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By David B. Cooper

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The notion of 'standard drinks' may not be an easy one to reconcile with many accepted drinking practices. From the point of view of educating the public about sensible drinking, guidelines that are in keeping with local drinking practices and drinking cultures seem a more reasonable approach. 12 Alcohol use Notes a This chapter was first published as What is a 'Standard Drink'? Report 5; September 1998, International Center for Alcohol Policies, Washington, DC, and is reproduced by kind permission of Professor Marcus Grant, President, ICAP and the author, Marjana Martinic, Director of Science Policy.

Damage occurs during the first few weeks of conception and in the last trimester when brain growth is maximal. 25 Caution is 36 Alcohol use necessary, however, because such children often come from dysfunctional and socially deprived families, in whom smoking and illicit drug use as well as alcohol is common. How best to counsel women about drinking during pregnancy? 26 Lungs Chronic bronchitis, aggravated by heavy smoking, is frequent; there is a fourfold increase in risk of complicating heart failure.

20 The characteristic features, seen in about one in five heavy drinkers, are a rounded, plethoric facies, obesity and hypertension. If alcohol is not recognised as the cause, patients may be subjected to unnecessary investigation; abstinence will reverse the condition. A precipitate fall in blood sugar (hypoglycaemia) may follow a binge or drinking on an empty stomach, when liver glycogen that produces glucose is depleted. Excessive drowsiness or unruly behaviour should raise suspicions. 21 Reproductive system22 Heavy drinking by men may cause loss of libido and reduced potency; the testes shrink, sperm production is reduced and testosterone levels fall while oestrogens increase, resulting in 'feminisation' with loss of body hair and breast enlargement.

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