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Alcohol

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In most countries, alcohol is so widely available that many people forget that it falls into the category of a depressant drug. This does not mean that by drinking alcohol you will feel down or depressed. It does mean that it depresses the brain’s functions. This, in turn, changes people’s behavior. It is because of its mind-altering properties, and other potentially damaging effects on the body, when consumed irresponsibly, that alcohol can be quite a dangerous substance and why its sales are controlled.

As people drink alcohol, you can see how their behavior starts to change.

  • People become a little louder and more confident as they lose their inhibitions
  • Some people may start to slur their words
  • Some may start to be unsteady on their feet
  • Other senses will start to be affected, including vision, causing difficulty in judging distances

If a drunk person continues drinking, it can have very serious effects. Automatic functions start to be affected (heart, lungs). This is known as alcohol poisoning and causes a person to lose consciousness. An unconscious person can choke to death on his or her own vomit. A person can also die from acute alcohol poisoning – from having too much alcohol in the bloodstream.

It is important to know the early symptoms of intoxication and to refuse to serve such customers well before they become obviously drunk.

As alcohol worsens the physical and mental functioning, the more individuals drink, the less likely they are to be able to make decisions about their own well being. This is why it is up to the server to decide who has had enough to drink, not the drinking customer.

Alcohol & the Body

Alcohol is made of very small molecules, and these are absorbed into the blood. Normally, this takes place in the small intestine, but, in theory, if you were to fill your mouth with, for example, a nip of whisky without swallowing it, the alcohol would still be absorbed into your blood through the lining of your mouth. Cell membranes are highly permeable to alcohol, so, once alcohol is in the bloodstream, it can diffuse into nearly every tissue of the body. This means that misuse of alcohol can damage many different organs in the body.

Normally, alcohol is swallowed and goes down to the stomach. The stomach breaks down food and drink before passing it to the small intestine. If there is no food in the stomach, then the alcohol passes more quickly into the small intestine from where it is absorbed into the blood. The alcohol circulates around the body (in the blood) until it reaches the brain. This takes approximately 5 minutes. When the alcohol reaches the brain, it begins to depress the functions of the brain, starting with the part of the brain that controls inhibitions and judgement.

If there is food in the stomach, alcohol will mix with the food before passing to the small intestine. It is this mixing with the food that slows down the alcohol being absorbed into the blood. Note that the process is only slowed down - not stopped. Eventually, all of the alcohol consumed will be absorbed into the blood and will travel around the body, affecting other body functioning.

Alcohol reaches the liver in approximately 20 minutes. The liver processes the alcohol – breaking it down and neutralizing it, then removing it from the body. In general, the liver breaks down alcohol at the rate of around 8 grams of alcohol per hour. See page 12 for help in calculating the number of grams of alcohol in any drink.

The amount of alcohol in the blood is determined by the quantity and type of alcohol consumed, the speed of drinking, whether or not there is food in the stomach and a variety of other factors. The immediate effects of drinking depend upon the amount of alcohol in the bloodstream – the blood alcohol concentration (BAC). BAC varies according to a person’s sex, weight, body composition and speed of drinking. Women tend to have a slightly higher BAC than men after drinking the same amount because they have less body fluid to dilute the alcohol.

A small amount of alcohol (less than 10%) is eliminated from the body in urine, breath and sweat. The rest is oxidized - this means, like food, it combines with oxygen in the blood to release heat, energy or calories. However, although alcohol has some nutritional value, it is of poor quality because it lacks vitamins, proteins and other nutrients. Also, unlike food, alcohol is metabolized almost exclusively by the liver. This means that the liver is one of the first parts of the body to suffer the harmful effects of heavy drinking. The diagram on the next page looks at alcohol’s passage through the body.

In summary, this generally means that when drinking the same amount of alcohol:

  • Women are more affected than Men
  • A Small person is more affected than a Big person
  • A Person who has empty stomach is more affected than a Person who has eaten a big meal

And because the body builds up a tolerance to alcohol:

  • A Person who drinks rarely will appear more affected than a Person who drinks regularly

Strength of Drinks

The strength of alcohol drinks varies. Even within a given sector, there is considerable variation across different drinks. For example, beer can range from about 2% to about 9% alcohol by volume (ABV). In addition, many drinks are mixed with soft drinks or water. In order to make measurement as uniform as possible, the agreed convention for standardizing drinks is grams of pure alcohol (ethanol). What it means in practice is that a “standard” drink will always contain a given amount of pure alcohol, regardless of whether it is beer, wine or distilled spirits.

