Recommendations 3

1. Reducing the risk of alcohol related harm or injury over a lifetime

  • The less a person chooses to drink, the lower their risk of alcohol-related harm. For some people not drinking at all is the safest option
  • For healthy men and women, drink no more than 4 standard drinks on any one day and no more than 10 standard drinks per week

2. Children and young people < 18 years of age

  • To reduce the risk of injury and other harms to health, children and young people < 18 years of age should not drink alcohol

3. Pregnancy and breastfeeding

  • To reduce the risk of harm to the unborn child, women who are pregnant or planning a pregnancy should not drink alcohol
  • For women who are breastfeeding, not drinking alcohol is the safest option

Note

1. The facts 1,2

  • Alcohol consumption continues to be a leading risk factor for all ages for death and injury in Australia from:
    • chronic conditions
    • vehicle accidents
    • poisoning, overdose, suffocation
    • assault and violence
    • intentional self-harm
    • falls, fires, drowning
    • inhalation of vomit
  • Twice as likely to cause death or injury in Aboriginal and Torres Strait Islander people
  • Associated with up to 50% of all violent crimes (e.g. domestic violence) to family (including children), friends, workmates and strangers

Table 1. Response to alcohol 2,3

Factor

Response

Gender

  • Women affected more due to body and liver size, and leaner tissue
  • Male death and injury higher due to risk-taking behaviour

Age

  • < 25 years are less tolerant and less experienced with effects of alcohol
  • Puberty is associated with higher risk-taking behaviours
  • Tolerance decreases with age, increasing risk of death and injury

Mental health

  • Those with mental health conditions have worse symptoms after drinking
  • Can trigger mental health conditions in people who are prone

Medicines

  • Can cause altered mood, behaviour, sedation, respiratory depression

Family history

  • A family history of dependence increases risk of developing dependence

Co-morbidities

  • Exacerbation of conditions e.g. cirrhosis, hepatitis, pancreatitis
Blood alcohol concentrations (BAC) for driving in Australia:
  • 0% for a holder of a learner or provisional license regardless of age and those with a commercial license for passenger vehicles (buses, taxis, planes) and trucks.
  • 0.05% for a holder of an open license

2. Response to alcohol 1,2

  • Everyone’s response to alcohol is different. No amount of alcohol is safe for everyone. See Table 1.
  • How much a person thinks they can ‘handle’ can lead them to believe they can drink more without harm

3. Immediate effects of alcohol 1,2

  • Affects the brain within 5 minutes of being ingested:
    • reduces reaction to stimuli, coordination, speech, cognition and senses
    • increases feelings of relaxation, wellbeing and loss of inhibition
  • BAC peaks after 30–45 minutes:
    • the liver takes about 1 hour to metabolise one standard drink
    • higher alcohol intake increases BAC by outpacing a livers' fixed metabolic rate
  • As BAC increases:
    • drowsiness, loss of balance, nausea and vomiting occurs
    • physical performance, behaviour and memory progressively deteriorates
    • likelihood of aggression and physical violence increases due to impaired cognitive and verbal capacity to resolve conflicts
    • renal function impairment resulting in diuresis and dehydration
  • As BAC reaches high levels:
    • life-threatening risks increase e.g. unconsciousness, inhibition of normal breathing, inhalation of vomit, injury, trauma, death
  • Eating slows BAC as stomach contents reduces bloodstream absorption
  • Drinking coffee, having a cold shower, vomiting or exercising does not reduce BAC
  • After a heavy night of drinking, a person may have a BAC > 0.05% in the morning

4. Cumulative effects of alcohol1,2

  • Associated with conditions that cause death or disability. See Table 2.

Table 2. Cumulative effects of alcohol 1,2

Condition

Effect

Cardiovascular disease

  • Raises blood pressure
  • Arrhythmias
  • SOB
  • Cardiac failure
  • Raises HDL-C
  • Mild anti-coagulating effect
  • Haemorrhagic stroke

Cancer

  • Oral cavity, throat, oesophagus, liver, colorectum and breast
  • Tobacco use in drinkers further increases cancer risks

Diabetes

  • Poor insulin sensitivity

Nutrition

  • Undernutrition
  • Thiamin, folate and vitamin A deficiency
  • Wernicke-Korsakoff syndrome
  • Inflamed skin, diarrhoea, dementia, and mouth sores

Overweight and obesity

  • Overweight and obesity (adult)

Fetal alcohol spectrum disorders (FASD)

  • Developmental delay or disability (child)

Liver diseases

  • Hepatitis
  • Cirrhosis
  • Liver failure
  • Oesophageal varices
  • Hepatocellular carcinoma

Digestive system

  • GORD
  • Pancreatitis
  • Gastritis
  • Gastric ulcers

Mental health conditions

  • Depression and anxiety
  • Reduces antidepressant efficacy
  • Violence and self-harm

Dependence

  • Takes priority over important behaviours e.g. parenting

Cognitive impairment

  • Brain damage
  • Dementia

Self-harm

  • Suicide and self-harm in both males and females of all ages

Higher BAC tolerance

  • Increases cumulative effects of above

5. The standard Australian drink 1,2

  • Defined as containing 10 g of alcohol
  • All canned, bottled or casked alcoholic beverages are required by law to be labelled with the approximate number of standard drinks. See Resource 1.

