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Dose, strength and purity

The size of drinks served at some hotels or at home can be bigger than the standard drinks you usually drink. Cocktails can have up to six standard drinks per drink.

The strength of alcohol can vary depending on the type of alcohol.

The alcohol content of beer usually ranges from 4% to 6% alcohol by volume. Wine has an alcohol content of around 9% to 16% and spirits have an alcohol content usually higher than 20%. As spirits are often mixed with soft drinks it’s easy to underestimate their strength and purity.

Using alcohol with other drugs

Using alcohol with other drugs can cause physical and psychological problems so it is a good idea to avoid it. Certain drugs including ecstasy, amphetamines and cocaine can fool your body into thinking you are more sober than you really are. This can lead to excessive alcohol intoxication and/or alcohol poisoning.

• Stimulants: Using alcohol with amphetamines increases the likelihood of aggression. Using alcohol with ecstasy can increase dehydration which can lead to unconsciousness. If too much fluid is consumed, 'brain swelling' may also occur.
• Other depressants: Using alcohol with cannabis may increase effects of alcohol such as increased confidence, dizziness, nausea/vomiting. Using alcohol with other ‘depressants’ including heroin, methadone, buprenorphine, sleeping tablets, muscle relaxants, GHB and ketamine is very dangerous as these drugs work on the central nervous system to slow the heart and breathing rates. Too many of these drugs in your system increase the likelihood of overdose and death.
• Prescribed medication: Using alcohol with any sedatives, including benzodiazepines (such as Valium, Xanax, Serepax, Mogadon), anti-psychotics (such as Seroquel), some anti-depressants (such as Luvox), some anxiety medication and older tricyclics, will make you feel a lot more drowsy compared to if you had twice the amount of just alcohol. Using sedatives and alcohol may also make you collapse, pass out or die from your brain's control of breathing stopping. Paradoxically, you might enter a high energy state - as if you were much more drunk in terms of disinhibition without being as sleepy - and you might be violent or do violent things without having any memory of what you've done.
  
  Also, in the first week after starting an antidepressant some people can become extremely agitated. This is not necessarily dangerous but you should tell the doctor who prescribed the antidepressant immediately. Alcohol in this critical period can turn this agitation into a very dangerous situation: people have been known to commit very violent acts towards themselves or others.
  
  In the long-term alcohol reduces the benefit from the antidepressant. It’s best not to drink on an antidepressant (as it can also lead to extra drowsiness if your antidepressant has that effect). However if you can’t go without a drink a good rule of thumb is to keep it to less than 2 standard drinks a day (bar drinks usually have 1-2 standard drinks’ worth of alcohol in them).
  
  Lithium: Lithium can damage the kidney irreversibly if you are taking it and become dehydrated even for a few hours. In severe cases people can end up needing dialysis for life.
  
  Antibiotics: Some antibiotics, such as Flagyll,  interfere with your body’s ability to break down alcohol. The combination can leave you feeling extremely sick (stomach pains, vomiting etc.).
  
  Epilepsy medication: Many illicit drugs and alcohol make seizures more likely and so reduce the benefit of your epilepsy medication. In addition some interfere with the body’s ability to process the epilepsy medication so you can get a toxic build up of the medication or not have enough in your blood stream depending on the particular interacting drug. Additionally many epilepsy drugs are hard for the body to break down and can take a toll on the liver, which if taken together with other substances (esp. alcohol) can lead to liver damage.

If you are planning to take any illicit substance or alcohol while you are going to be on medication that is about to be prescribed to you, talk with your doctor. Unless they have immediate concerns for your safety it will remain confidential. Each drug is different and interactions can be unpredictable and very dangerous. This is especially so if you’re on any highly specialised drugs (e.g. for heart problems, neurological – brain and nerves – problems, blood thinning medications or drugs for cancer).

Binge drinking and alcohol poisoning

Binge drinking involves heavy drinking over a short period of time and leads to immediate and severe intoxication.

Other than the obvious risks associated with intoxication such as road accidents, fights, violence and unprotected sex, the health risks associated with binge drinking include:

• potential damage to the small bowel, causing diarrhoea
• depression of the central nervous system
• hangovers
• headaches
• stomach problems leading to nausea, shakiness and vomiting.

Alcohol poisoning occurs after serious binge drinking when the blood alcohol level reaches a dangerous point. You may fit, lose consciousness, slip into a coma and in severe cases even die.

The most common ways people die from alcohol poisoning are:

• The depressant effects of alcohol slow the breathing and heart rates of the drinker, eventually stopping all together.
• While unconscious, the drinker chokes on their own vomit or even their own tongue.
• Alcohol reacts with another drug (prescription drug, over the counter drug or an illicit substance) in the drinker’s body. These deaths tend to be very unpredictable and its best to just avoid the combination.

You know someone has alcohol poisoning and it is best to seek emergency medical help when:

• The person is unconscious and can’t be awakened by shouting, pinching or prodding
• Their skin is cold, clammy, pale and bluish/purplish in colour
• The person is breathing very slowly and there is more than ten seconds between each breath
• The person is vomiting without waking up.