It is useful for consumers to be able to assess “low-risk levels of consumption”. However, different countries have different standard drink measures, generally ranging from 8g to 14g, and some countries don’t have such a thing as a “standard drink”.

Having an understanding of the risks and benefits potentially associated with alcohol consumption is an important tool for preventing harm. Guidelines can provide people with a sound basis for making decisions about their drinking and allow them to change their drinking patterns as appropriate.

Official guidelines on alcohol consumption are generally produced by relevant government departments (aministry of health or other department responsible for alcohol issues). Find out what they are for your country. Other guidelines may also exist, such as those given by medical associations.

Some countries have attempted to introduce measures to allow a better estimate of the number of standard drinks in a beverage. In the UK, for example, alcohol producers have made a voluntary decision to specify the number of UK units in a beverage, where 1 unit is equal to 8 grams of pure alcohol.

"An understanding of the risks and benefits potentially associated with alcohol consumption is an important tool for preventing harm."

You cannot presume that each drink, be it a prepackaged bottle of beer, a standard glass of wine or a measured spirit, is a standard drink. The calculator below allows you to gauge how many grams of pure alcohol are in a drink if you know the amount of drink in milliliters (ml) and the strength of the drink in alcohol by volume (ABV). Both are normally stated somewhere on the label or packaging, the latter usually expressed as a percentage. Alternatively, you can calculate this yourself:

Drink Amount of pure alcohol(g)
1 Imperial pint (568ml) of lager (4% ABV) 18.2
275ml bottle of flavored alcohol beverage (5% ABV) 11
330ml bottle of premium lager (5% ABV) 13.2
Whisky (35ml measure, 40% ABV) and cola 11.2
Vodka or gin (25ml measure, 37.5% ABV) and tonic 7.5
Glass (175ml) of wine (12% ABV) 16.8
Vermouth (50ml measure, 15% ABV) and lemonade 6

It is important that you offer a good range of drinks, including some of lower strength or alcohol-free, in a range of sizes.

Pouring Measures

So that people can keep account of what they are drinking, it is best practice to use standard measures for pouring drinks.

Some countries have made this law, as in the UK where the law states that a sign has to be displayed stating the size of measure for wine and the spirits (vodka, gin, whisky and rum). In the UK, wine has to be sold in glasses 125ml, 175ml or multiples of these, and the four spirits mentioned have to be sold in either 25ml or 35ml and multiples of these.

Pouring measures may differ depending on what drink you are serving. Find out what the laws are in your country by contacting your local government department dealing with trading standards or licensing issues.

The Permitted Measures
Some countries may have laws governing the type of promotions you can offer. Certainly, in most countries itis not good practice to run promotions that encourage people to drink a lot of alcohol in a short space oftime, since this can encourage drunkenness and all its associated problems.

Find out if there are any laws or good practices relating to promotions in your country.

Drinking and Driving

Most countries have laws about drinking and driving. In those that do, this varies from 0.00% BAC (“zero tolerance”), as in Hungary and the Czech Republic, to 0.02%, as in Norway and Sweden, and to 0.08%, as in Canada, New Zealand, the UK and the USA. Where there is a set limit, breathalyzers and blood samples are used to calculate the concentration, but sometimes physical tests are conducted initially to assess the level of intoxication, such as “walking in a straight line” in some States in the USA.

Find out what the laws are in your country with regard to drinking and driving by contacting your local government department dealing with traffic offenses.

There is no dispute that alcohol affects a person’s ability to drive. In fact, the body begins to be adversely affected from around 0.02% BAC (sometimes expressed as 20mg per 100ml of blood.) Many people ask, “How much can I safely drink and still drive?”

