also be easy to start drinking more as a result of major life changes such as job loss or retirement, relationship breakdown, “grown-up” children moving away, or a bereavement.

Depression and anxiety, sleep problems, forgetfulness, or shakiness and falls, may be mistaken for other causes when alcohol is to blame .

(10)

One drink isn’t always One Unit

Advice is described in “units of alcohol” instead of “number of drinks” because alcoholic drinks come in different sizes and different strengths .

Unit Calculator: abv % (Strength) multiplied by ml (Size) divided by 1000

The size of a drink depends on the measure or serving . The size is usually labelled on packaging in millilitres (ML) or litres (L) . It may be a pint glass, a wine glass, a bottle, a can or just a rough guess at home .

The strength of a drink is labelled on packaging as the % abv (percentage of alcohol by volume) . The higher the % abv, the stronger it is.

On average, a lot of drinks are stronger these days and measures are larger

(11)

Here are some examples of common drinks

Alcoholic drinks are high in calories, however they have no

nutritional value . For an online unit calculator and calorie counter, visit: www.drinkaware.co.uk

Can Pint Pint

Bottle Pint Premium Regular Pint Double Premium Drink Alcopop Ale Lager Lager Cider Vodka Lager % abv 5% 3 .6% 5% 4% 4 .5% 40% 5% Size 275ml 568ml 440ml 568ml 568ml 70ml 568ml Units 1.4 2 2.2 2.3 2.6 2.8 2.8 kcals 192 187 180 187 216 154 233

Large Can Bottle

glass Strong Bottle Tonic Bottle Bottle Bottle Drink Wine Lager Wine Wine Sherry Cider Spirits % abv 14% 9% 14% 15% 18% 7 .5% 40% Size 250ml 500ml 750ml 700ml 750ml 3 litre 700ml Units 3.5 4.5 10.5 10.5 13.5 22.5 28 kcals 200 330 600 600 975 1380 1554

We have included the strength (% abv), different sizes (ml), units and estimated calorie content (kcals).

(12)

Self-Test

How do I know if I am at risk?

Spend a few moments thinking about the last 12 months . Tick the answer that best fits you right now:

1 . How often do you have a drink containing alcohol? (This includes tonic wines or alcohol added to hot drinks)

(0) Never (skip to question 9) (1) Monthly or less

(2) 2-4 times a month (3) 2-3 times a week (4) 4 or more times a week

2 . How many units of alcohol do you have on a typical day when you are drinking?

(0) 1 or 2 (1) 3 or 4 (2) 5 or 6 (3) 7 - 9

(4) 10 or more

3. How often have you had 6 or more units if female, or 8 or more units if male, on a single occasion in the last year?

(0) Never

(1) Less than monthly (2) Monthly

(3) Weekly

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Self-Test

4 . How often during the last year have you found that you were not able to stop drinking once you had started?

(0) Never

(1) Less than monthly (2) Monthly

(3) Weekly

(4) Daily or almost daily

5 . How often during the last year have you failed to do what was normally expected from you because of your drinking?

(0) Never

(1) Less than monthly (2) Monthly

(3) Weekly

(4) Daily or almost daily

6 . How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session?

(0) Never

(1) Less than monthly (2) Monthly

(3) Weekly

(14)

Self-Test

7 . How often during the last year have you had a feeling of guilt or remorse after drinking?

(0) Never

(1) Less than monthly (2) Monthly

(3) Weekly

(4) Daily or almost daily

8 . How often during the last year have you been unable to remember what happened the night before because you had been drinking?

(0) Never

(1) Less than monthly (2) Monthly

(3) Weekly

(4) Daily or almost daily

9 . Have you or someone else been injured as a result of your drinking?

(0) No

(2) Yes, but not in the last year (4) Yes, during the last year

10 . Has a relative or friend or doctor or other health worker been concerned about your drinking or suggested you cut down?

(0) No

(2) Yes, but not in the last year (4) Yes, during the last year

(15)

Your drinking appears to be already causing you, or others around you, harm and

you may be developing a physical and/or psychological

dependency to alcohol . It may be dangerous for you to

cut down or stop drinking suddenly (see page 25) .

