• What is mephedrone
• A short history of mephedrone
• What mephedrone looks like
• How mephedrone works
• The effects of mephedrone
• How to reduce the harm
• Mephedrone and the law
• Risks of different ways of using
• Long-term harm
• Overdose
• Mephedrone and chemsex

What is mephedrone

Mephedrone is a synthetic stimulant drug. It’s also known by its chemical name, 4-methylmethcathinone (4‑MMC). It is part of a group of drugs called cathinones, which are related to the natural stimulant cathinone found in the Khat plant.

People in East Africa (mainly Somalia and Ethiopia) have chewed Khat leaves for centuries. The effect is similar to caffeine and is used as a mild social stimulant.

In the UK, authorities classify the Khat plant as an illegal Class C drug.

A short history of mephedrone

Mephedrone (4‑methylmethcathinone or 4‑MMC) was first made in 1929, but it stayed under the radar for decades. In the early 2000s, underground chemists rediscovered the drug and began producing it for recreational use. They used old scientific research to recreate the cathinone-based drug and sold it online and in headshops as a “legal high” or “research chemical”. Because mephedrone wasn’t listed in the UK Misuse of Drugs Act 1971, it could be sold legally for a time, often labelled “not for human consumption” to avoid regulation.

Mephedrone became part of a wave of synthetic drugs known as legal highs, most of which were produced in China or India and sold online or in UK headshops.

To stay ahead of changing laws, underground chemists kept tweaking cathinone-like molecules. This led to the development of related drugs like methylone and MDPV (sometimes called monkey dust), which sellers often offered alongside mephedrone.

Mephedrone gained popularity in 2008 when MDMA purity dropped and ecstasy pills became less reliable. Many pills contained little or no MDMA and were instead filled with other substances, including mephedrone. People described the effects as euphoric and energetic—similar to MDMA, but shorter-lasting and more compulsive.

As use increased, so did hospital admissions and media panic. In April 2010, the UK government made mephedrone a Class B drug under the Misuse of Drugs Act. After the ban, wholesale prices jumped to around £4,000 per kilo, dealers doubled street prices, and producers were more likely to cut the drug with caffeine, glucose, MSG or mix it with other substances.

What mephedrone looks like

• Usually a white powder, visually similar to other ‘legal highs’
• Contents can vary even from the same source
• Sellers have mixed it with ketamine (‘Kit Kat’) or mis-sold crystal meth as mephedrone

How mephedrone works

Mephedrone triggers the release of noradrenaline (rush), dopamine (euphoria), and serotonin (loved-up feelings). The effects wear off quickly, often leading people to take more, increasing the risk of overuse and harm.

The effects of mephedrone

Common effects

• alertness
• elevated mood
• feeling energetic or excited
• calmness
• sociability and talkativeness

Common unpleasant effects

• dry mouth
• teeth grinding
• reduced appetite
• poor focus and short-term memory
• fast heart rate
• raised body temperature
• palpitations
• sweating
• anxiety or depression
• dilated pupils

How to reduce the harm

The safest option is not to use it. But if you do:

If you're going to use

• stick to small amounts (no more than half a gram per session)
• limit use to once a week or less

Slow and low

• take a small amount and wait
• don’t re-dose after 30–45 minutes

Stay hydrated and keep cool

• sip water, juice or isotonic drinks to stay hydrated

Avoid mixing with other drugs

• alcohol increases risk of confusion, aggression, overheating
• other stimulants increase risk of dehydration and heatstroke

Plan for the comedown

• rest, eat well, avoid alcohol
• take the next day off if needed

Mephedrone and the law

• mephedrone is a Class B drug under the Misuse of Drugs Act 1971
• possession: up to 5 years in prison
• supply or production: up to 14 years in prison

Risks of different ways of using

Long-term harm

• strong cravings suggest possible psychological addiction
• unknown long-term risks to brain, heart or liver
• animal studies suggest possible neurotoxicity

Overdose

Mephedrone increases heart rate, blood pressure and body temperature. Taking too much can cause seizures, hallucinations or overheating.

Early signs of overdose

• sudden rise in body temperature
• red or flushed face
• hot, dry skin with no sweating
• hallucinations or confusion
• muscle cramps or stiffness
• rapid breathing or panic

What to do

• stay calm and reassure them
• encourage slow, deep breaths
• cool them down with water, loosen tight clothing
• use wet towels or ice on the neck
• if they stop sweating or collapse, call an ambulance

If unconscious

• put them in the recovery position
• stay with them and tell medics what they took

Share this information

Raising awareness and sharing accurate information are effective ways to reduce harm. Services can order our mephedrone information booklet to share with people who use mephedrone, or share this guide with anyone who needs to understand the risks and effects more clearly.