What to do if someone loses consciousness

• Call an ambulance on 000 - police do not routinely attend overdoses.
• Do not leave the person alone.
• Put the person in the recovery position (ie on their side making sure their airways are clear so that  they cannot choke).
• Loosen any tight clothing that might restrict their breathing.
• Keep them warm – unless the fainting is due to overheating.
• If they stop breathing, perform CPR until the ambulance arrives.

Tips for reducing harm

Some things you may consider to reducing harm from alcohol include:

• Avoid mixing alcohol with other drugs.
• Eat prior to and during alcohol use - it decreases the rate at which alcohol is absorbed and means you can stay out longer.
• Count your drinks and avoid top ups so you know how much you’ve had.
• Know your own limits - don’t drink at someone else’s speed.
• Break up your alcoholic drinks with non-alcoholic drinks - it’ll keep you hydrated and make the hangover not as bad.
• Stay with people you know and trust just in case something goes wrong
• Avoid swimming, driving and operating machinery while you are intoxicated - it doesn’t take much to make a big mistake.
• Carry condoms - alcohol lowers your inhibitions.
• Keep an eye on each other – problems are easier to fix if you stick together.
• Watch out for drink spiking - a number of drugs including extra alcohol, GHB and sedatives can be added to your drink to make you dizzy, drowsy and affect your memory. So buy your own drinks, know what you’re getting and keep an eye on your drink.
• When you are drunk you are more likely to make stupid decisions, embarrass yourself in front of others and find it difficult to perform tasks that are usually easy. You are also more likely to get injured or assaulted due to the mood and behaviour changes associated with alcohol.

If you want to reduce the risks associated with alcohol but still have drink, it is recommended that:

• Women drink no more than two standard drinks a day and men drink no more than four, with 1-2 alcohol free days a week.
• During one occasional heavy drinking day, women drink no more than four standard drinks and men drink no more than six.

Check out the Managing your drug use fact sheet for more info and suggestions, and this interview with Dr Dan Lubman from the Orygen Youth Centre where he argues that getting smashed is seriously bad for your brain and health, and suggests some practical strategies for avoiding the vortex that is binge drinking.

Untitled from Janice Atkin on Vimeo.If you are under 18 years of age, the safest option is to avoid drinking alcohol. Besides being illegal, it affects your development at these ages and you have many years ahead of you to drink if you decide you want to.

Alcohol and driving

Alcohol is a depressant. This means it affects the central nervous system by slowing down the messages going between the brain and the body.

Driving after using alcohol is dangerous because it slows down reaction times, it affects coordination, it affects your ability to concentrate, it slows the processing of information and often causes confusion and impaired thinking.

You might think that you can alter your driving to counteract any impairment to your driving ability, However, the effects of alcohol may mean that you have an altered view and experience of reality. This means that your actions and responses may be quite different to what is actually needed and you may be unaware how much your driving skills are affected after drinking alcohol.

The hangover effects of alcohol can also affect your ability to concentrate and drive safely, and may cause you to fall asleep while driving the next day.

Driving and legal blood alcohol concentration (BAC) limits

While any amount of alcohol can affect your ability to drive, in Australia, the legal limit you must not exceed when driving is a blood alcohol concentration (BAC) of 0.05. If you drive with a BAC of 0.05, the risk of you being involved in a road accident crash is double what it would be if you had not been drinking.

For learner, probationary and professional drivers the BAC limit when driving is 0.00 for most Australian states and territories. Some states allow learner, probationary and professional drivers to have a BAC level up to 0.02, however, it’s best not to drink at all if you want to stay under 0.02 BAC.

Personal factors

Personal factors such as weight, height, sex and general health all influence the way in which a drug may affect you. 

Drink plenty of fluids, eat well and sleep well if you are planning on taking drugs to better equip your body to deal with the substance.

Problem drinking

You might have a problem with alcohol when you

• neglect school work/tasks
• get into hassles at school, work or home
• think about drinking a lot during the day
• feel edgy
• drink more alcohol than you had intended on a night out, suggesting you may have problems controlling your own intake
• find that you need to drink more to get the same effect.

Check out the Assessing your drug use fact sheet for more info.

Tolerance and withdrawal

You can develop a tolerance to alcohol, meaning that means that you need to drink more to experience the same effect. As a result, some people can drink large amounts of alcohol without appearing to be intoxicated. However, the amount of alcohol consumed can still damage their health.

If you are dependent on alcohol and suddenly stop drinking you will experience withdrawal symptoms because your body has to readjust to functioning without alcohol.

Alcohol withdrawal symptoms include:

• loss of appetite
• nausea
• anxiety
• insomnia
• irritability
• confusion
• tremors
• sweating.

In severe cases alcohol withdrawal may cause:

• convulsions
• cramps
• vomiting
• delusions
• hallucinations
• death.

A person considering withdrawing from alcohol should first consult a doctor or other health professional.

This fact sheet was prepared with assistance from the Australian Drug Foundation.