Guidelines for Specific Groups
Guideline 4
A range of health and social problems may be associated with alcohol misuse. These include domestic violence, unsafe sex, financial and relationship problems, and physical conditions such as pancreatitis, high blood pressure and gastrointestinal problems. These problems may or may not involve dependence.
People experience the symptoms of alcohol dependence in different ways. You may have withdrawal symptoms, both physical and psychological (e.g. anxiety, tremors) when you stop drinking. You may have difficulty in limiting drinking on any one occasion. For some people, especially those with severe dependence, total abstinence will be the only realistic goal.
For some people with a drinking problem ‘controlled drinking’ is feasible, especially if they have social supports and if they tackle the problem early, before they become too severely dependent. If you already have significant alcohol dependence or major organ damage (eg damage to liver or pancreas), you will incur further harm if you continue to drink.
There are a number of professional, medical and voluntary agencies that can help you if you have problems with your drinking. Most States and Territories have an alcohol and drug telephone helpline, which can provide information on specialist services available.
Families offer a key resource in helping people with drinking problems, and are often the first to identify such problems. It is crucial that the impact of such problems on families and partners be recognised, and their needs supported.
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Guideline 5
If you have a family history of alcohol-related problems, including alcohol dependence, you are more at risk than the general population of being unable to control your level of drinking.
The degree of risk is related to:
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Guideline 6
In particular, if you are depressed and sometimes drink excessively, you are at much greater risk of self-harm and suicide, especially if you also regularly drink above Guideline levels.
Heavy drinking can also aggravate symptoms in people with depression and anxiety. While alcohol consumption may bring you some relief from anxiety and stress in the short term, it can also worsen your mood in the long term, especially at higher levels of consumption.
There is also some evidence to show that people with schizophrenia have poorer outcomes if they use alcohol.
With some mental health problems, the risk of alcohol dependence is significantly increased, particularly if you drink to relieve anxiety or change your mood.
Most of the medications used for mental health problems interact with alcohol.
If you have a mental health problem, you should discuss your alcohol intake with your doctor.
If you are the carer of a person with a mental health problem, you can encourage that person to stay within Guideline levels, or to abstain if necessary.
Alcohol can also disrupt your sleep. Even one or two drinks may reduce the quality of your sleep and cause early morning waking.
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Guideline 7
Even at low levels, drinking can cause problems due to interactions with some medications. Response varies from person to person. Such interactions can have serious implications if you are driving or operating machinery.
Alcohol dampens activity in the brain, and it can be particularly dangerous, or even lethal, when used with medications or other drugs, legal or illegal, that have similar effects (that is, that depress the central nervous system).
For more information on medications that may interact with alcohol, talk to your local doctor or pharmacist.
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Guideline 8
While alcohol has psychological, social and health benefits for many older people, the body’s ability to process alcohol decreases with age.
You may need to reduce your drinking or stop drinking completely to avoid harmful interactions with medications.
With age you are more susceptible to the effects of alcohol because:
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Guideline 9
Many young adults drink at low risk levels. However if you are a young adult, you are in the age group that is most likely to experience alcohol-related harm, according to statistics.
Young adults have the highest alcohol consumption in Australia and are the age group at highest risk of alcohol-related injury including road trauma, violence, sexual coercion, falls, accidental death (including drowning), and suicide. Younger, less experienced drinkers are at even higher risk due to their lower alcohol tolerance.
If you are a learner driver or a provisional licence holder, you must avoid alcohol in the hours before driving, to meet legal requirements in all States and Territories.
You need to weigh up the expected benefits of drinking alcohol against increased risk taking, loss of inhibitions, reduced decision-making skills, overdose related to a low tolerance to alcohol and the increased risk of accidents, violence and unwanted sexual activity.
Ways you can lessen the risk of harm from drinking include:
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Guideline 10
You should follow the recommendations under Guideline 9 and:
There is research from the United States to show that the earlier a young person starts to drink, the greater the risk of alcohol-related problems later in life.
Drinking by young people is very common in Australia, although there are also many young people who do not drink. Opinions vary about the best age to start drinking. Some cultures in Australia introduce children to very diluted alcoholic drinks at a young age.
Loss of inhibitions and decision-making skills place young people at particular risk of violence, accidents and sexual coercion.