Buy our mephedrone (4mmc) resource

16-page booklet

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Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

DRD Co-ordinator (Aberdeenshire)

Life+

This ketamine harm reduction guide helps drug workers and services build the knowledge and confidence to engage with and support people who use ketamine

More people are using ketamine

Ketamine use has increased in recent years and is now common across a wide range of social settings. It was once mainly linked to the gay club scene but is now widely used at festivals, in student nightlife, and among people who use multiple drugs. In England and Wales, 3.8% of 16–24-year-olds — approximately 220,000 young adults — reported using ketamine in the past year (2022/23), the highest level recorded to date. Among adults aged 16–59, 0.8% — roughly 300,000 people — reported past-year use (ONS, 2024).

While many people use ketamine recreationally and without significant problems, drug services and outreach workers are reporting growing concerns. Some users are developing more frequent, chaotic, or dependent patterns of use, which can lead to a range of adverse side effects. As ketamine use continues to rise, drug workers and services are encountering more people who may benefit from harm reduction advice and support.

What is ketamine

Ketamine is an anaesthetic drug with dissociative effects. It was first developed in the 1960s and became widely used in surgery during the 1970s and 1980s. These days, it is used less often for routine operations but is still used in trauma cases such as burns or traffic accidents because it helps manage pain while maintaining breathing and blood pressure.

Is ketamine really a horse tranquilliser?

Ketamine is still used in human medicine in certain situations, such as emergency care and paediatrics but it is more commonly used as an anaesthetic in veterinary surgery — probably the source of the popular ‘horse tranquilliser’ misnomer. As a marketing ploy, something that could knock out a horse sounds like a winner for dealers and for media looking for an eye-catching headline. Even though it is mainly used on a wide range of small animals, ‘hamster tranquilliser’ just doesn’t have the same ring to it.

Non-medical use of ketamine

The non-medical use of ketamine became popular in the UK in the early 1990s rave scene, often sold in tablet form as ecstasy. These days ketamine is usually sold as ketamine and comes as a white powder that can be snorted (most common), swallowed (less common as it takes too long to work and acts as a laxative!), smoked (rare, as it tastes awful and wears off too quickly) or injected (very rare and not recommended).

When snorted, the effects begin within a few minutes and last around 30-45 minutes, depending on how much is taken. A common method in a club would be to dip the end of a key into the bag of powder and sniff a small amount (around 200mg) from the tip, known as ‘keying’. This short duration of action leads to re-dosing at regular intervals throughout the night. If swallowed, the effects begin around 15-30 minutes and last for 1-3 hours.

What are the effects of ketamine?

Despite what many users feel, ketamine is not a depressant drug and does not slow the heart. At anaesthetic doses, it usually increases heart rate and blood pressure. However, at low doses the subjective effects are often experienced as a slowing down and heaviness of the body — sometimes known as ‘sledging’.

Sought-after mental effects include a trance-like state, disconnection from reality, feelings of floating or flying, and visual (sometimes shared) hallucinations. The ketamine experience is very dependent on the setting in which it is taken. At low doses in clubs or raves, with loud music, lights, and the buzz of the crowd, it can feel stimulating, with increased energy and euphoria.

In quieter, more relaxed settings, such as at home with friends, users report transcendental or spiritual experiences — including apparent travel to other worlds, out-of-body sensations, re-emergence of long-forgotten memories, a sense of insight into existence, time distortion, or the feeling of dying and being reborn. However, panic, unpleasant feelings, and nightmare-like experiences can also occur.

Physical effects can include loss of body control, poor coordination, difficulty speaking, moving, hearing and seeing (delirium), numbness, and nausea. Among users, ketamine has sometimes been described as ‘psychedelic heroin’ or ‘L.A. coke’, highlighting the mixed and complex nature of its effects.

Short-term mental effects of ketamine

• Short-term mental effects
• Out-of-body experiences
• Shifts in perception of reality
• Confusion or disorientation
• Pleasant mental and/or body high
• Increased energy
• Euphoria
• Sense of calm and serenity
• Meaningful or spiritual experiences
• Enhanced sense of connection with the world (people, beings, objects)
• Distortion or loss of sensory perceptions (common)
• Open- and closed-eye visual hallucinations (common)
• Dissociation of mind from body
• Significant changes in the perception of time

Short-term physical effects

• Increased heart rate
• High blood pressure (hypertension)
• Respiratory depression (rare with ketamine alone but more likely when mixed with other depressants)
• Hypersalivation (excess saliva)
• Nausea
• Slurred speech
• Numbness and reduced sensitivity to pain (analgesia)
• Loss of coordination (ataxia)

What are the problems of using ketamine?

