Book Notes: Drink?: The New Science of Alcohol and Your Health

One unit(u) is 10ml of pure alcohol or 7.89g of pure alcohol.

Binge drinking is when a women drinks more than 6 units in one sitting and men more than 8 units. Officially it means if you have a blood alcohol concentrate (BAC) of more than 0.08 grams.

The following information has been gathered from Professor David Nutt's book: Drink?: The New Science of Alcohol and Your Health. Or checkout him on LondonReal’s podcast.

Audio book chapter 9 or Book chapter 7

What is an alcoholic?

Can be categorized into 5 risk levels

  1. none drinker
  2. low, less than 14 units per week
  3. hazardous with at least 14u and less than 35u for women and less than 50u for men per week. One is usually not physically dependent but usually psychological
  4. harmful or high risk with more than 35u for women and more than 50u for men
  5. dependent, strong desire to drink, difficulty to control one's use with drinking, one continues to drink despite harmful consequences

Do I have an alcohol problem?

If one of these are true, then it could be that you have a problem with drinking alcohol.

  1. Drink more than intended to
  2. People criticize your drinking
  3. Has the criticization annoyed you
  4. Have you gotten into trouble or missed work
  5. Have you become ill due to alcohol
  6. Have you ever drunk alcohol to counter act the withdrawal symptoms, like having a drink to get rid of the trembles or sick to stomach aka counter beer
  7. Do you spend too much time drinking in comparison to other task that originally fancied you
  8. Do you spend too much money for drinking

Reasons why one drinks

  1. Anxiety especially social anxiety. When you stop, you will need more alcohol to feel normal and you will become hyper anxious
  2. Having fun, pleasure
  3. Remove emotional pain, life feel like a better place

The FAST test

On a scale of 0-4 with 0:never and 4:daily or almost daily

The questionnaire

1. How often did you drink more than 6u for women or 8u for men last year?

  • 0: never
  • 1: less than monthly
  • 2: monthly
  • 3: weekly
  • 4: daily

2. How often in the last year did you fail to do tasks as expected because of drinking

  • 0: never
  • 1: less than monthly
  • 2: monthly
  • 3: weekly
  • 4: daily

3. How often in the last year have you failed to remember what happened to you aka blackout

  • 0: never
  • 1: less than monthly
  • 2: monthly
  • 3: weekly
  • 4: daily

4. Has a relative or friend been concerned of your drinking

  • 0: never
  • 2: happened but not last year
  • 4: happened last year

Sum up all

If your total score is greater than 3, then you are FAST positive.

The FAST questionnaire is part of the larger AUDIT questionnaire.

Audio book chapter 10 or Book chapter 8

Why do we drink? The main reason is because of socializing and to have a good time with others.

Alcohol doesn't change you as much as you would think, your character. Basically alcohol dissolves your façade which you put on to mimic that which you think is socially acceptable.

Drinking gives you the best buzz. In general this is the ranking of the best buzzes:

Drinking > Yoga > Exercise > Socializing > Meditation > Food > Caffeine

Alcohol creates the greatest sense of sociability.

Alcohol is THE social drug!

The word alcohol was derived from the Arabic word "kohl" which means body eating spirit.

4 main motives why we drink more in a group

  1. Copying other's behaviors
  2. Conformity to fit in the group
  3. Hedonism to escape and have a good time
  4. Winding down for relaxation

Why would I want to drink?

  1. You want to get out of your head, you no longer want to be in control of your life
  2. Peer-pressure, buying rounds or drinking in a group, extreme version: drinking games
  3. Escape, an emotional anesthetic to take you of the dread of life
  4. For the LOLs and highs, feeling animated and interesting, you don't know where the night might lead
  5. Want to have sex, making you feel brave enough to talk to your potential date

Alcohol is the perfect dry cocktail for socializing

  • Making you energetic and positive as if you were on cocaine
  • Making you relaxed as if you are on GHB
  • Makes you love other people as if you were on ecstasy

The benefits of alcohol

  • Relaxation
  • Bonds you with others
  • Spending time with others
  • Creative expanding of our minds and territories. It is the driving force behind human's creativity and developed cultural expression in art, music, and religion.
  • Used for significant events such as bonding and war fares.

