If your drinking is having a negative effect on your life, it’s hardly surprising if it’s taken some time for you to decide to do anything about it because in the UK we love a drink. “Alcohol is a social lubricant and is embedded in our society,” says Sally Marlow, a professor of practice in the public understanding of mental health research at King’s College London. “Many people have some of the best times of their lives when they are consuming alcohol. But in order to accept this we also need to be aware of the harms it can cause. Dependence is when your alcohol intake becomes so normalised that your body can’t function without it.”
According to Drinkaware, 6 per cent of UK adults are either drinking at high risk, becoming dependent drinkers, or are already dependent on alcohol, while 27 per cent of drinkers in the UK binge drink – five or more drinks in about two hours for a man, or four or more drinks in two hours for a woman, according to the National Institute on Alcohol Abuse and Alcoholism.
For those who’ve decided it’s time to quit, there are rising numbers of Britons making that same decision. In 2023, 30 per cent of men and 26 per cent of women surveyed said they wanted to reduce the amount of alcohol they drink this year according to research by Alcohol Change UK. Here is how to do it safely.
- Understanding alcohol dependence
- Types of dependence
- Understanding withdrawal
- Preparation for quitting alcohol
- What are the best methods to stop drinking?
- Dealing with withdrawal symptoms
- Support systems and resources
- Maintaining sobriety
Understanding alcohol dependence
The most affected group for alcohol dependence is people in their 40s, 50s and 60s who have had several decades of drinking to build tolerance and dependence.
How to tell if you might be alcohol dependent:
- You find it difficult to stop drinking temporarily.
- “If you’re asking yourself, have I got a problem with alcohol? The answer is probably yes,” says Prof Marlow.
- You need to consume more or stronger drinks to achieve the same effects.
- The problems created by your consumption outweigh any social benefits that you get from alcohol.
- You are unable to do your job properly because of drinking or you lost a job due to drinking.
- You spend more money on drinks than you can afford.
- You feel that alcohol has control over you.
- You develop poor impulse control. “Every neuron in your brain comes into contact with alcohol and your brain drives your behaviour,” explains Prof Marlow.
- You look for excuses to go out drinking and spend time with people you don’t like because they will drink with you.
- Your sleep is regularly disrupted, and you are irritable.
- Friends or loved ones advise you to reduce your consumption.
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Types of dependence
David Nutt, a professor of neuropsychopharmacology and the director of the neuropsychopharmacology unit in Imperial College, London, explains that people who drink to achieve a psychological ‘buzz’ can become dependent quickly, while people who drink to deal with everyday stress will build tolerance more slowly.
“When they stop drinking and go to work, they have a hangover and more anxiety. And that will make the work [stress] worse, so they’ll drink more in the evenings, which starts the vicious cycle of dependence,” he says. “A lot of people don’t even realise they’re dependent and don’t seek help until they develop a physical problem.”
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Understanding withdrawal
Dependent drinkers who stop drinking may experience withdrawal symptoms which range from cravings and headaches, to seizures, hallucinations and delirium, depending on the level of dependency.
Prof Marlow explains: “Alcohol disrupts neurotransmitters. If you’ve been a heavy drinker for several years, it’s as if you’ve put a squeeze on the electrical activity in your brain. If you take the drinking away, your neurological processes are like a coiled spring with masses of electrical activity and that’s why the medical advice for heavily dependent people is not to go cold turkey without medical assistance, because you can end up fitting [ie, having alcohol withdrawal seizures] and it can be fatal.”
A 2008 paper published in the journal Alcohol Research and Health describes the processes behind dependence, withdrawal and relapse.
“In general, alcohol acts to suppress central nervous system (CNS) activity, and, as with other CNS depressants, withdrawal symptoms associated with cessation of chronic alcohol use are opposite in nature to the effects of intoxication.”
It lists typical features of alcohol withdrawal as:
- Signs of heightened autonomic nervous system activation, such as rapid heartbeat, elevated blood pressure, excessive sweating and shaking (tremor).
- Excessive activity of the CNS that may culminate in motor seizures (jerking and stiffening of muscles) and /or hallucinations and delirium tremens (the rapid onset of confusion) in the most severe form of withdrawal.
- A state of distress and psychological discomfort which can include irritability, agitation, anxiety and dysphoria, as well as sleep disturbances and a sense of inability to experience pleasure.
Prof Nutt explains that someone drinking two units of alcohol a day would experience minor withdrawal symptoms such as disturbed sleep and anxiety, so for them quitting would be easier than for someone with greater tolerance who would experience more severe withdrawal symptoms.
