Abstinence from alcohol

• Abstinence, ethnicity and religion
• Avoiding alcohol dependency or addiction
• What to do if you're trying for a baby
• Can you drink whilst on medication?
• Alcohol and antibiotics
• Alcohol intolerance
• Liver damage
• Taking a break from alcohol
• Are there any health benefits to drinking alcohol?

Despite the widespread assumption that drinking alcohol is an integral part of growing up, a recent report into why young people abstain showed that choosing not to drink is commonplace (2). Indeed, a fifth of 16 to 24 year olds in England do not drink (3). While the decision not to is central to many people’s identity, for others it is ‘no big deal’, just one of many of life’s choices (2).

There are a number of reasons why people abstain. It might be because of religious or medical reasons or because they don’t like the taste or effects of alcohol. Others don’t like how drinking makes them feel and want to stay in control of what they say and do.

Abstinence, ethnicity and religion

Globally, 45% of people have never consumed alcohol (4). In the UK, people from minority ethnic groups tend to have higher rates of abstinence as well as lower levels of frequent and heavy drinking compared with the British population as a whole. Those from South Asia, mostly Pakistan and Bangladesh, are the ethnic group most likely to report they’ve never drank alcohol. This includes people who were born in South Asia or people whose ancestors are from there (5).

Religion is the most common reason people give for not drinking. Overall, in the UK, Muslims are the religious group most likely to not drink, while Christians and people who say they have “no religion”, are the least likely to abstain (5). 

Avoiding alcohol dependency or addiction

Another reason for abstinence is the fear of becoming dependent on alcohol. Around 10% of people of child bearing age in the UK are dependent on alcohol. We also know that the tendency to develop alcohol dependency (sometimes known as ‘alcoholism’) is 60% inherited (6).

“In my experience, one of the main reasons that young native UK citizens do not drink is because they have had a bad home experience with alcohol, often with parents with alcohol dependency,” says Dr Nick Sheron, a liver specialist from Southampton University and Trustee of Drinkaware. 

What does it mean to be alcohol dependent?

People also abstain from drinking for a number of medical reasons, such as the ones below. 

When you’re pregnant or trying for a baby

The more you drink when pregnant the greater the risk you are taking with your baby’s health. Miscarriage, stillbirth, premature birth and small birth weight are all associated with a mother’s drinking during pregnancy. Drinking also increases the risk of the baby developing Foetal Alcohol Syndrome (FAS) which affects the way a baby’s brain develops.

The Department of Health recommends that pregnant women, or women trying for a baby, should avoid alcohol altogether. If they do choose to drink, to minimise risk to the baby, the Department of Health’s advice is to have no more than one to two units of alcohol once or twice a week.

Some medical evidence suggests that drinking alcohol can reduce your chances of getting pregnant. But another very important reason for avoiding alcohol while you’re trying to conceive is that alcohol can have a particularly damaging effect on your baby in the very early stages of pregnancy – before you even know you’re pregnant. The only way to avoid this risk is to stop drinking before you start trying for a baby.

The National Institute for Health and Clinical Excellence (NICE) has additional advice. This independent, organisation is responsible for providing national guidance on promoting good health and preventing and treating ill health. It says that women should not drink alcohol at all in the first three months of pregnancy because of the risk of miscarriage (7). 

If you’re taking medication for mental health problems

People taking sedative drugs, like Valium, or antidepressants, such as Prozac (fluoxetine), should avoid alcohol altogether. Alcohol is a depressant which slows down aspects of brain activity.

“Some types of medication also affect the way your brain works, so if you’re drinking alcohol there will be a conflict,” says Dr Paul Wallace, Chief Medical Adviser at Drinkaware. “Alcohol will increase the sedative effects of both, causing sleepiness and dizziness. It could also change the way the brain responds to the medication, making it less effective.”