Benefits of drugs based off of French researchers

  1. Hedonistic benefits, the intensity of pleasure obtained
  2. Identity benefits, how it allows an individual to socialize and be part of a group plus cultural value
  3. Auto therapeutic benefits, how it sooths internal suffering intentions
  4. Economic benefits, the value of production, sales, consumption etc. to society
  5. Social benefits, how it helps maintain social balance
  6. Cultural benefits, how it's used for celebration and social rituals

The result: alcohol is the most harmful for society, but also has the most benefits!

Audio book chapter 11 or Book chapter 9

What kind of drinker are you?

Type 1: Social, mainly to celebrate and have fun

  • Do you pre-load?
  • Do you have a good time when you don't drink?
  • Can you imagine a social occasion without drinking?
  • Do you feel you need to have a drink in your hand?
  • => Social gatherings are difficult at any age and drinking is a way to coup with them.

Type 2: Conformity, drinking to fit in, drink because others do

  • If friends go out drinking, it is very difficult to not to drink
  • Do you do rounds or do shots?
  • Do you feel like you have to keep up with other drinkers?
  • Does it feel rude to refuse a drink? Or if someone tops off your glass?
  • Would you be okay to be the person at the party who isn't drinking?

Type 3: Enhancement, drinking because it's exciting

  • Are you a risk taker? Or do you do things that you would normally not do?
  • Do you have the intention to get drunk?
  • Do you crave the feeling of being drunk?
  • Do you need to be drunk to let yourself go?
  • Do you tend to binge drink?
  • => Don't wait for something bad to happen to deal with your drinking behavior.
  • => If you drink to get drunk, start taking cutting down very seriously!

Type 4: Couping, drinking to forget your worries

The largest group, especially middle-aged people for self-medicating

  • => Most likely to become an alcoholic
  • => If drink for stress reduction, seek help!
  • Do you drink daily?
  • Do you use alcohol to numb bad feelings?
  • Do you drink more than you used to?
  • Are you able to spend a night alone without drinking?
  • => You should start to think off ways to coup without alcohol!

Solution: personal health strategies

First track how much you are drinking and when, why, plus with whom.

How to know if you should cut down or stop all together?

  1. If you have tried and failed, then you are probably a heavy risk or dependent and should stop

  2. If you have one of these medical conditions, that can be linked to drinking or will be made worst through drinking:

    • A mental health condition like anxiety or depression
    • Gastric upsets or GERD
    • Gave up smoking or intend to
    • Have hypertension
    • Have diabetes or pre-diabetic
    • Have risk of a stroke or heart attack or had them
    • Have a family history of cancers linked to alcohol
    • Have epilepsy
    • Have a history of other drug use
    • Want to conceive both male and female
    • Have insomnia
    • Want to control your weight

Then you should stop!

  1. Personality, if you lose control around alcohol. It is easier to say that "I don't drink" over "I am not drinking tonight" due to peer-pressure of others.

How to have a drink diary?

Week 1

Write down

  • when?
  • where?
  • what?
  • with whom?
  • how much?
  • how it felt?
  • and why?

There is a survey at Drink Meter that compares you to others who drink the same amount.

Write down why you want to cut down your drinking!

Week 2

  • Eliminate the drinks that weren't worth having last week.
  • Rank your drinks: the fun they brought, the satisfaction, and their results.
  • Write down your triggers: what were you doing that made you drink too much?
  • Work out what you will be doing instead next time.
  • Write down how much you drank. Use the tactic of alternating drinks to drink slower.

Week 3

  • Set your target threshold in units. Make sure that the threshold is something you can stick to!
  • Alcohol is one of the worst drugs for your judgement. Thus be VERY specific!
  • Make sure you have at least two drink free days per week.

Week 4

  • Change up your routine.
  • Which drinks can you cut?
  • Can you cut any that are just part of your habit and are no longer fun to drink?
  • Are you drinking those drinks out of stress?


  • Adopt 5 strategies from this chapter.
  • Continue to do these tactics until you achieve your weekly unit goal.
  • Decided the reward, if you achieve to stay within the limits. Of course not an alcoholic beverage!

Suggested drinking rules

  • Don't drink when thirsty. First have some water or a shandy.