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Preparation for quitting alcohol
Depending on the level of dependence, Prof Marlow advises starting by accessing information from organisations such as Club Soda, which supports mindful drinking. The Alcohol Change UK website also offers advice, support and interactive tools for those wishing to cut down or give up.
People with higher dependence should contact their GP who can offer advice and a referral, should medical help be required.
Alcoholics Anonymous hold open meetings, so attending one could be your first step.
Prof Marlow advises taking time off from work as sick leave or holiday. “It is an illness and withdrawal is a period of ill health,” she explains. “You will come out the other end but need to look after yourself.”
It is a good idea to stock up on alcohol-free alternatives for any social events where cravings for alcohol might be triggered. For example, SENTIA Spirits is a mood-enhancing drink which uses plant-based ingredients that have been scientifically proven to activate ‘GABA’ in the brain, which is the neurotransmitter responsible for sensations of sociability.
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What are the best methods to stop drinking?
If you’re dependent on alcohol to function, it’s recommended you seek medical advice to manage your withdrawal.
Some people may be prescribed medication to help achieve abstinence. You may also choose to attend self-help groups, receive extended counselling, work with a coach who specialises in alcohol addiction or use a talking therapy such as cognitive behavioural therapy (CBT). While there are private rehab services available, only about one in 100 people in the UK use residential clinics when quitting alcohol.
Everyone is different, and different pathways work for different people depending on a range of factors, including level of dependency, environment, access to services and personal relationships.
- Under the NHS you may be offered a ‘brief intervention’. This is a short counselling session which lasts about five to 10 minutes, and covers risks associated with your pattern of drinking, advice about reducing the amount you drink, alcohol support networks available to you, and any emotional issues around your drinking.
- Group therapy. A 2021 review of research into group treatment for drug use disorders, published in the journal Substance Abuse, Treatment, Prevention and Policy, concluded that participants in group treatment for drug use disorders exhibited more improvement on typical measures such as abstinence and use rates when compared to methods which did not include group work.
- Motivational interviewing. This is a therapy method which aims to encourage behaviour change by exploring ambivalence towards cessation of drinking. Some therapists offer this technique.
- Cognitive behaviour therapy (CBT) which focuses on challenging and changing cognitive distortions and negative behaviours, improving emotional regulation, and developing personal coping strategies.
- Mindfulness. A systematic review of 11 studies found mindfulness was effective in treating alcohol use disorder compared to no treatment or control conditions.
- Peer-to-peer support networks and mentoring, such as SMART Recovery and Alcoholics Anonymous.
- Medication. Common drugs used include disulfiram, also known as Antabuse, which deters alcohol use by causing patients to get ill when they drink, and naltrexone and acamprosate, which help reduce alcohol cravings and make withdrawal more manageable.
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Dealing with withdrawal symptoms
When you stop consuming alcohol your body goes through a period of detoxification, which is when the withdrawal symptoms are at their most acute. How and where you attempt detoxification will be determined by your level of alcohol dependency. In mild cases, you should be able to detox at home without the use of medication as your withdrawal symptoms should also be mild. Always seek professional advice before attempting to give up alcohol if you are alcohol-dependent.
If your consumption of alcohol is high (more than 20 units per day) or you’ve previously experienced withdrawal symptoms, you may also be able to detox at home with medication under the supervision of a healthcare professional. A tranquiliser called chlordiazepoxide is usually used for this purpose.
If your dependency is severe, you may need to go to a hospital or clinic to detox.
Your withdrawal symptoms will be at their worst for the first 48 hours. They should gradually start to improve as your body begins to adjust to being without alcohol. This usually takes three to seven days from the time of your last drink.
- During the detox, make sure you drink plenty of fluids (about 3 litres a day). However, avoid drinking large amounts of caffeinated drinks because they can make your sleep problems worse and cause anxiety.
- Eat regular meals, even if you’re not feeling hungry.
- Relieve stress by reading, listening to music, going for a walk and taking a bath.
- Several medications are recommended by the National Institute for Health and Care Excellence (Nice) to treat alcohol misuse, so speak to your GP about these.
- It’s important to avoid all sources of alcohol as they could also induce an unpleasant reaction. Products that may contain alcohol include aftershave, mouthwash, some types of vinegar and perfume. You should also try to avoid substances that give off alcohol fumes, such as paint thinners and solvents.
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Support systems and resources
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Maintaining sobriety
Withdrawal and detox are first steps, but further treatment and support is usually needed for long term sobriety.
Prof Marlow recommends: “Identify what your triggers are and avoid people who may encourage you to drink or who may also have problematic drinking patterns. Exercise can help. Keep busy and find a community of people you can speak to to help you stay focused. That may be supportive family and friends or online communities.”
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