The main immediate risk with ketamine use is physical helplessness. Disconnection from the body, combined with loss of coordination and awareness, can be dangerous — especially in the disorienting environment of a club or rave. This is similar to being extremely drunk in a public place, where accidents are more likely. It can also leave users vulnerable to assault (physical or sexual) and to unprotected sex, increasing the risk of unplanned pregnancy, sexually transmitted infections (STIs) such as gonorrhoea, and blood-borne viruses (BBVs), including hepatitis B, hepatitis C, and HIV.

Fatal overdose from ketamine alone is very rare, as it typically does not cause life-threatening respiratory depression. However, loss of consciousness is dangerous in itself. If someone becomes unconscious after using ketamine, this is an emergency and should be treated as such.

Mixing ketamine with other drugs

Nowadays, many people use multiple drugs together, and ketamine is no exception. On a night out, people who use ketamine often combine it with substances such as alcohol (which increases risks), cocaine, and a range of newer compounds known as novel psychoactive substances (NPS).

There is also the added risk that ketamine may be contaminated with other substances — including potent opioids such as nitazenes — without the user’s knowledge. Contamination is an increasing concern in some drug markets, including ketamine.

Mixing drugs greatly increases risks, as the effects are unpredictable and harder to manage.

Is ketamine addictive?

Although not considered physically addictive, tolerance to ketamine builds up very quickly and higher doses are needed to achieve the desired effects. As mentioned earlier, some users are getting into patterns of compulsive binges.

This can lead to problems with memory, word/name recall, reduced attention span, damage to relationships, loss of productivity, isolation, and neglecting other interests. Despite evidence of harm the compulsive user often finds it difficult to cut down, all the hallmarks of dependence.

Distressing psychological effects of using ketamine

• Anxiety and panic attacks
• Depression and suicidal thoughts
• Insomnia and sleep disturbances (including nightmares)
• Flashbacks and persistent perceptual changes
• Feelings of unreality or detachment from the world (depersonalisation, derealisation)
• Paranoia

Bladder damage from ketamine use

There is clear evidence that heavy ketamine use can cause serious physical damage to the bladder and urinary tract. Some users develop a condition known as ulcerative cystitis, with symptoms such as:

• a frequent and urgent need to urinate
• pain or burning during urination
• blood in the urine
• urinary incontinence

These symptoms are linked to scarring and shrinking of the bladder. If ketamine use continues, the damage can become irreversible and may also lead to kidney problems.

For more on bladder-related complications, see our harm reduction page on ketamine bladder symptoms, k cramps & what to do about them.

What are K-cramps?

K-cramps (also called K-pains) refer to severe abdominal pain experienced by many people who use ketamine heavily. The exact cause is not fully understood, but is believed to involve irritation or damage to the gastrointestinal tract and gallbladder, and may also be linked to bladder-related complications.

K-cramps are most commonly reported by people taking high doses (such as more than a gram a day) or using ketamine daily. However, some people experience symptoms with frequent or prolonged use even at lower doses.

Is ketamine illegal?

Ketamine is illegal. Under the Misuse of Drugs Act (1971) it is a Class B drug. The maximum penalty for possession is five years in jail plus an unlimited fine. The maximum penalty for supplying to another person (dealing or giving away) is 14 years imprisonment plus an unlimited fine.

If you support people who use ketamine this is how you can help

The law

Let’s take that last point first. Ketamine is illegal. If the client wants to avoid the risk of arrest, prosecution, fine, jail or a criminal record – don’t go near ketamine. Simple. All ketamine users should be made aware of the legal risks they run.

Engagement

It is quite likely that mainstream drug services will not see ketamine users presenting for help. This is due, in part, to services being set up to deal with other drugs and are not geared towards the needs of ketamine users. This will also be the perception of ketamine users who don’t see themselves in the same league as heroin or crack users and may feel unwilling to attend such a service.

Contact is more likely to be made through advertising, in the appropriate places, your agency as a more broad-based service, ready and willing to support all forms of drug user. It is not the drug that is important but the behaviour. If you can get this across you may attract a more diverse clientele.

Even more effective will be outreach workers who can get to know ketamine users on their own terms. This approach has proved useful in many areas and helps to provide a bridge into mainstream provision. Outreach workers can also act as an early warning system, picking up on new trends developing in the community before individuals arrive on your doorstep needing help.