Ask your doctor or local alcohol service for

extra advice and support .

Your drinking appears to have potential to put you, or others around you, at risk of future harm . This guide can help you reduce to healthier

and safer levels .

Scores 20+ PROBABLe DePenDenCe Scores 16-19 HIgHeR RISk Scores 8-15 InCReASIng RISk Score 0-7 LOWeR RISk

Your drinking is likely to be already causing you, or others

around you, harm. You may not have been aware they were linked together . This guide can help you reduce to healthier and safer levels and some people benefit from extra support along the way

(see back page) .

Congratulations! Your drinking does not appear to be putting you,

or others, at risk unless you are drinking at times when any amount of alcohol

is unsafe e.g. when driving, during pregnancy . If in doubt, talk to a local health

advisor or pharmacist . now add up your total score / 40

The score is not a diagnosis, however it gives you an idea of your risk category and the options available to you .

(16)

Mouth and throat cancers Risk of tooth decay

Alcohol dependency syndrome – e.g. withdrawal anxiety, insomnia, shakes, sweats, fits, hallucinations, cravings Alcohol poisoning and choking

Weight gain, stomach complaints, pancreatitis, Type II diabetes, liver damage, liver cancer Irritable bowel, bowel cancer

Vulnerability – e.g. blackouts, injuries, assaults, accidents,

unwanted pregnancies, falls in later life, 1 in 3 fire-related deaths Alcohol can affect your physical and mental state

and your behaviour . You may have experienced some problems already without realising they have been linked to your drinking habits .

A healthy liver breaks down 1 unit of alcohol every hour

(17)

Anxiety, depression, mood swings, insomnia, self-harm, suicide, dementia High blood pressure, heart disease, strokes Breast cancer Impotence, infertility, harm in pregnancy, forgetting to use a condom Low vitamin B and nerve damage – e.g. tingling and numbness in hands and feet Crime: drink driving, starting fights, damaging property,

urinating / vomiting in public, noise nuisance, anti-social behaviour 1 or 2 units can be good for the heart but only for men over 40 and women

after the menopause

Harm can occur while under the influence of alcohol or while sobering up . It can also happen slowly over time with regular use over months or years . Money worries or relationship/family problems are also common as time goes on .

(18)

The impact on children and childhood

is significant

A serious hidden consequence is the impact a parent or carer’s drinking can have on children .

Children can be left alone and unsupervised, and not kept safe from immediate danger or harm .

They may take on caring roles at an early age and become “young carers” .

(19)

Arguments and conflict can become more common at home, leaving children feeling scared, vulnerable, and as if it's their fault .

Often children will keep an adult's drinking a secret, and feel lonely and isolated .

Children must come first

To help protect your child, do something early about your drinking, rather than wait for problems to worsen or crises to occur . Eclypse Family Service can support you as a parent/carer as well as your children (see back cover) .

(20)

How alcohol enters the body

Feeling “drunk” is generally caused by drinking alcohol at a faster rate than the body can break it down .

1 . An alcoholic drink is swallowed .

2 . It is soaked up in the stomach and travels to the intestines .

3 . The small intestines take the alcohol into the

bloodstream .

4 . It arrives at the brain .

Eating before drinking helps slow down how quickly alcohol travels to the brain

(21)

The intoxicating effects of alcohol

Alcohol is a depressant drug . This means that certain parts of brain activity will start to slow down or switch off after swallowing – it is intoxicating . Often people binge drink to feel the intoxicating effects of alcohol – i .e . to feel drunk. For example, they feel less inhibited, fearless, or feel like they can “forget everything” .

But there can also be unwanted effects like slurring words, bumping into things, falling over, or incontinence .

While these may be embarrassing, other effects of alcohol can be more dangerous or even fatal: losing control of what you say or do, having memory

blackouts, passing out, choking on your own vomit, or even having a heart attack . Heart Beat Short-term Memory Co-ordination Concentration Mood & emotions Breathing Speech

(22)

How alcohol can affect medication

Sometimes the medication will increase the intoxicating effects of alcohol.

Alcohol taken with any medicine that has a sedating effect – like sleeping tablets, some anti-depressants, pain killers or cold remedies – can make you more drowsy or light-headed . Drinking alcohol while taking

medication can have unpredictable effects .