6. Identifying an alcohol problem 4

  • Take an alcohol consumption history if indicated
  • Screen for problem drinking using a questionnaire. See Resources 2–4.
  • Suspect problem drinking if clinical indicators are present. See Table 3.

Table 3. Indicators of problem drinking 4

Context

Tips

 

Physical

  • Bloodshot eyes
  • Dilated facial capillaries
  • Hand and tongue tremor
  • Hypertension
  • Gastrointestinal disorders
  • Cognitive impairment
  • Signs of trauma

Psychosocial

  • Work, financial, marriage, legal or relationship problems
  • Insomnia
  • Think a lot about alcohol and when they will drink next
  • Become anxious or depressed when they don’t drink
  • Use alcohol to deal with certain situations
  • Get violent, into arguments or have accidents
  • Are in debt because of drinking

Abnormal investigations

  • Raised LFT
  • Raised mean cell volume
  • Raised BAC
  • Raised carbohydrate-deficient transferrin
  • Alcohol dependence is likely if > 3 of the following are present:
    • strong desire to drink alcohol
    • difficulties in controlling alcohol use
    • persisting with alcohol use despite harmful consequences
    • a higher priority given to alcohol than to other activities and obligations
    • increased tolerance
    • sometimes a physical withdrawal state

7. Engaging a person with an alcohol problem 5

  • See Engaging our patients
  • Discuss confidentiality
  • Often people do not recognise they have a drinking problem
  • Listen to the person without judgement or providing advice
  • Be compassionate, open, honest, sincere and supportive
  • Understand the person’s perception of their drinking
  • Outline what can be provided and how the person can be assisted
  • Encourage person to set their own goals to reduce risky drinking. See Table 4.

Table 4. Tips to reduce risky drinking 5

Context

Tips

Knowledge

  • Know how many standard drinks are in each beverage. See Resource 1.
  • Count the number of standard drinks consumed
  • Keep a smart app drink diary. See Resource 5.
  • Drink low-alcohol beverages

Social

  • Avoid people topping up your glass
  • Avoid keeping up with friends
  • Avoid drinking games
  • Refuse being pressured into drinking
  • Drink slowly
  • Take sips instead of gulps
  • Put the drink down between sips
  • Only have 1 drink at a time
  • Get involved in activities that don’t involve drinking
  • Avoid drinking situations

Prevention

  • Eat while drinking
  • Alternate between plenty of water and alcohol to prevent dehydration
  • Switch to low-alcohol drinks when starting to feel the effects of alcohol

8. Supporting a person with an alcohol problem

  • Encourage the person to reach out to friends and family to support their efforts
  • Refer to a MHAODs counsellor, social worker, psychologist or alcohol and drug information support services. See Resource 6.
  • Clinicians can contact Alcoholics Anonymous and setup local support meetings or enrol people into nearby meetings via telehealth, MS Teams™ or Zoom™. See Resource 7.
  • The only person that can reduce their alcohol intake is the person themselves:
    • many difficult lifestyle changes are required to alter drinking behaviours
    • many attempts to change drinking behaviours may occur before success
    • to continue drinking is a personal choice
  • Clinicians can access withdrawal management tools and guidelines to assist people with alcohol reduction or cessation. See Resource 8.

9. Medicines for long-term management of alcohol dependence

  • If considering medicines use, start after withdrawal symptoms have resolved, usually 3 to 7 days after the last drink

Table 5. Long-term management of alcohol dependence 6

Naltrexone

  • Convenient once a day first-line agent for long-term management of alcohol dependence
  • Contraindicated in those taking opioids, with liver failure or acute hepatitis
  • No effect in patients with minimal or moderate alcohol intake
  • Can cause liver toxicity. Assess liver biochemistry prior to commencing, monthly for 3 months, then (if normal) every 3 months
  • Side effects include nausea, but a gradual dose increase and night-time dosing can reduce this

Naltrexone 25 mg PO, nocte. Increase after 5 days to max. 50 mg daily

Acamprosate

  • May reduce some post-acute withdrawal symptoms, such as anxiety, irritability and cravings
  • Increases the time to first drink, prolongs abstinence, reduces the number of drinking days and especially with psychosocial intervention
  • Seek specialist advice before prescribing for patients with kidney impairment
  • Must be swallowed whole 3 times a day to maintain effect because of rapid renal clearance
  • Used as a first choice in patients whose options are limited by liver disease

Acamprosate If < 60 kg: 666 mg PO mane, 333 mg at midday and 333 mg nocte. If patient > 60 kg: 666 mg PO, tds

Last updated: November 2024

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