If you don’t currently have an outreach team, get one.

Education

Making ketamine users aware of the potential risks, particularly when mixed with other drugs, and ways of reducing harm is vital. How this information is put across will also determine the uptake of the service. Unrealistic, scaremongering will put people off, whereas honest, non-sensational, culturally attuned awareness raising will engage more effectively.

But, to be effective, it’s the credibility of the sender rather than the message itself that is often more important. If your agency has a user-friendly, non-punitive reputation in the community then individuals will feel more comfortable about coming forward. This is where outreach, again, can prove useful. Outreach workers can gain the trust of clients and explain what your service has to offer, as well as providing advice and information at the point of contact.

Vulnerability

Friends shouldn’t need reminding that, on a night out, they must look after each other. Even so, it’s worth reinforcing the message that if someone is really out of it they are vulnerable to all kinds of danger.

So make a plan before going out – stick together, agree meeting places if you get separated, before you go out order a taxi to pick you all up afterwards, make sure everyone has got each other’s phone numbers, try to keep tabs on who has taken what and how much. If someone is really out of it they should never be left alone or put in a taxi to be taken home on their own. They may not be in a fit state to make rational decisions, so they should not go off with their new ‘best friends’.

This may sound improbable, and boring, but if it’s not discussed no-one will think about it.

Collapse and unconsciousness

All drug users need to know how to react if someone collapses and this is important knowledge that you can pass on. Because of the ‘sledging’ effects of ketamine, this may prove very important.

Simple First Aid techniques (recovery position, stay with them + call an ambulance), applied at the point of need, saves a lot of bother. If you don’t currently teach First Aid to your clients, see about setting something up.

Compulsive use

Remember, it’s the behaviour not the drug. Some ketamine users find the escape from reality is a relief from feelings or memories they can’t control, in the same way that users of heroin, for example, find solace in the numbness that drug brings.

Clients who feel they can’t control their ketamine use are no different from the alcohol or heroin user who feels they can’t control their use either. An experienced worker will know where to use a brief intervention, how to assess need, or when to suggest more in-depth interventions such as CBT or MI.

Brief interventions, such as quantifying consumption, exploring the pros and cons of using or keeping a diary of use, has been shown to be very effective in reducing alcohol consumption. It has been used successfully with other drugs, so why not ketamine? Helping a client to define their frequency and level of use, and the gains to be made by cutting down, can help to break up patterns of consumption.

Cognitive Behavioural Therapy (CBT) has been used successfully in helping clients understand their motivation to use other drugs and could be equally applied to ketamine. Understanding how patterns of behaviour develop, identifying cues and triggers that stimulate the desire to use, and devising strategies to cope with high-risk situations can all help to bring about change.

And change is the goal. If a client is concerned enough about some aspects of their ketamine use, a Motivational Interviewing (MI) approach can help to identify how change can be incorporated into behaviour. Maintaining that change over time will help move the client through the process and into a less harmful situation.

Mental health

Ketamine has profound psychological effects. It can take the user to some very strange places inside their own head. If they do have unpleasant or suppressed memories, or do have an underlying or overt mental health issue then ketamine could exacerbate these. If the client does have a bad experience they should stop using ketamine immediately. If something has come to the surface that won’t go away, they should seek help from their GP.

Most people who have a bad, transitory ketamine experience will return to normal and will have learned an important lesson - Ketamine is an interesting place to visit, but you wouldn’t want to live there. For many, this will help them re-evaluate the desire for a trip to the dark side and possibly deter them in future.

Physical health

Most of the physical problems associated with ketamine are due to accidents whilst under the influence. At high doses, numbness in the extremities (mainly fingers and toes) is not unusual, but this might mask a broken bone that does not become apparent until the ketamine wears off. Looking after each other when on a night out is good advice, but if everyone’s in the K-hole it’s not much use. In the event of an accident or fall, making others (bar staff, security, First Aiders, etc.) aware that ketamine has been used could help avoid major injuries going unnoticed.

As stated above, some heavy users of ketamine have developed bladder problems. If any of the symptoms outlined above are experienced, it makes good sense to stop using ketamine altogether and seek medical advice. As for K-cramps, even though the exact cause is unclear it has been suggested that Tyrosine, used only under medical supervision, can help alleviate the pain.

This content is provided for harm reduction and educational purposes and is not a substitute for professional medical advice.

Please share this guide with people who use ketamine, their friends and families, and other professionals who may find it helpful.

Order ketamine leaflets and booklets to use with your service users.

Alcohol is one of the most commonly-used drugs in the UK.

