What is substance misuse?

Substance misuse and alcohol affect mental health and wellbeing. This page has information about the risks, ways to cut back and how to help yourself and get support. There is a personal experience at the end of this page.

‘Substance misuse’ refers to the harmful use of substances (like drugs and alcohol) for non-medical purposes. It includes substances like glue, petrol, caffeine and prescribed medication. People who misuse substances do it regardless of the consequences because they might enjoy the feelings they get, or they use substances as a way of escaping painful and distressing thoughts. Some substances, like alcohol and heroin, can be physically addictive so for people who misuse them regularly it can be extremely hard to stop. They need to do this safely to minimise the risk of harmful effects on their bodies.

Many people use substances from time to time. This is known as recreational use. Mostly there are no harmful effects. However, longer term misuse can lead to the following:

• Isolation from family and friends.
• Physical illness.
• Mental health difficulties.
• Education problems.
• Employment difficulties.
• Committing crimes.
• Involvement with police.

There are many different ways to seek help and support for substance misuse issues; take a look at the links at the bottom of the page for further information and guidance.

Resources

AddAction: For people with mental health difficulties who are also struggling with substance misuse visit AddAction.

AdFam: For families affected by drug and alcohol misuse visit AdFam.

Alcoholics Anonymous: Alcoholics Anonymous have groups throughout the UK visit Alcoholics Anonymous.

NHS Services: Search for drug addiction services in your area visit NHS Drug Addiction Services.

Talk To Frank: FRANK offers lots of information about drugs and where to go for help visit Talk To Frank.

Rehab 4 Addiction: Rehab 4 Addiction provides information about the services available to support the different kinds of addiction someone may experience visit Rehab 4 Addiction.

What is alcohol to you?

What springs to mind? How is your relationship with alcohol? Do you think alcohol affects your mental health?

Let’s look at the facts. Alcohol or Ethyl alcohol (ETOH) is a neurotoxin. Neurotoxins are poisons that target the nervous system.  When we drink alcohol, our bodies have to turn it into a chemical called acetaldehyde in order to process it. Acetaldehyde can damage our cells and can stop cells from repairing this damage.  Also, alcohol is a diuretic, a substance that makes us pass more water through urination, leaving us dehydrated.

Why do we drink?

Having a glass of wine in the evening is very common, especially within the 40 to 65 years age group. Alcohol is linked with celebrations, stress release, having fun, relaxing, and unwinding. This is similar to food which is often linked with reward at the end of a challenging day.  It’s important to remember our thoughts about alcohol may not be accurate.  There are actually no psychological or physiological advantages of drinking alcohol.

We might drink out of habit. Habits are patterns of behaviour formed over time. We may have many habits we’re not aware of but perform religiously. For example, automatically having a glass of wine with dinner or a beer when you watch football.

Alcohol affects the part of your brain that controls inhibition. Often people report feeling more at ease and confident (in the short term) when drinking alcohol.  Relying on alcohol for a confidence boost can become a habit.  Alcohol and self-esteem tend to mutually impact one another.  By reducing inhibitions, alcohol diminishes our awareness of potential social risks such as awkwardness or rejection.  Building confidence without relying on alcohol is important for positive mental health.

People often drink because they believe it helps them relax and / or sleep.  Research shows that alcohol reduces the time it takes to fall asleep. This gives people the perception it helps them to sleep. However, alcohol disrupts sleep in the second half of the REM cycle.  REM sleep is essential for memory consolidation and emotional processing.  Early waking due to alcohol consumption is common. This is because, when the sedative effects of alcohol have worn off, increases in adrenaline wake you up.  High amounts of alcohol decrease sleep quality by 39.2%. High amounts are more than two drinks a day for men or one a day for women.

What does ‘drink responsibly’ actually mean?

To keep health risks from alcohol low we should have no more than 14 units a week. And to have several alcohol-free days and never binge drink. More than 8 units of alcohol in a single session for males. Or more than 6 units for females, is the technical definition of a binge.

