Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines. You may find the Alcoholism and Problem Drinking article more useful, or one of our other health articles.
Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
See the separate related articles Alcoholism and Alcohol Misuse - Recognition and Assessment and Alcoholism and Alcohol Dependence (Management).
The recommended maximum alcohol intake per week is 14 units for men and 14 units for women.
In 2018, men and women aged 55 to 64 had the highest proportions of alcohol intake, usually drinking over 14 units in a week. 38% of men and 19% of women aged 55 to 64 usually drank over 14 units in a week.
Morbidity and mortality statistics for alcohol abuse
In 2018-19, there were an estimated 358,000 admissions where the main reason for admission was drinking alcohol (6% higher than 2017/18 and 19% higher than 2008/09).
There were 5,698 alcohol-specific deaths in 2018 (2% lower than 2017 and an increase of 7% on 2008).
- Death and illness from accident and injury, drowning, alcohol poisoning, and self-harm related to alcohol.
- Drinking five UK units on a single occasion more than doubles the relative risk of an injury in the six hours afterwards, and this relative risk rises even more rapidly when higher levels are consumed.
- Increased risk of some cancers, including:
- Cancers of the oral cavity.
- Laryngeal cancer.
- Oesophageal cancer.
- Colorectal cancer.
- Gastric cancer.
- Liver cancer.
- Breast cancer.
- For female breast cancer, relative risks of both illness and death increase by 16% if drinking regularly at 2 units per day and by 40% if drinking regularly at 5 units per day.
- The lifetime risk of bowel cancer in men who drink at least 35 units weekly is almost double that of men who do not drink alcohol.
- Atrial fibrillation.
- Hypertension: Excessive alcohol use is associated with hypertension and subsequent target organ damage such as strokes, myocardial events and chronic kidney disease.
- Dilated cardiomyopathy with heart failure.
For cardiac arrhythmias in men, relative risks of illness and death from the disease increase by 13% if drinking regularly at 2 units per day and by 34% if drinking regularly at 5 units per day.
Alcohol accounts for over a third of all cases of liver disease. The three conditions most associated with alcohol use are fatty liver (steatosis), hepatitis (acute hepatitis and chronic hepatitis), and cirrhosis.
Alcoholic cirrhosis is associated with a significant increase in risk of death due to bleeding oesophageal varices, infection, renal failure, and/or liver failure.
For cirrhosis of the liver in men, relative risks of death from the disease increase by 57% if drinking regularly at 2 units per day and by 207% if drinking regularly at 5 units per day.
Alcohol increases the risk of oral cancers. This is especially associated with spirits and the risk is increased with concomitant use of tobacco. Adenocarcinoma of the stomach and oesophagus are thought to be related to alcohol use. Some of these cases may be genetically determined .
Portal hypertension is a complication of cirrhosis and leads to a raised venous pressure in veins in the oesophagus and stomach. These swollen veins are superficial and bleed easily. Bleeding from oesophageal varices is serious and is associated with a high level of morbidity and mortality .
Management of bleeding varices is a medical emergency and requires adequate resuscitation (patients may need to be intubated to protect their airway). Blood transfusions are necessary and correction of abnormal clotting with vitamin K and fresh frozen plasma (FFP) may also be required. Various options for treatment are available including vasoactive drugs, obturation with glue and balloon tube tamponade.
Both acute pancreatitis and chronic pancreatitis are associated with excessive alcohol consumption. One study found that consumption of spirits was more likely than wine or beer to cause acute pancreatitis. The pathophysiology of alcohol-related pancreatitis is not clearly understood. Patients usually present with epigastric pain with vomiting. The amylase is high in acute pancreatitis but may be normal in patients with chronic pancreatitis. Pancreatitis can be associated with a number of complications such as shock, sepsis and abscess formation. Long-term complications include diabetes mellitus and weight loss from steatorrhoea.
Acute alcohol intoxication can present with blackouts, head injuries and subdural haemorrhages. Alcohol withdrawal is associated with fits which may be unresponsive to antiepileptics.
The Wernicke-Korsakoff syndrome results from lack of thiamine (commonly seen in those with alcohol dependency, due to malnutrition). Wernicke's syndrome occurs acutely and patients present with confusion, visual impairment (diplopia) and ataxia. Korsakoff's syndrome occurs more chronically and is characterised by memory deficits and confabulation .
Young people may be especially at risk of alcohol-induced brain impairment.
Other adverse effects on the neurological system include peripheral neuropathy and cerebellar degeneration.
