Health: Alcoholic? Me?

The National Temperance Society claims more people than ever are shunning alcohol. Should you join them? Dr Phil helps you decide.

Why should I take drinking advice from a doctor?

Good point. An alcoholic, or so the adage goes, is someone who drinks more than his doctor. But if you don't mind the hypocrisy, your GP may at least have some insight in it, which is more than you can say for most illnesses.

Do alcoholic doctors differ from other heavy drinkers?

We tend to hide it better. If medical training teaches you anything, it's how to appear competent with a distillery coursing through your veins. All you need is a stout nurse to lean against and a packet of extra-strong mints. The mints, of course, don't mask the smell, any more than talc covers unwashed genitals, but doctors, like all professionals, can rely on their status to conceal drink problems. Most hospitals have one surgeon who's a bit shaky first thing without a couple of sharpeners to warm him up.

How does alcohol work?

The precise reason why two atoms of carbon, six hydrogens and an oxygen should combine to make you microwave the cat is not fully understood. Alcohol is absorbed into your bloodstream from the stomach and small intestine. This absorption is speeded up if you drink on an empty stomach, and if the alcoholic content of the drink is between 20 and 30 per cent. Thus a surfeit of preprandial sherry can wipe you out before the hors-d'oeuvre.

Alcohol is highly water soluble, and since 70 per cent of the body is water it gets pretty much everywhere. This explains the depressing list of side-effects, eg anxiety, depression, insomnia, dementia, gastritis, oesophagitis, cirrhosis, blackouts, fits, burning legs, chest pains, bronchitis, pneumonia, back-ache, rheumatism, gout, obesity, infertility and acne.

The only place alcohol doesn't go is fat. Since women have more of it than men and a smaller fluid volume, alcohol tends to concentrate more in their blood. When it reaches the brain, alcohol alters cell membranes and neuro-transmitter function. If this disruption reaches a critical level, you start singing "Ee-oh Tinky Winky" with pants at your ankles.

Although your liver works very hard to stop you making a prat of yourself, the enzymes that metabolise alcohol quickly get saturated, so you can't get rid of the stuff any faster no matter how much coffee you drink and hearty breakfasts you eat. Hence you can still be over the limit on the morning red-eye into work.

Is alcohol a euphoriant or a depressant?

It can be either, depending on how much you drink and your mood when you started. Euphoria can start at a blood alcohol level of 30mg/ 100 ml and leads to the sort of disinhibition that can have such disastrous effects when it extends to the operation of heavy machinery. In a simulated driving test, bus drivers with alcohol levels of 50mg/ 100 ml (still below the legal limit) thought they could drive through obstacles that were too narrow. Such calamities are followed by a profound sense of melancholy and a wish to run away and hide. At 160-200 mg/ml, most of us slur our speech, fall over and pass out. At 400mg/ml, we usually die.

Am I an alcoholic?

Aside from using your GP as a bench-mark, the best person to ask is the one closest to you. Dependence on alcohol can be psychological, when the habit becomes so deeply ingrained that the mere thought of stopping induces outright panic, or physical, when abstinence results in morning shakes, nausea and dry heaves. But the crucial question with alcohol is whether you can control the beast. Can you have a week off without crawling up the wall? If not, get help.

How much is safe?

The recently up-voted safe limit guidelines (21 units spread over the week for women, 28 for men) seem generous until you realise that a unit is only a half of ordinary-strength ale, a glass of wine, half a glass of fortified wine or a tot of spirits. So Miss Sensible should limit herself to a small sherry every eight hours. Party on.

Now the good news please

A couple of drinks a day cuts your risk of premature heart disease by up to 20 per cent. Alas, you can get the same result with unfortified grape juice. Happy New Year.