(23)

Drinking alcohol can stop some

medicines from working (or they don't work as well).

If you are taking medication that acts on the brain – like anti-epileptic medication or anti-depressants – you might feel more drunk more quickly or suffer worse side-effects such as feeling dizzy or unsteady on your feet .

Common side-effects of the medication can get worse, or new side-effects can result because of the mixture with alcohol.

Always check with your local pharmacist or doctor before taking prescribed or over-the-counter medication .

(24)

How alcohol leaves the body

It is important to remember that nothing can speed up how fast alcohol leaves the body. Drinking lots of water, black coffee or having a cold shower are all myths .

1 . The liver breaks down 90% of alcohol in the body .

2 . The remaining 10% leaves the body through urine, sweat and breath .

3 . A healthy liver breaks down approximately one unit every hour . 4 . Regular heavy drinking also reduces the amount of Vitamin B1 (Thiamine) stored in the body - an important vitamin for brain and nerve cells .

Allow plenty of time for the liver to break down all the alcohol before you drive, go to work, operate machinery

(25)

What is alcohol-dependency?

If you drink frequently over a long period of time, your body may become more “tolerant” to the effects of alcohol . This means that:

• You may need to drink more to feel the effects of alcohol .

• You may not feel “drunk” despite having high levels of alcohol in your body .

• You may feel like you can “handle your drink” or that it won't cause you harm .

Increasing tolerance may be the first warning sign that you are becoming alcohol-dependent .

You may also start to have an overwhelming urge to drink alcohol and be unable to limit or stop yourself from drinking once you have started .

It is important to remember that there is no typical picture of someone who will become “alcohol-dependent” .

Ultimately, drinking at higher risk levels puts you at risk .

(26)

Alcohol withdrawal

MeDICAL WARnIng!

If you are alcohol-dependent, you should not suddenly reduce your alcohol intake, because withdrawal

symptoms can be life-threatening.

If you become alcohol-dependent, you may develop withdrawal symptoms if you stop drinking or suddenly reduce the amount that you drink .

Alcohol withdrawal can vary from mild problems, such as sleeping badly and feeling shaky and anxious, to much more serious, sometimes

life-threatening problems . If you have sudden and severe alcohol withdrawal, you may have some very serious symptoms . You may have fits (called seizures) where you may temporarily lose consciousness .

You may also experience something called delirium tremens (sometimes called DTs), which can include hallucinations (seeing, hearing or feeling things that aren't there) and feeling agitated and confused .

(27)

Some of the questions below may be similar to the ones you have answered already in the Self-Test .

If you answered “yes” to any of these questions, you should get help from a local alcohol support service (see back page) . They

will be able to advise you on how

to avoid withdrawal symptoms if you want to stop drinking or reduce the amount you drink (called “planned withdrawal” from alcohol) .

Are you drinking more to feel the effects of alcohol? Y / N Y / N Y / N Y / N Y / N Do you have an overwhelming urge to drink alcohol?

Do you have difficulties limiting or stopping yourself from drinking once you have started?

Do you experience withdrawal symptoms if you stop drinking or suddenly reduce the amount that you drink? Have you started to neglect other areas of your life because of your drinking?

Y / N Are you continuing to drink despite experiencing

(28)

A Typical Week

It can be helpful to keep a Drink Diary to find out when, where, why and how much you drink. You may want to think of a typical week now or fill it in when you are ready .

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Start Time

(29)

Totals

Thoughts / Feelings

Before First Drink Consequences / ImpactOn Others

How Many Units

Heaviest drinking day:

(30)

What do I like about drinking?

Looking back over your Drink Diary, how frequently do you drink in the following situations?

Situation To relieve stress or feeling fed up To celebrate To get off to sleep

(31)

Use the blank space provided to note other situations that are not listed here .

Situation To reward myself To relieve pain Other . . .

(32)

What do I like about drinking?

When planning to cut down or have time off, it will be important to find other ways to manage these situations .