If you’re taking medication for long-term conditions

The effects of alcohol can make some drugs, taken for long-term conditions, less effective. Examples include people taking drugs for epilepsy or diabetes, or drugs like warfarin to thin the blood. Alcohol can affect the way these drugs are absorbed by the body or broken down in the liver.

“If you drink alcohol regularly, especially if you drink excessive amounts, your liver produces more enzymes so that it can get rid of the alcohol more quickly,” says Dr Wallace. “Those same enzymes break down some medications so they no longer have the same effect.”

People with diabetes who are treated with insulin or some tablets, including suplhonylureas, are at risk of low blood sugar or ‘hypos’. Alcohol can increase the risk of severe hypos, which can cause brain damage and can even be fatal. People with diabetes are advised to limit their alcohol to 2 units a day for women or 3 units a day for men (8). However, if your diabetes is treated with a medication which puts you at risk of hypos, it may be advisable to avoid alcohol altogether.

Many medications, including some antihistamines (such as Piriton) and many painkillers, can cause drowsiness. Even a small amount of alcohol can increase this effect, putting you at risk of accidents. It’s especially important to avoid alcohol if you’re taking any of these medications and you need to drive or operate machinery. Your pharmacist or doctor can advise you.

If you’re taking antibiotics

There are a wide variety of antibiotics and some of them don’t mix with alcohol.  For example, the antibiotics metronidazole and tinidazole can lead to a build up of acetaldehyde, one of the breakdown products of alcohol which causes nausea, vomiting, flushing of the skin, accelerated heart rate or shortness of breath.

So you should always read the label of the antibiotics to check whether they can be mixed with alcohol. NHS advice is that people who choose to drink when taking antibiotics that are safe to mix with alcohol, should limit their intake in line with the government’s daily unit guidelines.

If you have an intolerance to alcohol

If people have an abnormal reaction to drinking alcohol, it could mean that they are intolerant to it. “Some people have a genetic mutation of the enzyme needed to break down alcohol; this can lead to flushes or nasal congestion if they drink alcohol because their bodies can’t break it down properly,” says Dr Wallace. “In this case, the medical advice is to abstain from drinking alcohol."

You might also be allergic to some of the ingredients in alcoholic drinks, for example wheat or yeast in beer. “Much of the protein which causes allergy to wheat and yeast is eliminated in the brewing process but it is theoretically possible that people with these allergies might also be allergic to beer,” says Dr Wallace.

If you have liver damage

Drinking too much alcohol directly damages your liver and this is one of the main reasons why it’s so important not to regularly exceed the government’s unit guidelines. If you do develop liver problems, then you must stop drinking altogether.

If you have early stage liver damage, abstaining from alcohol can allow the organ to recover. And if you have end stage cirrhosis, cutting out alcohol is essential to prevent you from dying from liver failure which is when your liver stops working completely. Under these circumstances the only ‘cure’ would be to surgically replace the liver but you will only be considered for a liver transplant if you do not drink alcohol for at least three months.

Why taking a break from alcohol is important

Many medical experts recommend taking regular days off from drinking to lower your risk of becoming psychologically or physically dependent on alcohol.

Taking regular breaks from alcohol can help to break any habitual patterns of drinking you’ve unintentionally fallen into. Such as going straight to the fridge or wine rack to get a glass of wine or beer after coming home from work or after putting the kids to bed. It will also reduce the risk of you building up a tolerance to alcohol, which is when you find yourself having to drink more to get the same effect. This can mean you end up drinking to levels that are harmful to your short and long-term health.

Will I miss out on any health benefits from not drinking alcohol?

You may have heard that for some people, drinking within the government’s daily unit guidelines can have protective benefits. This is probably true but it is not a good reason to start drinking if you haven’t before. “There is evidence to show that drinking small amounts of alcohol (no more than 1-2 units/day) can have protective benefits on the heart especially for over 45 year olds,” says Dr Wallace. “But it’s not a good idea to start drinking for this reason if you are a non-drinker, because any benefits are outweighed by the risks of developing other illnesses, such as liver disease or cancer.”