Psychiatric conditions associated with alcohol misuse include:
Approximately 44% of community mental health patients report problem drug use or harmful alcohol use in the previous year.
The national confidential inquiry into suicide and homicide by people with mental illness found that there was a history of alcohol misuse in 45% of suicides among the patient population during period 2002 to 2011.
Alcohol consumption during pregnancy can adversely affect the fetus:
- Fetal alcohol exposure can cause miscarriage, stillbirth, and intrauterine growth restriction.
- Heavy drinking during pregnancy (repeatedly consuming more than around five units per day), can result in fetal alcohol spectrum disorders (FASD).
- Social complications relating to alcohol misuse include:
- Family conflict and domestic violence and abuse.
- Impaired performance at work.
- Relationship problems.
- Violent crimes - eg, domestic violence and drink driving offences.
- Antisocial behaviour.
Alcohol plays a part in 25-33% of known cases of child abuse.
In a study of four London boroughs, almost two thirds of all children subject to care proceedings had parents who misused substances, including alcohol.
In a study of young offending cases where the young person was also misusing alcohol, 78% had a history of parental alcohol abuse or domestic abuse within the family.
Miscellaneous problems associated with alcohol abuse
- Loss of libido
- Fetal alcohol syndrome
Alcohol withdrawal symptoms occur within a few hours of not having a drink and can last beyond 48 hours. Patients experience hallucinations, anxiety and a coarse peripheral tremor. On examination, patients may be pyrexial, tachycardic and hypertensive. They may also develop seizures and auditory and visual hallucinations.
Delirium tremens is the severe end of the spectrum of alcohol withdrawal and consists of a severe form of the above symptoms; it may be associated with circulatory collapse and ketoacidosis.
See the separate Acute Alcohol Withdrawal and Delirium Tremens article for more details.
This is characterised by the following:
- A strong desire to drink.
- Difficulty controlling alcohol intake.
- Physiological withdrawal when intake is reduced.
- Tolerance, such that increasing amounts are required to produce the same effect.
- Harm resulting from continued alcohol use - eg, work or relationship problems.
Treatment of alcohol dependence includes education, support, counselling and controlled alcohol withdrawal. Patients may need to be admitted to hospital for detoxification.
See the separate Alcoholism and Alcohol Dependence - Management article for more details.
Further reading and references
Management of alcohol-related liver disease; European Association for the Study of the Liver - EASL (2018)
Nichols M, Scarborough P, Allender S, et al; What is the optimal level of population alcohol consumption for chronic disease prevention in England? Modelling the impact of changes in average consumption levels. BMJ Open. 2012 May 302(3). pii: e000957. doi: 10.1136/bmjopen-2012-000957. Print 2012.
Statistics on Alcohol: England - 2020; Health and Social Care Information Centre (HSCIC)
Alcohol - problem drinking; NICE CKS, February 2018 (UK access only)
Alcohol-use disorders: Diagnosis and clinical management of alcohol-related physical complications; NICE Clinical Guideline (June 2010, last updated April 2017)
Roswall N, Weiderpass E; Alcohol as a risk factor for cancer: existing evidence in a global perspective. J Prev Med Public Health. 2015 Jan48(1):1-9. doi: 10.3961/jpmph.14.052. Epub 2015 Jan 27.
Piano MR; Alcohol's Effects on the Cardiovascular System. Alcohol Res. 201738(2):219-241.
Osna NA, Donohue TM Jr, Kharbanda KK; Alcoholic Liver Disease: Pathogenesis and Current Management. Alcohol Res. 201738(2):147-161.
Rocco A, Compare D, Angrisani D, et al; Alcoholic disease: liver and beyond. World J Gastroenterol. 2014 Oct 2820(40):14652-9. doi: 10.3748/wjg.v20.i40.14652.
Mukherjee S; Alcoholism and its effects on the central nervous system. Curr Neurovasc Res. 2013 Aug10(3):256-62.
Hermens DF, Lagopoulos J, Tobias-Webb J, et al; Pathways to alcohol-induced brain impairment in young people: a review. Cortex. 2013 Jan49(1):3-17. doi: 10.1016/j.cortex.2012.05.021. Epub 2012 Jun 17.
Allen MS, Walter EE; Health-Related Lifestyle Factors and Sexual Dysfunction: A Meta-Analysis of Population-Based Research. J Sex Med. 2018 Apr15(4):458-475. doi: 10.1016/j.jsxm.2018.02.008. Epub 2018 Mar 6.
Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence; NICE Clinical Guideline (February 2011)