Advice for people who use alcohol

When people want to reduce their alcohol use there are two options:                   

1. Reduce alcohol use to within advised levels
2. Stopping alcohol altogether

The option that suits you will depend on your own individual circumstance and weighing up the pros and cons of each option. It is worth bearing in mind that it can be difficult to keep your alcohol use to low levels if you notice you have been drinking too much alcohol for several months or years. This means that if you have concerns about your alcohol you should think seriously about stopping alcohol completely. This will also allow you to see the full benefits of not using alcohol. It may take months or even years to see these benefits.

Most people can reduce their alcohol use without problems. However, some people notice effects on their body (withdrawals) when they stop their alcohol. This is more likely in the following situations:

• Drinking alcohol almost every day for several months or years
• Drinking 15 units or more of alcohol per week (15 units is about 6 pints of normal strength lager/ 2 Litres of strong Cider/ 3 pints of super strength lager/ ½ bottle of gin or whiskey/ 1½ bottles of wine)
• Withdrawal effects on stopping  alcohol in the past
• Having other medical problems – diabetes/liver disease/ heart disease/ lung disease/ pancreatic disease
• Being of low weight and finding it hard to eat a good diet each day

For some people these can be mild to moderate severity and would include the following:

• Tiredness
• Shakiness
• Feeling nervous
• Restlessness and feeling agitated

For certain people, there can be severe withdrawals symptoms including:

• Feeling mixed up (confusion)
• Marked sickness, vomiting and diarrhoea  
• Hearing things and seeing things that are not there (hallucinations)
• Seizures (similar to epileptic seizures)
• Unsteadiness when walking  and poor coordination
• Worsening of liver disease
• Worsening of other medical conditions such as diabetes/ lung disease

For mild or moderate withdraws you may be able to reduce the symptoms by drinking alcohol in a careful gradual manner until it reduces the symptoms to a manageable extent. Once you feel the symptoms are under control, you will need to work out how much alcohol you need on a daily basis to prevent these symptoms occurring again.

You will also need to work out the times of the day that you will need to use alcohol to stop the withdrawals from occurring. Using your drink diary will help with this.  If you do not use alcohol to manage the withdrawal symptoms they may continue for about a week. Usually they would reach maximum intensity two or three days after you stop the alcohol. However, they may also progress to severe withdrawal symptoms.

If you have severe withdrawals you will need to seek immediate medical advice either by your GP or by acute hospitals via the Accident and Emergency department.  A decision will be made as to whether your symptoms can be managed in the community or whether you will need an admission to hospital.

Depending on where you live there may be dedicated alcohol services within the hospital that could help to coordinate your treatment in the community. Given the current pressures on emergency services it is likely your treatment will be in the community unless there are very high risks to your physical health.

Further information about managing your alcohol use is available on the internet as follows:  

• NHS online resources https://www.nhs.uk/conditions/alcohol-misuse/treatment/
• Drinkaware  https://www.drinkaware.co.uk/
• Other organisations recognised in helping people with alcohol problems https://www.alcoholics-anonymous.org.uk ; https://www.breakingfreeonline.com/

Further advice could be sought from services in your local area:

• Your GP or practice nurse at your GP surgery
• Local drug and alcohol services (provided via the local council)
• Recognised organisations to help people with alcohol problems such as Alcoholics Anonymous and SMART recovery  

People often find talking to people with lived experience of stopping alcohol extremely helpful and your local drug and alcohol services or organisations such as Alcoholic Anonymous will have people with lived experience working for them.  

These organisations generally offer a mixture of one to one meetings plus a number of group based meetings.  Even with their help, it may take weeks or months to completely stop your alcohol.

Sometimes your local drug and alcohol service may offer you the option of using sedating medication such as diazepam to help you stop your alcohol use. This is usually given alongside vitamins for about 7 to 10 days. Sometimes it has to be given in a hospital but other times it can be given to you to take at home alongside support from your family. After this period of intensive treatment, you would be able to use the usual resources for a further period of time to help you avoid the use of alcohol. Given current stresses due to COVID -19, it is likely these services will be much reduced compared to normal times.

People generally see the benefits of stopping alcohol very soon after the withdrawals symptoms have stopped. However, you may start get urges to use alcohol in certain situation even though, on balance, you would prefer not to use alcohol. A good approach to manage these feelings is to:

1. Distract yourself by doing something you enjoy – reading/ watching TV/ exercise
2. Remind yourself that this will pass after a few minutes even though the urge can be very intense
3. Speak to someone who may be able to help – a friend / family member or a health professional

Your GP or local drug and alcohol provider may also be able to provide the medication to help with these feelings and support relapse prevention; these include Acamprosate, Disulfiram (Antabuse), Naltrexone and Baclofen.