The research defines ‘chronic drinking’ as drinking more than 14 units regularly over time. (14 units equates to roughly 7 drinks spread over a week). 

What if we don’t keep to these evidence-based guidelines?

Regularly drinking more than 14 units of alcohol a week risks damaging your health.  Alcohol can kill liver cells, and lead to scarring called cirrhosis.  Chronic drinking increases the risk of liver disease. It also increases the likelihood of high blood pressure, high cholesterol, and heart disease. 

Research indicates drinking alcohol increases the risk of cancer.  The risks are higher the more alcohol you drink.  There are 3 main ways alcohol can cause cancer. Alcohol can damage our cells and stop cells repairing the damage. Alcohol affects chemical signals which can make cells more likely to divide. This increases the chance that cancer will develop. Alcohol makes it easier for cells in our mouth and throat to absorb cancer-causing chemicals.   

Drinking alcohol causes seven different types of cancer. Including breast and bowel cancer, mouth cancer, some types of throat cancer and liver cancer.  Some studies show that drinking 3 or more alcoholic drinks per day increases the risk of stomach and pancreatic cancers.  There is also evidence that drinking alcohol increases the risk for prostate cancer.

Breast cancer is the most common cancer in the UK . Drinking alcohol is one of the biggest risk factors for breast cancer. Drinking alcohol causes around 1 in 10 breast cancers. This is about 4,400 cases a year. Even low levels of alcohol increases this risk. 

Alcohol and mental health and wellbeing

Alcohol can literally change neuronal function and lead to neurodegeneration.  Drinking alcohol affects both ‘inhibitory’ and ‘excitatory’ neurotransmitters within the brain. Glutamate is an excitatory neurotransmitter that alcohol inhibits. This results in us feeling slowed down and making life seem less chaotic. Gamma-aminobutyric (GABA) is an inhibitory neurotransmitter. Alcohol increases GABBA transmission making us feel calmer and more relaxed. Decreasing glutamate and increasing GABA at the same time is powerful! Our brain becomes flooded with feel-good chemicals, such as dopamine, in the short term. 

Regular drinking impacts mental health

When we drink regularly, we flood our brain with massive amounts of dopamine. Over time chronic alcohol use leads to our bodies producing less dopamine naturally.  A large body of evidence Indicates that dopamine plays an important role in motivation, reinforcement, and feelings of happiness.  Alcohol use effectively turns down our natural dopamine response.  Research shows that when someone drinks alcohol often, normal levels of dopamine trend lower and levels of cortisol trend higher. This means less dopamine is released naturally. This includes when we are doing things we enjoy. For example, walking somewhere beautiful, exercising and socialising.

By inhibiting glutamate and increasing GABA regularly over time we are impacting on chemical balances within the brain. This affects brain functioning. This makes it more difficult to deny strong urges.  Alcohol is a depressive. Long-term chronic drinking results in us being more susceptible to stress, and less emotionally resilient when we are not drinking.

Alcohol has a significant impact on the gut, liver, brain axis. This means even relatively low to moderate alcohol use can have a detrimental impact on our mood and mental health. About 50% of our body’s dopamine is produced in our guts (not our brains). When we drink alcohol, we decrease the gut’s natural dopamine production by causing imbalances in our healthy gut microbes.

Science shows that even low levels of alcohol (1 to 2 units) can also disrupt our sleep waves.  Over time this contributes to ‘adrenal fatigue’, a disruption of the adrenal hormone system that leads to hormone imbalance. For women within the perimenopausal or menopausal stages of life alcohol’s effects could get worse. This is because lower oestrogen levels can increase anxiety and brain fog.

How do we reduce our alcohol intake for our physical and mental health?

It’s normal to run into psychological and physiological barriers when working towards a changed relationship with alcohol.  Understanding why we drink is critical in changing our relationship with alcohol. The better awareness of why we drink, the greater our ability to change our drinking patterns and habits.