It is impossible to say that a certain number of grams of alcohol or a certain number of drinks will keep you below a government set limit or ensure your driving is safe. As we’ve already seen, the amount of alcohol in your blood depends on age, sex, size, what you’ve eaten and many more factors. This means it is impossible to predict the exact effect and therefore the only truly “safe” level is not to drink alcohol at all when driving.

If a customer who may be driving is served intoxicating amounts of alcohol, servers in some countries (e.g., in some States of the USA) may face legal responsibility if the person has a car accident and is found to be drunk. This is known as “server liability”. Even if this is not the case in your country, we all have a social responsibility. This is why it is important to let the drivers know the facts and offer them an alcohol-free or low-alcohol alternatives. Other good practices include placing details of local taxi services or bus timetables on display and distributing materials of any designated driver schemes.

Sobering Up

Ask anyone how to sober up or get rid of the alcohol from the body, and people give a variety of answers. However, most of this advice is incorrect and some can cause more harm. Let us look at a few:

  • Drink coffee wrong - coffee contains caffeine (which is a stimulant) and mixing it with alcohol (which is a depressant) can have harmful side effects.
  • Drink water wrong – although this may help rehydrate the body, drinking water has no effect on getting rid of the alcohol.
  • Be sick / vomit wrong – this will only get rid of the alcohol in the stomach and, as alcohol is quickly absorbed into the bloodstream, this won’t help
  • Stop drinking and wait RIGHT - there is nothing you can do but wait for your liver to process the alcohol out of your body. It takes around 20 minutes from when you first start drinking for the liver to start to process alcohol out of the body. The liver then processes this alcohol at a steady rate of around 8g per hour.

The best way to avoid drunkenness is for individuals to “pace” themselves - that is, drink at a rate no faster than the body can break down the alcohol.

It is important to think about the amount of time it takes to get rid of ALL the alcohol in your system, especially if you are driving or operating machinery later the same day or even the next day after drinking a significant amount.

Alcohol & Lifestyle

Depending on the culture of your country, the proportion of drinkers in the adult population will vary. In some countries, it is as high as over 90%. Drinking tends to be associated with good times like parties, events and celebrations and is often used as a “release”, for example at the end of a hard week at work. If consumed in moderation, at the right time and place, alcohol can be compatible with a healthy lifestyle. However, people who tend to drink too much, either binge drinking or over consuming, are at greater risk of developing health and other problems.

Binge Drinking - drinking too much in a single session. The precise definition varies around the world. In the US, it is defined as 5 or more drinks for a man and 4 or more drinks for a woman in a single session.
Excessive Consumption - Drinking too much over a period of time. Sensible drinking guidelines also vary between countries.

We have already covered some of the short-term effects of problem drinking, which include the possibility of alcohol poisoning, as well as a high risk of being involved in an accident or a crime. There are also many long-term effects, particularly on health.

When the liver has had to deal with too much alcohol, liver damage may result, ranging from fatty deposits and inflammation to cirrhosis, leaving permanent damage. Excessive consumption also has a corrosive impact on the linings of the stomach and esophagus, causing gastritis, ulcers and reflux; it may also damage the pancreas. Drinking more than 80g at a time is linked with a significant rise in blood pressure, which increases the risk of heart attack or stroke. In fact, alcohol can affect almost all parts of the body adversely when taken in excess of the recommended guidelines.

The Good News
In contrast, there are some reported health benefits associated with low to moderate levels of drinking that is at or below the guidance levels. Alcohol can be a protective factor for the heart, but only at these low levels. Additionally, to date, this effect has only been shown for people over the age of 40.

Summary / Action Points

  1. Be aware of the early signs of intoxication. Discuss with other staff and / or your manager what signs would mean you would say no to serving a customer
  2. Find out what the official recommended alcohol consumption guidelines are for your country
  3. Calculate how many grams of alcohol are there in 3 or 4 of the most popular types of drinks you regularly serve in your job
  4. Find out what the laws in your country say with regard to measuring drinks before you serve them.

If there are no laws, is there best practice?

  1. Find out what the laws in your country are with regard to drinking and driving
  2. Managers - review the range of products you stock and the information about each of them, so that customers can make sensible, informed choices
  3. If you don’t already do so, display information in the way of posters or other materials to discourage drinking and driving