What a post-January booze blowout does to your body

If January was a desert devoid of drink for you, what will your February be like? A deluge or a drizzle? A month off alcohol might have made you realise a few things. If you are shocked by how easy the whole undertaking was and have determined to reduce your intake in the future, then proceed with confidence. But if you're already planning your re-emergence onto the drinking scene with a blowout, then you might want to stop and ponder more carefully your segue back into booze.

Professor Adam Winstock, a consultant addiction psychiatrist, has spent 20 years trying to get the British to reconsider what a binge drinking session might look like. A binge in the UK is defined as drinking six or more units in a single session if you are a woman, or eight or more in a single session if you are a man.

For context, the low-risk drinking guidelines are up to 14 units a week for both men and women (roughly equal to six pints of beer or seven medium glasses of wine). That's a lot compared with the Canadian government's view, for example, which is that no amount of alcohol is "safe" and that individuals should drink no more than two standard drinks per week in order to minimise their risk of chronic diseases.

'We don't teach people how to drink'

Prof Winstock believes that the UK guidelines are satisfactory. "If you stick at this level over the long term, your risk of getting serious alcohol-related conditions is low," he says. However, the problem with the guidance, he points out, is that "for most people in the UK who get drunk, that wipes out most of their guideline amount in one day. So then what do you do for the rest of the week?"

Much of his work has centred on changing our perspective on what a drinking session should look like. "We don't teach people how to drink," he points out, "but studies have shown that a group of guys drinking eight pints will have just as much fun if they slow down and have five. Changing thinking about group drinking means we all win."

Prof Winstock believes that while there is not much of a cost to people drinking a bit less, "there are real benefits in cutting down. And that's why [an initiative such as] Dry January is good."

Risky business

The general health risks associated with long-term drinking include high blood pressure, heart disease, stroke, liver disease and digestive problems. However, as Sir Ian Gilmore, chairman of the Alcohol Health Alliance, points out: "If you can stick to 14 units, you've got less than a one in 100 chance of dying of an alcohol-related disease."

Sir Ian, who is also director of the Liverpool Centre for Alcohol Research, adds: "The big ones people don't know about are breast cancer and colon cancer. Even light drinking, three or five drinks a week, does increase the lifetime risk of breast cancer.

"If a woman drinks a bottle of wine a week, she probably increases her lifetime risk of cancer by 10 per cent."

As in all areas of life, it's about balancing risk. "I say to patients that getting out of bed carries a risk - and so does staying in bed," says Sir Ian

But what of those risks associated with binge drinking? "The major risks are increased risk of being involved in an accident, such as a road-traffic one or falling over and hitting your head," he says. "You are also at more risk of being so drunk that you can't protect your airway, such as vomiting and inhaling it."

Getting paralytic obviously increases your risk of impaired judgment and blackouts, but, he adds: "There are no discernible long-term effects of bingeing, not if it's once every few weeks, as opposed to daily. If you have eight pints once a week and provided you're not drinking in between, then the risks are not high."

However, as Prof Winstock points out, regular binge drinking in excess of the guidelines "is generally worse for your heart and your immune system".

Researchers at the American Heart Association looked at the effects of repeated episodes of binge drinking on individuals aged 18 to 45 and found that they were linked to cardiovascular problems. This includes high blood pressure, higher LDL ("bad") cholesterol, and higher glucose levels in the blood. Male binge drinkers also had higher levels of cholesterol, including LDL cholesterol, compared with abstainers. High blood pressure in individuals under the age of 45 is associated with higher risks of cardiovascular disease, including heart attack and stroke, later in life.

For reasons the authors of the study could not explain, the same results were not observed in female binge drinkers.

The effect of regular binge drinking on the immune system was reported in a 2015 study in the journal Alcohol, which found that binge drinking can reduce infection-fighting white blood cells known as monocytes in the hours after peak intoxication, essentially weakening your immune system.

If you love your wine and are the first to wave a news story extolling the benefits of a glass of red a day then note, says Prof Winstock, that a single episode of binge drinking once a fortnight or week "totally blows out any cardioprotective effect of alcohol, which is basically information put out by the alcohol industry, anyway".

