Alcohol moderation

For any change, we need to know why and how.

It is literally sobering to see the damage that too much alcohol can cause and how ubiquitous drinking alcohol is. Times have changed. I still have friends who post pictures of their bottles of wine or whisky on social media as their reward for a long day and others whose lives have been shattered as a result of alcohol. Alcohol is advertised alongside sporting events and lubricates our social occasions and rites of passage.

The UK has advised adults of any gender to drink no more than 14 units per week. It is easy to slip beyond this. The World Health Organization has recently declared that “Alcohol is a toxic, psychoactive, and dependence-producing substance and has been classified as a Group 1 carcinogen” and that there is no safe limit.

Alcohol in pregnancy

When I was pregnant, last century, one obstetrician encouraged me to drink red wine as a glass would increase placental blood flow. Yet we now know that the tiny molecules of alcohol (ethanol) cross the placenta and the blood-brain barrier instantly and are damaging to the developing brain. Fetal alcohol spectrum disorder affects up to 6% of Western children, causing irritability, impulsiveness and difficulty focusing and even a few young people having a different life trajectory need more support with behavioural, educational and social issues. Pregnant women should be advised to avoid alcohol. There is a potentially perioperative angle to this - Caesarean birth represents 43% of all births in the NHS in England (19% of all deliveries are elective Caesarean sections and 24% are emergency Caesarean sections).

Why reduce alcohol in the perioperative period?

Any amount of alcohol is bad for health and more is worse. It is particularly bad around an operation. It also reduces inhibitions increasing the chance of excess snacking or risky behaviours.

Alcohol induces liver enzymes, so you need more anaesthetic. It alters liver function, so it is difficult for proteins to be processed, interfering with healing of wounds and body tissues, such as ‘anastamoses’ where blood vessels, gut or other tubes are repaired. It alters how antibodies are made (these are proteins) and changes immunity. People who drink regularly and stop in hospital can develop withdrawal symptoms. People who drink when they get home are more likely to fall over, sleep badly and impair their nutrition and healing.

What do we need to know about the science of alcohol?

Alcohol works on the brain to make us feel good. It is a small molecule that is rapidly absorbed from the stomach or duodenum. It works in around 20 minutes – so it is useful to pace yourself and not accept a second drink when the first might not have had its full effect. The liver metabolises about one unit per hour – another reason to slow down. It is first metabolised to acetaldehyde, a highly toxic substance and known carcinogen. This is metabolised to acetate which is less active and further broken down into water and carbon dioxide. There are other routes involving fatty acids, that cause central obesity and liver damage.

Drinking alcohol is a habit. We associate it with certain events or times. Any habit is hard to break. Similar to smoking, it takes a few minutes for each craving to reduce, two weeks for the irritability and overwhelm to start reducing and a month to build a new habit.

Alcohol dependence means a person needs alcohol to survive and has severe withdrawal symptoms on stopping.

Some people are more susceptible to the harmful effects of alcohol and/or to alcohol dependence.

How to reduce alcohol in the perioperative period?

Alcohol dependence needs medical help. Here are some tips for people who are not alcohol dependent who want to cut down or reduce their alcohol before and after surgery.

This is about your future self putting in place measures to help you through difficult times.
Have alcohol free days – allow your body to recover.
Know your triggers.
Set a date.
Change your activities and environment.
Find alternatives, such as fizzy water with fruit, decaf or fruit teas or low alcohol substitutes.
Avoid buying alcohol or having it in your home.
Have something to do during the cravings – have your shoes ready to go for a walk.
If drinking alcohol, drink slowly, have a non-alcoholic drink between.
Set yourself a limit.
Offer to be the designated driver.
Tell your friends and family what you are doing and ask for help. Ask them not to offer you alcohol.
Consider doing Dry January. For “ordinary” drinkers, the following few months can be much more moderate because you have tested your strategies. Or you might want to continue it.
Be ready for the risk of relapse. Have strategies in place.
You might want to think about things to do in the short term (to get through the craving or decision) and things to do in the medium term (positive things to do).
It is possible to change several habits at once – you might want to take up parkrun/parkwalk to change how you socialise.

By reducing your alcohol consumption, you will be amazed at how clear your mind is. You will still enjoy the party but be able to remember it in the morning.

Sources of help

There are many organisations offering help
Be aware that some organisations are funded by the alcohol industry, which means there is a risk their techniques keep alcohol in the forefront of someone’s thinking – a technique that I believe is similar to those used by the gambling industry.
AlAnon can help family-members and friends of someone whose drinking they are worried about.

Although this information is aimed at health professionals, many tips can be imparted to others.

Good luck!

Professor Scarlett McNally