Alcohol: the cost in money and health

Alcohol occupies an unusual position: a substantial recurring household expense and a health risk factor whose guidance has moved in one direction for two decades.

What the guidance now says

Low-risk drinking guidelines vary between countries and have generally tightened.

Several have moved to weekly rather than daily limits, with recommendations to spread consumption and to have drink-free days.

The framing has shifted from safe to low-risk, since risk is continuous and there is no threshold below which there is none.

The previously reported cardiovascular benefit of moderate drinking has been substantially undermined by better-designed studies, which found that the apparent benefit was largely explained by sick people abstaining and by other confounding.

Mendelian randomisation studies, which reduce confounding, have not supported a protective effect.

The health picture

Where the evidence is strongest.

Alcohol is classified as a group 1 carcinogen, with causal links to cancers of the mouth, throat, oesophagus, liver, colorectum and breast.

The link with breast cancer begins at low levels of consumption and is poorly known among the public.

Liver disease, which has risen in several countries.

Hypertension, atrial fibrillation and cardiomyopathy.

Mental health effects, since alcohol is a depressant and next-day anxiety is a pharmacological rebound.

Sleep disruption, since it fragments the second half of the night.

Injury and accident risk.

And dependence, which develops gradually and frequently in people who never intended to drink much.

The money

Which people consistently underestimate.

Calculate it honestly: units consumed per week multiplied by typical cost, plus the associated spending — meals out, taxis, next-day convenience purchases — that accompanies drinking occasions.

Annualised, it is frequently among the larger discretionary items in a household budget and is rarely reviewed.

Alcohol duty and minimum unit pricing raise the price in several countries deliberately, on the basis of evidence that price affects consumption at population level.

Reducing it

Practical steps with evidence.

Count accurately for two weeks, since almost everyone underestimates substantially and the counting itself reduces consumption.

Set specific drink-free days rather than a general intention.

Remove it from the house, since availability predicts consumption more reliably than intention.

Use smaller glasses, since pour size is elastic.

Alternate with water.

Identify the trigger it is being used for — stress, sleep, social discomfort, habit — and substitute something, since removing a coping strategy without replacement fails.

Change the routine, since drinking is heavily cue-driven.

Tell someone, which improves outcomes measurably.

And use one of the free tracking apps produced by public health bodies, which are better designed than most commercial ones.

Alcohol-free alternatives

A genuine development.

The quality and range of alcohol-free beer, wine and spirits has improved substantially, and they occupy the social and ritual role that is frequently the actual reason for drinking.

They are not free — some cost as much as the alcoholic version — which is a legitimate complaint.

And they are not appropriate for everyone in recovery, where the cue exposure may be unhelpful, which is an individual matter.

Signs it has become a problem

Behavioural rather than numerical.

Drinking to cope rather than to enjoy.

Difficulty stopping once started.

Needing more for the same effect.

Planning around it.

Drinking alone or in secret.

Continuing despite consequences to health, work or relationships.

Morning drinking, or drinking to relieve shaking or nausea.

And other people expressing concern, which is worth weighing rather than dismissing.

The safety point about stopping

Which must be stated.

Anyone physically dependent — drinking daily and heavily, with morning shaking, sweating or nausea relieved by drinking — should not stop abruptly without medical supervision.

Alcohol withdrawal in dependence can cause seizures and delirium tremens, which are medical emergencies.

Medically assisted withdrawal is available and safe.

Free specialist alcohol services exist in most countries, accept self-referral, and are considerably better than most people expect.

Which makes seeking help before making a change the right order in this specific case, unlike almost everything else.

What improves

Reported consistently by people who reduce or stop.

Sleep quality within weeks.

Baseline anxiety, which many are surprised to find was largely generated by the drinking.

Energy and mood stability.

Liver markers and blood pressure.

Weight, since alcohol is energy-dense and disinhibits eating.

And the money, which is the part people notice first.

General information only, not medical advice. Consult a qualified clinician about alcohol use, and do not stop drinking abruptly if you are physically dependent.