  • Never allow top-offs, because it will be easier to keep track how many drinks you had.

  • You must empty the glass before a refill.

  • Say no to champagne or any other drinks heavily with bubbles, because they make you drunker faster.

  • Don't wash down food with wine.

  • Only have wine between meals or courses, not before or when food is presented before you.

  • Refuse aperitifs, are assumed that they are a necessity for feasting, but truly it is a way to get drunker faster.

  • Only have two drinks, because you are very likely to stay within your recommended limits.

  • Aim to get never drunk. If you are drunk, then that means you have at least consumed 5 units.

  • Never have one for the road.

  • Volunteer to drive. That way you can refuse all forms of alcohol without offending others.

  • Take a week off of drinking. It is not as effective as a month. Though it will help to reset your tolerance. If you do it, make sure you don't go back to the same drinking level as before.

  • Only buy booze as needed.

  • Adopt a drinking curfew.

  • Alternate your drinks with e.g. water or non-alcohol beverages.

  • Don't get your alcohol delivered, because it anonymizes your purchase.

  • Buy expensive alcohol or at least the most expensive you can afford, so that you can actually savor it.

  • Find low or non-alcoholic drinks you like.

  • Change up your patterns like become a "80/20-drinker", where you drink only two days out of 10. Or a "2/5-drinker", where you drink two days and stop for 5. Or become a "weekend warrior", where you only drink on Friday, Saturday, and/or Sunday, but do NOT binge drink!

  • Find new activities to do instead of drinking like a sports club or evening classes.

  • Schedule drink-free days, even one drink-free day is better than none, best would be two for your liver.

  • Don't drink alone, especially in front of a screen, because you become a mindless drinker.

  • Don't buy alcohol at the supermarket, and instead make alcohol a special shopping trip. Thus you will learn how much you spend on alcohol.

  • Avoid cheap alcohol like happy hours.

  • Make sure you are hydrated. Keep a refillable water bottle with you, because the more hydrated you are the less likely you are to drink your first one fast.

  • Enjoy what you drink, savor it. Think of alcohol as a delicious treat. Sip not gulp!

  • Never buy a wine box, because it makes drinking too accessible.

  • Never open a second bottle of wine.

  • Don't eat salty snacks, because they are made to make you drink more.

  • Treat your stress first! For example do exercise, yoga, meditation, or breathing exercises, call a friend, have a bath, or go for a walk.

  • Calculate how much you will drink and tell it to someone. Also be specific when and where you will drink them.

  • Practice saying "no thank you", because people can be very persistent. If needed, make sure you have a better excuse than just that you want to drink less.

  • Order the smallest measure. The smaller the drink, the less we drink. Do this also at home.

  • Turn down the music. Loud music makes us drink faster.

  • Don't get involved in rounds and make sure you buy your own drinks, so that you are in control. Thus you won't attempt to drink to get your money's worth.

  • Use straight glasses, which will make you drink slower. Because of the curvature of it gives off the illusion that the halfway point is much lower than expected. If the glass is marked with a line, it will also slow down your drinking.

  • If you know how much you are drinking, this will regulate your drinking.

  • Talk with your doctor, which can drop your drinking up to 20%.

  • Surround yourself with non-drinkers.

  • Go out later. You will drink less and are less likely to binge.

  • Don't do shots (range from 1-3 units) or cocktails (even higher).

  • Follow the rule: 1 unit per hour. 1 in 1 out. On average you process one unit per hour. It comes with the advantage that you probably won't have a hangover.

  • Get an app:

  • Don't drink at lunch time.

  • Never drink at work including evening dues.

  • Don't drink on an empty stomach.

  • Schedule an early morning event, ideally where others are relying on you, so you less likely to skip it. Thus you are less likely to get plastered the evening before.

  • Don't use energy drinks as mixers, because caffeine makes you drink more due to its rewarding properties.

  • Buy the third round. That way you can stay with your limit of two drinks and you can order a non-alcoholic drink.

Essential safer drinking rules

  • Know your number of units just like you know your daily calorie intake.
  • Make your intake target 3 units or less, which is acceptable and above that the effects accelerate.
  • Take pride in lowering your number.
  • Take two drink-free days per week.
  • If you take a month off from drinking, your average over the year will also decrease.