Due to concerns about this virus, there are fewer options available for treatment of alcohol problems. It may be not be possible to easily contact your GP/ practice nurse and your local drug and alcohol services may not be providing the usual treatments. This means that other options need to be considered.

Self-assessment options

Some practical steps in this situation include:

• Assess your alcohol use as described above (using alcohol diaries)
• Complete a list of your medical problems including your medication and mental health problems and make sure you are taking these appropriately
• Think carefully about whether you are at risk of withdrawals
• Ask others in your life (friends and family) whether they feel you have problems with alcohol use and what support they can offer to help you stop your alcohol use
• Find out information about any organisation locally still functioning that may be able to help you manage your alcohol use
• Use national resources, such as Alcoholics Anonymous, for advice and help
• Use free online resources such as Breaking Free Online
• If you have had previous experiences working with drug and alcohol services, you could reflect on your past treatment with those services and see if you still have any treatment information provided by them
• Consider whether it is the right time to stop alcohol or whether you want to continue your alcohol at your level until more support is available

If you are planning to continue to use alcohol, you will need to think about how you will be able to obtain your usual levels of alcohol, particularly if you need to self-isolate (for example, is there someone who could buy alcohol for you in that situation?). However, any reduction is helpful and so it still would be worth trying to reduce to the minimum amount of alcohol you need to avoid withdrawals.

Self-Reduction

Even with the reduction of services in the current times, you may still want to stop your alcohol use. In these current times, it is unlikely you will be able to get sedating medication, such as diazepam, to help you through this process. However, you may be able to get vitamins, such as Thiamine, from your GP. This is a vital medication as it helps to prevent memory loss when people are using high levels of alcohol.

You could either choose to reduce your alcohol slowly or relatively fast. Most people find that they can manage gradual reduction of their alcohol over a 6 to 8-week period to 0 without experiencing marked withdrawals. For example, a person drinking 8 cans of normal strength lager daily could reduce by about 1 can every week and would thereby reduce to 0 after 8 weeks

However, some people may only have support for a short period of time from family and friends or may choose to reduce more quickly for other reasons. For example, some people prefer to get the process over quickly.

A faster reduction could be as follows. If a person is using 8 cans of normal strength lager daily then they could try reducing 1 can every 1 or 2 days. There is a risk of having more severe withdrawals if this option is taken.

In either case, if severe withdrawals occur (such as seizures, marked confusion, hallucinations or marked worsening of your physical health or mental health) then you would need to contact emergency medical services such as an Accident and Emergency Department or obtain an emergency appointment with your GP. Given pressures on health services, this is something you will need to avoid if possible.  If mild to moderate withdrawals occur, this could be managed by increasing your alcohol use in a safe and gradual manner.

Tips to cope with the reduction process include

• Have a safe place to complete the reduction. You would need to ensure you have safe provision of food, fluids, adequate heating and shelter
• Ensure you have good support with trusted friends or family. This is important as you may experience confusion during the reduction process and at that point your ability to make decisions by yourself could be affected. As mentioned above, there are a number of other medical problems that can occur.  It is important to get help for these quickly
• Use only one form of alcohol rather than multiple types with different strengths
• Try to use weaker forms of alcohol- e.g., normal strength alcohol rather than super-strength alcohol; using mixers with spirits rather than using them undiluted
• Use the same glass to mark out your alcohol use accurately
• Looks at reducing your midday alcohol use initially – people find that this can be the easiest initial step
• You may find your sleep is disturbed. Try to avoid any additional stimuli that could worsen your sleep (caffeine, overstimulation prior to going to bed) and use techniques to help your sleep (bedroom only used for sleep, appropriate level of exercise if possible)
• Try to eat regular meals and try to eat food with high thiamine levels (green peas, pork, fish, beans). Try to continue to eat even if you have a poor appetite. Your appetite usually returns after a few days once you stop or reduce your alcohol use
• It can be a stressful period so try to relieve stress using methods that work for you. Some people find activities such as reading, taking a bath and listening to music helpful
• Use the support of any national or local organisation that are still available as outlined below
• Use techniques to manage cravings as described previously
• Try to optimise your mental health during this period by using resources locally that are still available or national resources listed below
• Keep up to date about the risks with COVID-19: https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance#guidance-for-the-public. You may have risk factors for severe complications from this virus and you need to make steps to manage this

For many people, getting control of their alcohol can completely transform their life.

Advice on alcohol

https://www.drinkaware.co.uk/

https://www.breakingfreeonline.com/

https://www.alcoholics-anonymous.org.uk

https://www.nhs.uk/conditions/alcohol-misuse/treatment/

https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/

Mental health resources

https://www.nhs.uk/oneyou/every-mind-matters

https://www.gmmh.nhs.uk/

https://web.ntw.nhs.uk/selfhelp/  ( mental health self-help booklets)

COVID-19

https://www.gov.uk/government/collections/coronavirus-covid-19-list-of-guidance#guidance-for-the-public