Helping young people to learn about drinking and the effects of alcohol within a safe and supportive environment can help them to manage their drinking in ways that minimise the risk to themselves and to others, both when they are young and throughout their adult years.
This Guideline should be interpreted within the context of the relevant State/Territory laws in relation to alcohol and young people.
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Guideline 11
Alcohol in a woman’s blood stream passes to her unborn child, and this may affect the child from conception onwards. It is difficult to identify the exact levels of drinking which may cause harm to the child, and for this reason, you may consider not drinking at all.
The limited evidence available indicates that if you average less than one drink per day, there will be no measurable impact on the physical and mental development of your child. The evidence indicates that episodes of drinking above the Guideline levels considerably increase the risk to your unborn child, including the risk of miscarriage, low birth weight, cognitive defects and congenital abnormalities. Heavy bouts of drinking increase that risk.
The most important consideration is for you to avoid a high blood alcohol level at any time during your pregnancy. The first weeks after conception are probably the most critical in relation to alcohol and you may not be aware of the pregnancy at this stage. This Guideline is therefore important not only for women who are pregnant, but also for those who may soon become pregnant.
Good antenatal care and good diet, including folate and vitamin B supplements, and not smoking are all also very important.
Breastfeeding: A prudent approach
If you are breastfeeding, you are advised not to exceed the levels of drinking recommended during pregnancy, and you may consider not drinking at all. Alcohol in your blood stream passes into the breast milk.
There is little research evidence available about the effect of alcohol in breast milk on your baby. However, practitioners report that, even at relatively low levels of drinking, it may reduce the supply of milk and cause irritability, poor feeding and sleep disturbance in the infant.
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Guideline 12
you should be supported in your decision not to drink and not feel pressured to drink for potential health benefit.
There are many good health, family and social reasons why you may choose not to drink. These include personal, cultural and religious considerations.
The potential protection that alcohol provides against heart disease, and to a lesser extent gallstones or diabetes, is of importance only for people aged from about age 40 onwards when these diseases are more common.
If you choose not to drink, a healthy diet, regular exercise and giving up smoking wil provide similar health benefits.
See Also: Guidelines for Everyone
Additional guidelines for specific groups including pregnant women, young people, young adults, older people, people with mental health problems, people with health or social problems made worse by alcohol, people taking medication.
- If you have a health or social problem related to, or made worse by, alcohol (including alcohol dependence).
- If you have a relative who has, or has had, a problem with alcohol.
- If you have a mental health problem (including anxiety or depression and/or problems sleeping).
- If you take medications or other drugs.
- If you are an older person.
- If you are a young adult (aged about 18-25 years).
- If you are a young person (aged up to about 18 years).
- If you are pregnant, or are planning to become pregnant.
- If you choose not to drink alcohol.
Guideline 4
If you have a health or social problem related to, or made worse by, alcohol (including alcohol dependence)
- you should consider not drinking at all;
- you are strongly advised to stop drinking for at least several weeks or months;
- you might then try drinking at low levels* (substantially below Guideline 1) under the supervision of your doctor;
- you should not drink at all if you have developed severe alcohol dependence;
- you should never drink if you have a severe health problem made worse by alcohol (e.g. cirrhosis of the liver, pancreatitis);
- if you have hepatitis C, or another form of chronic viral hepatitis, you should consider drinking only infrequently and well below the levels recommended in Guideline 1.
* the appropriate level will vary from person to person
A range of health and social problems may be associated with alcohol misuse. These include domestic violence, unsafe sex, financial and relationship problems, and physical conditions such as pancreatitis, high blood pressure and gastrointestinal problems. These problems may or may not involve dependence.
People experience the symptoms of alcohol dependence in different ways. You may have withdrawal symptoms, both physical and psychological (e.g. anxiety, tremors) when you stop drinking. You may have difficulty in limiting drinking on any one occasion. For some people, especially those with severe dependence, total abstinence will be the only realistic goal.
For some people with a drinking problem ‘controlled drinking’ is feasible, especially if they have social supports and if they tackle the problem early, before they become too severely dependent. If you already have significant alcohol dependence or major organ damage (eg damage to liver or pancreas), you will incur further harm if you continue to drink.
There are a number of professional, medical and voluntary agencies that can help you if you have problems with your drinking. Most States and Territories have an alcohol and drug telephone helpline, which can provide information on specialist services available.