Top Tips

• Keep track and be honest with yourself.
• Make 1 change at a time.
• Have drink free days.
• Alternate alcoholic drinks with non-alcoholic drinks.
• Don’t stock up on alcohol at home.
• Use smaller glasses or measure out your drinks.
• Freeze leftover wine for cooking.
• Don’t top up your own or other people’s glasses.
• Don’t buy rounds of drinks with people.
• Buddy up with a friend or family member.
• Use an app to help you.
• Build up regular use of other strategies to help you relax and unwind. For example, deep breathing, mindfulness, meditation, stretching, yoga and other gentle exercise.

Drinkline is the UK National alcohol helpline. If you are worried call this free helpline in complete confidence. Call Drinkline 0300 123 1110 (weekdays 9am to 8pm, weekends 11am to 4pm).

Resources & References

• Centre for Disease Control & Prevention
• Cancer Research UK.
• National Institute for Health & Care Excellence.

Personal Experience

Hi, I’m Dr Sarah Jordan, the Clinical Lead for Health and Wellbeing.  As part of the Better Health at Work Campaign I’ve decided to share the intentions I’ve set to consciously and actively keep my alcohol units down.  This is not an easy thing to do. It feels like some kind of AA confession but thankfully I’m not alcohol dependent. 

Health risks

I’m sure we all know that to keep health risks from alcohol low we should have no more than 14 units a week. Also to have several alcohol-free days and never binge drink. More than 8 units of alcohol in a single session for males, or more than 6 units for females, is the technical definition of a binge. If I am honest with myself and you I know that I don’t always and consistently stay within these guidelines.  The more I learn about the negative effects of alcohol on physical and mental health the more I wonder why I even drink at all?  It seems at odds with my passion regarding health and wellbeing and my interests in nutrition and exercise.  It’s something that with the onset of perimenopause I have become even more self-conscious of.

Having a glass of wine in the evening is very common, especially within the 40-65yrs age group. Alcohol is linked in our minds with celebrations, stress release, having fun, relaxing, and unwinding. Like food it is often something that we link with reward at the end of a challenging day. 

My parents have one large glass of wine with their dinner every night. I’ve never seen them drunk or go to the pub just for a drink. This regular drinking has been normalised for me. When we discussed this, they were surprised that they exceed the weekly recommended guidelines. They didn’t know that alcohol could have a detrimental impact on their health. Or that according to research they would be classed ‘chronic’ drinkers.

Chronic drinking

Chronic drinking is when you have seven or more drinks spread over a week. It has been linked to high blood pressure, heart disease, digestive problems and liver disease and some cancers.  I have learnt about the impact alcohol has on the gut-liver-brain axis. I now realise how detrimental even low to moderate alcohol can be on our mental health.

When we drink alcohol, we decrease the gut’s natural dopamine production by causing imbalances in our healthy gut microbes. Alcohol is a depressive and long-term chronic drinking results in us being more susceptible to stress. It makes us less emotionally resilient when we are not drinking, because of its impact on the gut-liver-brain axis.  Alcohol literally can change neuronal function and lead to neurodegeneration.  As a woman entering the perimenopause stage of life it is also possible that alcohol’s effects will get worse. This will be as my oestrogen levels decrease and may increase symptoms such as anxiety and brain fog.

Being informed

Although the research looks bleak, this is information that has helped me cut down.  I am ambivalent about giving up alcohol completely, but I definitely want to keep my alcohol units low.  I’ve found it helpful not to buy wine with my weekly shop and reduce drinking at home. This had increased during the lockdowns.  I find it helpful to do other things to relax and switch off in the evenings. This includes reading, yoga and messaging friends.  I remind myself that ultimately alcohol is a poison that my body doesn’t need after a hard day’s work.  I’m starting to think ‘I’m so glad I haven’t had a glass of wine this week’. I am noticing I’m sleeping well, and my energy and motivation levels are good. 

If you’re interested in learning more about reducing your alcohol intake visit Drinkaware’s website using the button below. Drinkaware’s mission is to use their expertise and knowledge to support individuals, communities and organisations. It supports people to make informed decisions about alcohol and how to reduce the harm it can cause.