"The idea that it's good for you is nonsense," he says. "And if it is good for you, it's at about a half a unit a day, which would mean a bottle of red wine would last you about a week and a half."

While binge drinking once a week does give your liver a chance to recover and reduces your risk of developing dependency, the NHS recommends that drinking is spread throughout the week. But, adds Dr Sadie Boniface, head of research at the Institute of Alcohol Studies: "Drinking on a daily basis is also not advisable in terms of habit-forming, so it is good to have alcohol-free days every week."

Dry January's growing popularity

The annual national Dry January campaign is now 10 years old and growing in popularity every year. This is very welcome news, says Dr Boniface, because nearly one in three men and one in seven women drink above the guideline levels, increasing their risk of health harm from alcohol. "Alcohol harm has increased sharply in the wake of the pandemic, with the latest data showing that there are 27 per cent more deaths from alcohol than three years ago," she points out.

However, while Dry January is becoming more popular, only a minority of the population take part at present, and the evidence for longer-term behaviour change is also not very strong, she adds.

For Prof Winstock, the all-or-nothing approach encourages people to think that there are only benefits if you stop drinking altogether, "and therefore, I don't accept that many of those benefits might be retained if I return to a lower level of drinking". Thus, the typical response for many Brits to a month off alcohol is to see drinking as a reward, he says.

"I get that, and it's socially and culturally ingrained in us, but just pause for a moment and look back at your life over the past month and be honest with yourself about how much more miserable and unhappy you really were. Quite a lot of people might look better, and feel a little better and be a little thinner."

Drinking is a major source of calories, Prof Winstock points out. "If you're drinking 10-15 pints a week, then you are drinking two days of calories a week. If you are overweight, you are more sensitive to alcohol-related liver disease. If you drink a bit less, you will lose weight and you will protect your liver. There are not that many downsides."

Why do we drink too much? Survey research by the Global Drug Survey, of which Prof Winstock is founder, asked why people got more drunk than they wanted to. The top three reasons were drinking too quickly, mixing drinks and hanging out with people who are big drinkers.

"All of these reasons you're getting too drunk are entirely under your control," says Prof Winstock. "Slow your drinking down. Nobody needs Jägerbombs at 11pm at night. And stop hanging around with big drinkers."

He says there is another factor to consider if you are the type of drinker to binge. "When you're drinking above a couple of pints, your body can't break alcohol down any faster, so you suddenly feel more drunk."

Finding that sweet spot and staying there might actually improve your night, as well as curb your alcohol intake. "If you're at the pub and you've had two and a half pints in the past hour, having two and a half more will send your alcohol levels shooting through the roof. It's knowing when you need to slow your drinking down. Have a pint every hour or two, alternate with a soft drink, and you'll stay at that sweet spot."

Maintain the momentum

If you are looking ahead into February and beyond and want to maintain some of the positives from Dry January, what else should you be thinking about doing? Some general tips from Dr Boniface are to set yourself a weekly limit and try keeping track with a drinking diary; try non-alcoholic alternatives; or choose different activities, situations or social groups.

However, she says, be aware that cutting down and stopping drinking is not this simple for everyone. "Some people will need support to cut down, and if you might be dependent on alcohol - if you have signs such as craving or withdrawal symptoms - then it is dangerous to quit 'cold turkey' and you need medical supervision.

"If you need support, start by contacting your GP. You may be able to self-refer to a service local to you, or there is Alcoholics Anonymous and other third-sector-run groups locally and online."

The majority of people who are alcohol-dependent in the UK don't know it, adds Prof Winstock. "It's the most undertreated psychiatric condition in the world, and in the UK, probably 85 per cent of people who are alcohol dependent are not in contact with services. There are a lot of people who are quite delusional about their drinking."

What Prof Winstock doesn't want to do is tell people to stop drinking. "The Global Drug Survey is asking people to look at the drinks you had last week and remove the unnecessary ones. For me, it's just saying to people, if you had another one or two days not drinking a week, and on the days you drink, you had one or two less, that would probably have a huge difference on your health and your wallet."