Families offer a key resource in helping people with drinking problems, and are often the first to identify such problems. It is crucial that the impact of such problems on families and partners be recognised, and their needs supported.
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Guideline 5
If you have a relative* who has, or has had, a problem with alcohol
- you should be careful about how much you drink;
- you should take particular care to have regular alcohol-free days (one or two days per week); and
- you might consider not drinking at all.
*First-degree relatives (parents, siblings) or second-degree relatives (grandparents, uncles, aunts and cousins).
If you have a family history of alcohol-related problems, including alcohol dependence, you are more at risk than the general population of being unable to control your level of drinking.
The degree of risk is related to:
- the closeness of the relative who has the alcohol-related problem (first or second degree relatives); and
- the number of relatives involved.
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Guideline 6
If you have a mental health problem (including anxiety or depression and/or problems sleeping).
- if you choose to drink, you should take particular care to stay within the levels set out in Guideline 1, and you should consult your doctor or pharmacist about possible side-effects;
- you may need to consider not drinking at all, if you find it difficult to keep your drinking within these Guideline levels; and
- you may need to stop drinking entirely if symptoms persist.
In particular, if you are depressed and sometimes drink excessively, you are at much greater risk of self-harm and suicide, especially if you also regularly drink above Guideline levels.
Heavy drinking can also aggravate symptoms in people with depression and anxiety. While alcohol consumption may bring you some relief from anxiety and stress in the short term, it can also worsen your mood in the long term, especially at higher levels of consumption.
There is also some evidence to show that people with schizophrenia have poorer outcomes if they use alcohol.
With some mental health problems, the risk of alcohol dependence is significantly increased, particularly if you drink to relieve anxiety or change your mood.
Most of the medications used for mental health problems interact with alcohol.
If you have a mental health problem, you should discuss your alcohol intake with your doctor.
If you are the carer of a person with a mental health problem, you can encourage that person to stay within Guideline levels, or to abstain if necessary.
Alcohol can also disrupt your sleep. Even one or two drinks may reduce the quality of your sleep and cause early morning waking.
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Guideline 7
If you take medications or other drugs
- you should carefully read the labels and pamphlets with your medications (including herbal preparations) to check for harmful interactions with alcohol. You may need to reduce your drinking or stop drinking alcohol altogether;
- you are advised to be very cautious if you drink alcohol while using benzodiazepines, heroin, methadone or other central nervous system depressants;
- if you take a number of medications, you are at greater risk of increasing the effects of alcohol and/or decreasing the effectiveness of your medication - you may need to reduce your drinking or stop drinking alcohol completely;
- you should consult your doctor or a pharmacist to discuss any possible interaction of your medication with alcohol.
Even at low levels, drinking can cause problems due to interactions with some medications. Response varies from person to person. Such interactions can have serious implications if you are driving or operating machinery.
Alcohol dampens activity in the brain, and it can be particularly dangerous, or even lethal, when used with medications or other drugs, legal or illegal, that have similar effects (that is, that depress the central nervous system).
For more information on medications that may interact with alcohol, talk to your local doctor or pharmacist.
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Guideline 8
If you are an older person
- you are advised, if you drink, to consider drinking less than the levels set in Guideline 1.
While alcohol has psychological, social and health benefits for many older people, the body’s ability to process alcohol decreases with age.
You may need to reduce your drinking or stop drinking completely to avoid harmful interactions with medications.
With age you are more susceptible to the effects of alcohol because:
- as you continue to age the total water content of your body decreases, so that a given amount of alcohol tends to produce a higher blood alcohol level;
- you are at increased risk of falls;
- your driving may be affected; and
- any medications you take may have a harmful effect when combined with alcohol.
- you can achieve the potential benefits of alcohol with as little as one to two standard drinks per day for men, and less than one per day for women; but
- you can gain similar benefits from other strategies, such as regular exercise, giving up smoking and a healthy diet.
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Guideline 9
If you are a young adult (aged about 18-25 years)*
- you are especially urged not to drink beyond the levels set in Guideline 1;
- you should not drink at all for at least several hours before you undertake potentially risky activities (for example, driving, swimming and boating); and
- you should not mix alcohol with mood altering drugs.
*While this Guideline applies to everyone, it is particularly important if you are aged about 18-25 years. The issues and concerns overlap with those covered under Guideline 10 for young people (up to about 18 years)
Many young adults drink at low risk levels. However if you are a young adult, you are in the age group that is most likely to experience alcohol-related harm, according to statistics.