Situation To relieve strong urges or cravings To not feel left out To feel more confident

(33)

You are most likely to think about a drink in the situations you have ticked . Situation To make new relation-ships To relieve boredom Other . . .

never Sometimes Often Use the blank space provided to note other situations that are not listed here .

(34)

Thinking about change?

The way we make decisions or choices usually happens in stages .

I’m going

to keep

going

I’ve gone back to

how I was before

I’m

happy

as I am

(35)

I’m in

two minds

what to do

I’m almost

ready

I’ve already

started

It can take one big thing or lots of little things to happen before we move on to another stage . Thinking about your drinking habits, where would you say you are right now?

(36)

Thinking about change?

Imagine staying exactly as you are right now and then imagine making a change . . . . Write down what would be “good” and “not so good” for you about these two situations:

Situation

Staying as I am

Making a change

(37)

Situation

Cut down

Have time off

good things good thingsnot so

Do I cut down or have time off?

Imagine yourself cutting down and then imagine having time off . . . . Write down what would be “good” and “not so good” for you about these two options:

(38)

Importance and confidence

1 2 3 4 5 6 7 8 9 10

1 . How important does it feel for you right now to make any changes to your alcohol use? If 1 was “not important at all” and 10 was “very important”, what number would you give yourself? _______ If you feel this has low importance right now, what would need to happen to move your score one step higher?

_______________________________

_______________________________

_______________________________

_______________________________

High

2 . If you decided right now to make some changes, how confident do you feel about succeeding? If 1 was “not confident at all” and 10 was “very confident”, what

number would you give yourself? ________ If you feel low in confidence right now, is there anything you have found helpful when you have made other changes in your life? Is there anything you have heard works well for other people?

_______________________________

_____________________

___________________

___________________

____________________

____________________

(39)

Action Plan

The most important reasons why I want to make this change are:

I am going to:

cut down have time off My personal limits are:

Units in one session __________ Units in a week __________ My alcohol free days (circle):

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time Off:

My last drink will be on __________

(40)

Action Plan

My high risk times: How I can handle them:

I plan to do these things in order to cut down:

My first drink of the day will be after __________ am/pm I will keep a Drink Diary

I will lower the % abv strength of what I drink I will choose smaller measures or servings I will change my usual tumbler/glass at home I will eat before drinking

I will avoid caffeinated mixer drinks

I will pace my drinks with alcohol free alternatives I will avoid drinking on my own

I plan to do these things if I have an urge or craving for alcohol: Tell myself the urge will pass with time

Tell myself I can wait it out

Tell myself to eat or drink something else Tell myself to do something I like or enjoy Remind myself of the reasons I want to change

(41)

I plan to do these things in order to cut down or have time off: Plan alternatives for common times when I drink

Distract myself if I get urges to drink Avoid drinking situations

Avoid friends/family who pressure me to drink Explain to friends/family what I am doing I will keep a Non-Drinking Diary

Get support from a counsellor Get support from a group Ways I can reward myself:

Ways I can meet people/try new things:

(42)

Managing my stress bucket

A lot of people have urges to drink alcohol when they feel stressed .

(43)

What fills your stress bucket (causes of stress)?

How do you know when your stress levels are rising (signs)?

What can you do to relieve your stress levels before they “spill over” (healthy solutions)?

The “stress bucket” can help people look at causes of stress, spot signs of stress levels rising, and find healthy solutions.

e.g. – work stress, money problems, health worries

e.g. – not sleeping, feeling irritable, racing heartbeat

(44)

Health benefits of change

Normal sleep patterns begin to return after three months . For dependent drinkers, they are usually back to normal after nine months .

High blood pressure can reduce after one week of changing habits .

People with anxiety have reported a week-by-week recovery with time off . Anti-depressants can work better and memory improves . You will have more personal safety by

being aware of your natural feelings of caution .

Drinking less often improves relationships and sexual health . People often remember to use condoms, put them on correctly, and avoid sexually transmitted infections or unwanted pregnancy .

(45)

Some medicines start working again (or work better) with less or no alcohol . Side effects from mixing alcohol with medicines improve or disappear .

Ten pints of lager a week can cost £25 or more – save £1,300 a year. 5 bottles of wine a week costs £20 or more - save £1,040 a year.

