When is alcohol a problem?

Just like having an occasional sweet won't ruin your entire healthy eating pattern, most people can have an alcoholic beverage on occasion without it harming their health. However, regularly drinking alcohol too often (alcohol abuse), or drinking excessive amount of alcohol in a short time (binge drinking) can seriously harm your health and relationships.

How much is too much?

According to the US National Institute for Alcohol Abuse and Alcoholism:

Moderate drinking means:

• Up to one drink a day for women
• Up to two drinks a day for men

Heavy drinking means:

• More than three drinks a day for women
• More than four drinks a day for men

Moderate drinking doesn't mean you're drinking safely. Drinking moderately every day still poses a great risk to your health, behaviour and relationships and it increases your risk for alcohol use disorder.

As a general rule: The more alcohol you consume and the longer you keep doing it, the greater your level of risk.

What counts as a drink?

Don't fall into a trap of thinking a glass of any size counts as a drink. For working out your alcohol use, a 'drink' is a unit of alcohol. There's a huge difference between a pint and a bottle of beer. The kind of alcohol, its alcohol percentage and the volume all work together when you work out what counts as one drink.

These all count as one drink:

• A regular beer (355 ml) - 5% alcohol
• A malt liquor (235 - 265 ml) - 7% alcohol
• A glass of table wine (145 ml) - 12% alcohol
• A glass of fortified wine, like sherry or port (89 - 120 ml) - 17% alcohol
• A double tot of brandy or cognac (45 ml) - 40% alcohol

What is binge drinking?

'Binge drinking' means drinking a lot of alcohol in a single session, usually five or more drinks for men and four or more drinks for women. Even though it takes place on a single occasion, binge drinking is a form of heavy drinking and is just as bad for you as other forms of alcohol abuse.

Overall, this type of drinking is a common, costly and deadly pattern of excessive alcohol use. It tends to be twice as common among men as among women.

How do I know if I have a problem with alcohol?

People who abuse alcohol are not always aware of their behaviour, and cannot always acknowledge the problem.

You should listen to what trusted family members, friends and colleagues say about your use of alcohol. Also reflect on your own level of wellbeing, relationships, productivity and ability to function in carrying out everyday activities, in relation to your use of alcohol.

You might have a problem with alcohol if you:

• Have a strong urge or need to drink
• Drink more, or for longer, than you had intended to
• Find yourself in dangerous situations while drinking or after drinking (including drunk driving, swimming, operating machinery, visiting dangerous areas, and engaging in risky sexual behaviour)
• Have withdrawal symptoms when the effects of alcohol wear off or if you haven't had alcohol such as nausea, trouble sleeping, shakiness, irritability, anxiety, depression or sweating
• Spend a great deal of time in activities necessary to obtain alcohol, drinking alcohol, or recovering from its effects
• Abuse other substances together with alcohol
• Continue drinking, even though other people are concerned about your drinking behaviour or amount of alcohol you consume
• You must drink an increasing amount to have the desired effect, and to get drunk
• Have tried more than once to cut down on your drinking or stop drinking, but couldn't
• Drink alcohol when you are alone, to help you sleep or manage stress
• Experience increasing conflict and difficulties in your relationships as a result of your alcohol use
• Experience that drinking alcohol, or being sick from drinking, interferes with your ability to look after yourself and engage in your usual activities
• Have been arrested more than once or experienced other legal problems related to drinking
• Experience personality changes, behavioural changes, tremors (shaking), panic attacks, confusion, hallucinations, blackouts or seizures related to your alcohol use

The more symptoms you have, and the longer you've been experiencing them, the greater your risk of having a problem with alcohol.

What does abusing alcohol do to you and those around you?

What it does to you

Alcohol abuse:

• Increases your risk of all manner of injuries (from falls to burns, poisoning and more) at work, home or school or in public venues
• Causes, negatively influences, worsens or prevents the effective management of various health problems, like:
  • Liver disease
  • High blood pressure
  • Stroke
  • Stomach bleeding
  • Diabetes
  • Sleep disorders
  • Various mental health challenges, like depression and anxiety
• Decreases productivity and functioning at work and school
• Causes you to make poor decisions that may have serious consequence

What it does to others

Abusing alcohol is also dangerous because alcohol and the behaviour it causes puts other people's health and wellbeing at risk:

• Abusing alcohol causes difficulties in your relationships at home, work and school.
• If you drink and drive, you not only increase your risk of injury or death as a result of a serious motor vehicle accident, but you could also cause injury or death to other road users.
• Being intoxicated increases your risk of taking part in unsafe sexual practices that can lead to sexually transmitted infections (STIs) and unintended pregnancy.

What it does during or after pregnancy

Alcohol is not considered safe at all during pregnancy. Using alcohol during pregnancy can result in poor health outcomes for the pregnant person and the child both before and after birth.

Drinking alcohol during pregnancy and abusing alcohol after birth can result in:

• Poorer pregnancy outcomes overall
• Foetal alcohol spectrum disorders: alcohol exposure during pregnancy results in serious, lifelong developmental and neurological difficulties for the child
• Sudden infant death syndrome and infant suffocation or neglect: when caretakers abuse alcohol there is an increased risk of babies being put down to sleep in unsafe positions, which increases the risk of sudden infant death syndrome. Caretakers might also put infants to sleep beside them or in unsafe locations, which also increase the risk of suffocation or death.

What must I do if I suspect I have a problem with alcohol?

Acknowledge and accept that you may have challenges and difficulties related to your drinking behaviour and ask for help. There's nothing to feel ashamed about. Seeking help is a courageous step to take. Speak to a counsellor or your doctor.

Understand and accept that you have challenges with using alcohol. Maintaining sobriety is a long term process!

If you have family member or friend who is experiencing challenges with their drinking behaviour, you should encourage them to seek counselling or consult their doctor.

Where to get help

• Alcoholics Anonymous South Africa is an informal society without membership fees. They meet in over 350 locations around the country. Call them on 0861 43 57 22.

Types of treatment:

• Going for counselling
• Joining a support group
• Using medicine
• Going into a rehabilitation programme