Young adults have the highest alcohol consumption in Australia and are the age group at highest risk of alcohol-related injury including road trauma, violence, sexual coercion, falls, accidental death (including drowning), and suicide. Younger, less experienced drinkers are at even higher risk due to their lower alcohol tolerance.
If you are a learner driver or a provisional licence holder, you must avoid alcohol in the hours before driving, to meet legal requirements in all States and Territories.
You need to weigh up the expected benefits of drinking alcohol against increased risk taking, loss of inhibitions, reduced decision-making skills, overdose related to a low tolerance to alcohol and the increased risk of accidents, violence and unwanted sexual activity.
Ways you can lessen the risk of harm from drinking include:
- alternating alcoholic and non-alcoholic drinks;
- choosing low alcohol drinks;
- eating while drinking;
- staying with friends rather than driving; and
- not accepting lifts with a drunk driver.
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Guideline 10
For young people (up to about 18 years)
You should follow the recommendations under Guideline 9 and:
- if you choose not to drink, others should support your decision;
- in settings where alcohol is available to you, you should be under adult supervision at all times;
- you should keep your drinking to a minimum;
- most importantly, you should not drink to become intoxicated; and
- to become a responsible adult drinker, a gradual, supervised introduction to alcohol is recommended.
There is research from the United States to show that the earlier a young person starts to drink, the greater the risk of alcohol-related problems later in life.
Drinking by young people is very common in Australia, although there are also many young people who do not drink. Opinions vary about the best age to start drinking. Some cultures in Australia introduce children to very diluted alcoholic drinks at a young age.
Loss of inhibitions and decision-making skills place young people at particular risk of violence, accidents and sexual coercion.
Helping young people to learn about drinking and the effects of alcohol within a safe and supportive environment can help them to manage their drinking in ways that minimise the risk to themselves and to others, both when they are young and throughout their adult years.
This Guideline should be interpreted within the context of the relevant State/Territory laws in relation to alcohol and young people.
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Guideline 11
If you are pregnant, or are planing to become pregnant.
- you should consider not drinking at all;
- most importantly, you should never become intoxicated;
- if you choose to drink, you should have less than 7 standard drinks over a week, AND no more than 2 standard drinks (spread over at least two hours) on any one day; and
- you should note that the risk in highest in the earlier stages of pregnancy, including the time from conception to the first missed period.
Alcohol in a woman’s blood stream passes to her unborn child, and this may affect the child from conception onwards. It is difficult to identify the exact levels of drinking which may cause harm to the child, and for this reason, you may consider not drinking at all.
The limited evidence available indicates that if you average less than one drink per day, there will be no measurable impact on the physical and mental development of your child. The evidence indicates that episodes of drinking above the Guideline levels considerably increase the risk to your unborn child, including the risk of miscarriage, low birth weight, cognitive defects and congenital abnormalities. Heavy bouts of drinking increase that risk.
The most important consideration is for you to avoid a high blood alcohol level at any time during your pregnancy. The first weeks after conception are probably the most critical in relation to alcohol and you may not be aware of the pregnancy at this stage. This Guideline is therefore important not only for women who are pregnant, but also for those who may soon become pregnant.
Good antenatal care and good diet, including folate and vitamin B supplements, and not smoking are all also very important.
Breastfeeding: A prudent approach
If you are breastfeeding, you are advised not to exceed the levels of drinking recommended during pregnancy, and you may consider not drinking at all. Alcohol in your blood stream passes into the breast milk.
There is little research evidence available about the effect of alcohol in breast milk on your baby. However, practitioners report that, even at relatively low levels of drinking, it may reduce the supply of milk and cause irritability, poor feeding and sleep disturbance in the infant.
Top of page
Guideline 12
For people who choose not to drink alcohol
you should be supported in your decision not to drink and not feel pressured to drink for potential health benefit.There are many good health, family and social reasons why you may choose not to drink. These include personal, cultural and religious considerations.
The potential protection that alcohol provides against heart disease, and to a lesser extent gallstones or diabetes, is of importance only for people aged from about age 40 onwards when these diseases are more common.
If you choose not to drink, a healthy diet, regular exercise and giving up smoking wil provide similar health benefits.
See Also: Guidelines for Everyone