By drinking less alcohol in one day, cancer risk reduces (breast, mouth, throat, bowel, liver). A lot of people find they can stop smoking when drinking less too .

Reducing your drinking will automatically reduce your calorie intake . Snacking when drunk or hungover can also be avoided .

The liver can repair itself . Fatty liver can disappear and alcoholic hepatitis can be reversed when stopping drinking . People react better for treatment of other liver conditions (such as Hepatitis B or C) .

(46)

Menu of options

A lot of people find it easier to reach their goal when they have a menu of options of how to get support at different times . Write down your options for the situations below (or see back cover for more ideas) .

Someone who I can share worries with: ______________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________

Someone who has done this before: ____________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ____________________

Someone who will spend time with me without alcohol: ___ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________

Someone who will remind me of my goals: _______________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________

(47)

Final Tips

Help with anxiety and sleep problems

• Keep a Drink Diary or Non-Drinking Diary

• If you are thirsty, have a soft drink first

• Plan alternatives to replace the good things about your drinking • Choose lower strength abv % drinks or pour smaller

measures at home

• Avoid caffeinated mixers drinks and pace your drinks • Remind yourself to stop when you have reached your limit • Spend time with friends or family who will support you

• After drinking more than 6 units (women) or 8 units (men) allow at least 48 hours before your next alcoholic drink

• Check with your doctor or local pharmacist if you are planning to drink alongside taking medication .

• Share your worries with a “good listener”

• Try to spot situations that you find stressful and take steps to tackle it

• If you catch yourself thinking negatively, challenge your thoughts and talk to yourself positively

• Avoid caffeine during the day and close to bedtime • Go to bed and get up at a regular time

Parents or carers should never sleep with their baby in a bed, chair or sofa as this can be dangerous and even fatal for the child .

(48)

Drink Diary

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Drinking Limit
(49)

Totals

Who With Thoughts / Feelings Before First Drink Many How Units

Heaviest drinking day:

(50)

non-Drinking Diary

Monday Tuesday Wednesday Thursday Friday Saturday Sunday Time

Day Where Who With

Use the Non-Drinking Diary to record times you thought about having a drink but did something else instead .

(51)
(52)

Down Your Drink is a free and confidential interactive self-help website, packed full of

motivational and CBT based exercises for you to choose from over 1 hour, 5 days or 4 weeks . Web: www.downyourdrink.org.uk

Manchester Community Alcohol Team offers one-to-one specialist advice and support

to anyone over the age of 16 who is worried about their own or someone else’s drinking . Appointments take place in local health centres as well as GP surgeries across the city . Tel: 0161 234 5055 Mon-Fri, 9am-4.30pm. Web: www.manchestercat.org

Brian Hore Unit (BHU) offers recovery-based treatment and support for people who

want to stop drinking and maintain abstinence . Unsure as to whether to stop drinking or how? The BHU also offer a motivational group to help people with their decision to stop drinking . Tel: 0161 217 4435 Mon-Fri, 9am-8pm; Sat, 9am-3:30pm.

Manchester Specialist Midwifery Service provides dedicated support to women who

are worried about their drinking when pregnant or trying to conceive .

Tel: 0161 226 6669 Mon-Fri, 9am-5pm.

eclypse Under 19s Service offers a range of options to support and advise children and

young people who are using alcohol or drugs . Tel: 0161 273 6686 Mon-Fri, 9:30am-5pm.

eclypse Family Service offers a range of options to support families affected by one or

both parents/carers' alcohol or drug use . Children and their parents/carers are supported as a family and individually . Tel: 0161 273 6686 Mon-Fri, 9:30am-5pm.

Alcoholics Anonymous Manchester has a number of AA meetings in different venues

across the city . Tel: 0161 839 2881 11am-11pm . Web: www.manchestermeetingslist.com

end the Fear – If you are worried about domestic abuse, try to find someone you trust

who can listen and help you think about your options . You can call the greater

Manchester Domestic Abuse Helpline for help and advice . Tel: 0161 636 7525 Mon-Fri,

10am-4pm . 24 hour Domestic Violence Freephone Helpline: 0808 2000 247.

Web: www.endthefear.co.uk

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