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Alcohol and problem drinking

Alcohol can be a common and enjoyable part of Australian life - at least when consumed sensibly. It’s important to remember though that alcohol is a drug and, as a drug, it can cause problems for those who drink too much.

When does alcohol drinking become a problem?

Problem drinking means drinking alcohol at levels that can cause harm, either to your health, or your personal or working life. Alcohol kills or hospitalises more people between the ages of 18 and 34 in Australia than tobacco, and more than all illegal drugs put together. Alcohol-related problems may also extend to the family of the drinker and to the broader community.

What a ‘harmful level’ of alcohol is varies from person to person, based on the interaction of a number of factors – not just on the amount you drink. These factors include age, gender, genes, individual metabolism and general health, as well as social factors. This is why some people seem to ‘hold their drink’ better than others.

Because of these individual variations, there is no definitive amount of alcohol that is considered safe for everyone. However, the evidence from many large studies suggests adults:

  • Drink no more than two standard drinks a day to prevent adverse effects to health
  • Limit consumption to no more than four standard drinks in one sitting to reduce the chances of injury or doing things you’ll later regret.

What is alcohol tolerance?

Tolerance to alcohol is when people who drink alcohol regularly are not as easily affected by it as people who don’t drink regularly. This is partly because their liver becomes more efficient at breaking down alcohol. While this might seem like an advantage, there’s a downside. It can encourage higher alcohol consumption to get the same effects. This may lead to an increased risk of alcohol dependence and other illnesses in the longer term.

What is alcohol dependence?

A person is described as being ‘dependent’ on alcohol when their need to drink becomes the main priority in a situation. It supersedes all other things that the person previously considered important.

There are degrees of dependence on alcohol. Some people may find it a little difficult to go a day without a drink or regularly binge drink. Others may find it hard to stop before having several drinks even when there’s a good reason not to drink. Although this level of dependence may not initially seem to be a big problem, for some people the dependency may get worse and become of increasing concern.

Anyone can become dependent on alcohol, but some people have an increased risk including:

  • those with a family history of alcohol or drug dependence
  • people with a mental health problem, including anxiety or depression, who may use alcohol to try and feel better.

Physical dependence and withdrawal

Being physically dependent on alcohol (sometimes called ‘alcoholism’) is at the severe end of the spectrum of problem drinking. A person can become so tolerant of alcohol that they only feel they can function as usual when they’re drinking. When they stop using alcohol their body must physically readjust to going without it — a process called withdrawal.

Typical withdrawal symptoms can include:

  • shaking (tremors)
  • nausea and vomiting
  • anxiety
  • depression
  • sweating
  • headache
  • difficulty sleeping (which may last several weeks).

For some people withdrawal is easier than others, but for heavy drinkers, withdrawal symptoms can be severe and dangerous. You can experience convulsions, cramps, delusions and hallucinations, and it can even lead to death.

Anyone who is dependent on alcohol and wants to quit should see a doctor or someone from a drug and alcohol service first — they may need professional assistance to help them safely stop drinking.

Signs that someone is dependent on alcohol

If someone has three or more of the following signs over a year they are considered by the medical profession to be dependent on alcohol:

  • a strong desire or craving to drink alcohol
  • difficulty in controlling alcohol consumption (how much and when to stop)
  • increased tolerance to alcohol
  • neglecting work and social activities for alcohol use
  • continues drinking even though alcohol is harming health, personal or work relationships or work performance
  • has withdrawal symptoms or continues to drink alcohol to prevent withdrawal.

Other health consequences of drinking too much alcohol

Regularly drinking alcohol over time increases your risk of the following:

  • cancer, heart disease, diabetes or becoming overweight
  • mental health problems such as anxiety and depression
  • alcohol-related brain injury (ARBI) if you develop a drinking problem. This can be mild, moderate or severe and the type of brain damage experienced depends on how alcohol has caused the damage. People with ARBI often have problems with their memory and thinking processes
  • deficiency in important vitamins such as folate, vitamin A, and thiamine (vitamin B1)
  • liver damage
  • sexual impotence, especially if you’re a man.

It’s worth getting help

Whether it’s you or someone else who has a drinking problem, there are services that can help. Information on how to contact some of these services is listed below in the Further Information section.

It is worth seeking professional help. Research shows that over half the people who have a substance abuse problem with alcohol or drugs can eventually recover with the right help and support. A full recovery is less likely for people with mental health problems as well, but it is still possible to manage the problem and lead an active, fulfilling life.

It can also help to rely on family and friends who don’t drink or drink at safe levels to increase your chances of recovery in the long term.

Further information

Alcohol and Drug Foundation
www.adf.org.au/

Australian Drug Information Network
www.adin.com.au/help-support-services

The Right Mix
www.therightmix.gov.au

Smart Recovery
www.smartrecoveryaustralia.com.au

Sources

Best DW Luman DI. The recovery paradigm. A model of hope and change for alcohol and drug addiction. Aust Fam Physician. 2011; 40: 593–597.

Demirkol A Haber P Conigrave K. Problem drinking. Detection and assessment in general practice. Aust Fam Physician. 2011; 40: 570–574.

Demirkol A Haber P Conigrave K. Problem drinking. Management in general practice. Aust Fam Physician. 2011; 40: 576–582.

Mayo Clinic. Alcoholism: risk factors. [online] 2012. [Accessed 19 May 2014] Available from: www.mayoclinic.org

National Health and Medical Research Council. Australian guidelines to reduce health risks from drinking alcohol. Canberra: Commonwealth of Australia, 2009.

Synapse. Alcohol-related brain injury [online] 2014. [Accessed 20 May 2014]. Available from: www.synapse.org.au

Last updated: 21 July 2014

Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

Bupa Australia Pty Ltd makes no warranties or representations regarding the completeness or accuracy of the information. Bupa Australia is not liable for any loss or damage you suffer arising out of the use of or reliance on the information. Except that which cannot be excluded by law. We recommend that you consult your doctor or other qualified health professional if you have questions or concerns about your health. For more details on how we produce our health content, visit the About our health information page.