• Vicky Holmes

Covid-19: Guidance on cutting back or stopping alcohol

Is this advice for me? This advice is for you, if you are drinking daily and may be at risk of withdrawal symptoms if you stop or cut down alcohol consumption (detox). The support available from NHS and other local services to help with alcohol detox and reduction will be reduced during the COVID-19 pandemic, though some may be able to provide telephone and online advice. This advice is to help you and your families and friends self-manage alcohol withdrawal as safely as possible.

What withdrawal symptoms may I notice? The most common symptoms of withdrawal are sweating, shaking, and feeling sick and anxious. These typically last around a week. Occasionally, more serious symptoms occur which need medical help, but approaching detox in an organised way can help reduce your risks and is beneficial for your health in the long term.

What are the more serious symptoms of withdrawal to look out for? In more severe cases alcohol withdrawal can cause:

 Worsening of initial symptoms such as severe tremor and profuse sweating  Seizures (fits) even if you have not had one before  Hallucinations (seeing, hearing or feeling things that aren’t there);  Confusion (about where you are, what time it is, who you are with);  Poor coordination and unsteadiness on your feet. If you experience any of these, please call for urgent medical attention. Am I at risk of having alcohol withdrawal symptoms?  Do you drink over 15 units of alcohol every day? (This is around a ½ bottle of spirits, 1½ bottles of wine, 6 pints of regular strength beer, 3 cans super lager or 2 litres of strong cider.  Have you had withdrawal symptoms in the past when cutting back or stopping alcohol (symptoms sometimes take up to a few days to start)  Do you regularly drink alcohol soon after you get up to relieve shakes, or sweats If you fall into any or all of these categories, it is likely you will need to do some planning if want to stop or cut down your drinking.  People who drink in bouts of a few days with regular days with no alcohol at all, usually do not experience problematic withdrawal.

When is the right time to cut down or stop alcohol? The decision about whether the time is right to make any change to your drinking is up to you. You may decide to keep going as you have been, or decide to try to cut back or to stop drinking alcohol.

If you are drinking daily at high levels, you are at increased risk of the health impacts of the COVID-19 virus , as well as potentially not being able to access sufficient alcohol to continue drinking at your current level, so you may choose to reduce or stop drinking alcohol during this time.

In general, cutting down and staying at lower levels of alcohol may be harder than stopping all together, but the process for doing so is much the same for both, and explained below.

STEP 1 : WHAT AM I DRINKING NOW? The first step is to work out your typical daily intake. You may know this already or easily be able to work it out from your buying routine.

If you are unsure, keeping a diary of your drinking for around 3 days should help. Be honest! If you drink a combination of drinks, for instance, beer through the day and wine at night, use a drink calculator to work out your overall typical daily intake in units. If you are going to detox, it is usually easier to use only one type of drink so try to decide which drink will be the easiest for you to reduce and stop.

Tell a trusted friend or family member what your typical daily intake is. Even if you are not planning to make any changes to your drinking now, this may be important information for people involved in your care in the future.

STEP 2: MAKE A PLAN Once you have worked your typical intake, stick at that level for around 3 days and monitor how you feel, looking out for shakes and sweating. If at this level you are already experiencing symptoms it may be that you have underestimated how much you were drinking. Keep a note of what times of day are most difficult for you.

If you have decided to quit, set a day to start your detox. Tell some trusted people you are doing this and keep in contact with them. Ensure that you have food and other necessities in the house. If you are in touch with an Alcohol Worker let them know so they could provide you with more support and advice.

You are aiming to reduce at a pace for a “soft landing” so the important thing is to reduce each day at a pace that is manageable for you. Better to make a bit of progress each day than to try to go to fast, find it hard and give up.

Keep a note of your daily intake. Use the same size glass to help keep track. Use a measuring cup if you have one. Be honest with yourself and other people.

Many people find it is the drinks in the middle of the day which are easier to cut back to start with, so they keep their early and late “doses” stable in the start of detox. If you are a spirit drinker, gradually reducing the alcohol and increasing the mixer can help but make sure to measure the amount of alcohol.

STEP 3 HOW TO REDUCE AND STOP YOUR DRINKING You will set your own pace, but eight days is a typical period for alcohol detox. So by Day 2 you might be at ¾ of your previous intake, for instance 6 cans rather 8. By Day 4 you might be at half your intake, for instance a ½ bottle spirits rather than a bottle.

Withdrawals will often peak on Day 2 or 3 so make sure to use your supports on these days. If you have an alcohol worker arrange to speak with them at least once on each of these three days.

In general, after about five days, your symptoms should lessen and you can continue your gradual reduction of alcohol and stop around Day 8.

If, by Day 5 things seem to be getting worse rather than better, contact your local community alcohol/ addiction service for advice or phone 111.

If you develop more severe withdrawals (fits, hallucinations and confusion) seek urgent advice. If someone is supporting you then advise them that if you have any of these symptoms to seek urgent advice.

One thing that may take time to improve is your sleep. Sleep depends on routine and improves with practice. All parents know this! So be patient, stick to a sleep routine. Sleeping tablets are rarely helpful and best avoided.

STEP 4: IMPROVE YOUR GENERAL PHYSICAL AND MENTAL HEALTH Try to make sure you have a safe place to stay when you are planning to detox. During the COVID-19 crisis it will be more difficult than usual to have friends and family to stay or to visit them. Keep in touch by phone or online. Tell your trusted friends about your progress with alcohol, but talk about other things too.

It is very important that you have good nutrition during detox. Your vitamin and mineral intake are important, in particular a vitamin called Thiamine. You get this in bread, rice, fish and meat. If you have Thiamine tablets or a multivitamin tablet, take as directed on the bottle. If you have a fever, your Thiamine intake is even more important. If you are vomiting and unable to keep your food down, try nutritious liquids such as soup. If this doesn’t work, seek advice from 111 in the first instance.

Keep up your fluids intake. Water or tea is better than coffee or soft drinks. Avoid “energy drinks.”

Use supports to stay well. Many local organisations are arranging online support and your local community alcohol/ addiction service will be able to give you up to date information.

Other potentially useful resources: Alcohol Health Alliance:

Alcohol change UK

Active Inclusion Newcastle information update: 6 April 2020

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