There’s a lot more to intoxication than just being drunk. And much more to alcohol withdrawal than simply “the shakes”.
Let’s look firstly at what happens in the brain when we drink alcohol. Alcohol is a Central Nervous System (CNS) depressant, or a substance that slows down activity in the CNS, but alcohol also affects two types of neurotransmitters in the brain - GABA and Glutamate. Neurotransmitters work by sending chemical messages between the brain and the body. GABA is responsible for calming the brain and body. When we drink alcohol, this increases the effect of GABA which is why small amounts of alcohol can make us feel calm or more at ease. Glutamate works in the opposite way and ‘stimulates’ the brain and body. When we drink alcohol, this decreases the effect of Glutamate in the brain, which is why we feel drowsy after drinking alcohol.
Hangovers are influenced by a few factors including dehydration, blood sugar levels, and your neurotransmitters trying to rebalance. Think of it like a see-saw, the brain will want to get back to its normal state after drinking.
Regular alcohol use can also affect important vitamins and nutrients from being absorbed by the body. In particular, our brains need Thiamine and Magnesium to function. This is why some people can experience problems with short-term memory, concentration and irritability when they regularly drink alcohol.
To keep things in balance, it’s better to stay within the recommended low-risk drinking guidelines by drinking no more than 14 units a week, spread over three or more days and with, at least, a few days off. And to avoid consuming a lot of alcohol in one drinking session, often referred to as 'binge drinking'.
The World Health Organisation defines binge drinking as drinking six or more units of alcohol for women or eight or more units of alcohol for men in a single occasion.
A good way to think about alcohol withdrawal is through a seesaw analogy or the concept of homeostasis. Homeostasis simply refers to your body’s natural state and can be visualised as a balanced seesaw. We can also use the seesaw analogy, or homeostatis, to understand what is happening during alcohol dependency.
Drinking alcohol regularly and building tolerance to alcohol are all risk factors for alcohol dependency. It’s important to note that alcohol affects people differently and that anyone can be at risk of developing alcohol dependency. When the body is physically dependent on alcohol the body’s balance, or homeostasis state, has adjusted over time and has tipped too far one way, so the body requires alcohol to feel ‘normal’ or balanced. When a person doesn’t have alcohol in the system, the body goes into overdrive trying to balance itself, which leads to the withdrawal symptoms that people can experience including but not limited to fits, shaking hands, sweating, seeing things that are not real, insomnia, low mood, anxiety, agitation.
If you are a heavy or dependent drinker, it's important to be able to spot the signs of alcohol withdrawal to protect yourself. It’s also important if you are a loved one supporting a family member who may be alcohol dependent that you don’t withhold alcohol and instead encourage them to seek assessment and medical advice from their GP or local alcohol service.
If you are drinking at high levels, you could be physically dependent on alcohol. This means your body will react negatively if you stop drinking alcohol. These reactions are alcohol withdrawal symptoms. They can be very dangerous, and even fatal. It’s important to know the signs of alcohol withdrawal so that you can seek help urgently if you need it. You can use our ‘Check your drinking’ quiz if you’re not sure if you’re drinking at high levels.
Warning:
People who are clinically alcohol dependent can die if they suddenly, completely stop drinking. If you experience fits, shaking hands, sweating, seeing things that are not real, depression, anxiety, or difficulty sleeping after a period of drinking and while sobering up, then you may be clinically alcohol dependent and should NOT suddenly, completely stop drinking. But you can still take control of your drinking. Talk to a GP or your local community alcohol service who will be able to get help for you to reduce your drinking safely. Find out more.
If you are experiencing severe symptoms like seizures/fits or suspect you may have, you should call 999 urgently.
You’ll need to be careful about cutting down if you regularly drink over 15 units of alcohol every day. This is around half a bottle of spirits, or one and a half bottles of wine, or six pints of normal strength beer, or three cans of super-strength lager, or two litres of strong cider each day.
You need to be particularly careful if you are drinking over 30 units every day. This is about the same as a bottle of spirits, or three bottles of wine, or 12 pints of normal strength beer, or seven cans of super-strength lager, or four litres of strong cider each day.
If you are drinking at these levels, you should speak with your GP or local alcohol service before attempting to cut down or go alcohol-free. They may say that you need the support of a healthcare professional to cut down or stop drinking. If they say this, it is very important that you follow their advice.
There are other important things you can do to protect your health, whether you are being supported to cut down, cutting down independently or while you wait for this support.