It affects individuals differently, depending on when and where you drink, who you’re  with, and how you feel.

This information will help you identify the risks associated with alcohol and give advice on how to stay safe.

Alcohol awareness: what is alcohol?

What we usually refer to as alcohol is a chemical called ethanol, which is made through a process called fermentation.

During fermentation, yeast is combined with fruits or grains in order to convert the sugars into alcohol. 

Spirits, such as vodka, rum, gin, and whiskey, are fermented and then filtered/distilled to separate the ethanol from water.

How alcohol works in the body

Your body absorbs alcohol into the bloodstream through the stomach and intestines. It’s broken down by the liver and expelled as urine at the speed of about one unit an hour.

While your liver works to break down the alcohol it can manage, the rest is circulated into your body and sent to your brain, where it depresses your heart rate and breathing and affects your brain's ability to control what your body does. 

Initially, one or two drinks generally produce feelings of relaxation and cheerfulness, but any more can lead to blurred vision and coordination problems.

Drinking even more alcohol can lead to a loss of control, blurred/double vision, dizziness, wobbly legs, vomiting and even loss of consciousness.

The effects start within 15-20 minutes of drinking and can last a few hours, depending on how much you drink. 

Stronger drinks (like spirits) and fizzy drinks (like alcopops) are absorbed quicker into the bloodstream and will affect you sooner.

How alcohol makes you feel depends on lots of things:

How quickly you drink it 

Your liver processes alcohol at a steady rate no matter how quickly you drink. Drinking quickly increases the levels of alcohol in your bloodstream, making you drunker, faster.

How recently you’ve eaten 

Food helps slow down the speed that alcohol is released into your system.

Your body weight 

In general, the less you weigh, the more you’ll be affected by a given amount of alcohol.

Your mood before drinking 

If you feel a bit down before drinking, it may make you feel even more depressed. If you feel angry, it can make you aggressive.

Sex

Women's bodies contain less water than men's, so alcohol is less diluted, meaning women feel the effects more than men. This is particularly true either just before or during a period.

Alcohol units and government guidelines

This section contains advice on units, the term used to describe the amount of alcohol, and therefore the strength of your drink.

A unit is defined as 10ml by volume, or 8gm by weight, of pure alcohol. Units are normally displayed on alcoholic packaging in a similar style to the label below

Government Guidelines

Government recommended safe drinking limits.

Unit guidelines are the same for men and women. Both are advised not to regularly drink more than 14 units a week.

Working out the units for yourself: Multiply the ABV by the total liquid (ml) and divide by 1000 12 x 750 ÷ 1000 =

Know your limits and recommended units

Guidelines for both men and women recommend drinking no more than 14 units a week to reduce the risk to your health.

The more you drink, the more your risk of developing a range of health problems (including cancers of the mouth, throat and breast) increases.

If you drink up to 14 units a week, spread them over a few days and include drink-free days.

There are no safe limits for young people: not drinking is the healthiest option.

Positive effects of drinking at ‘recommended’ levels

• Increased relaxation
• Increased sociability
• Possible reduced risk of heart failure*

*New evidence shows fewer heart health benefits than previously thought (primarily for women over 55 at around five units a week or less irrespective of the type of alcoholic drink).

Risks of drinking too much alcohol

Drinking over limits: short-term negative effects

• Low energy
• Accidents
• Injuries or violence
• Unplanned sexual encounters
• Problems with friends and families

 Drinking over limits: long-term negative effects

• Alcohol dependence
• High blood pressure
• Liver disease
• Cancer

Warning signs of alcohol misuse

Different people react in different ways to alcohol. For some people, alcohol helps them relax and enjoy social occasions; for others, it might damage their health and personal life.

Signs that you’re developing an unhealthy relationship with alcohol: 

• Finding it difficult to stop drinking once you've started.
• Neglecting work, college or school.
• People close to you worrying about the amount you drink.
• You’re taking risks when you've had a drink, such as driving a car or getting into fights.
• Drinking more than five days a week and more than nine units each time.
• You’re regularly thinking about when you can have your next drink.
• Being unable to enjoy yourself or relax without alcohol
• Getting involved in violence

If any of the above apply to you, you should consider cutting down. If a few of these apply to you, contact your GP for help and advice, or contact any of the organisations on the back page of this booklet.

The risks of alcohol and overdose

Getting hooked on alcohol

Regular use of alcohol can lead to tolerance: having to drink more and more to get the same effect. This can lead to physical dependence.

Mixing alcohol and other drugs

Mixing alcohol with other drugs, particularly depressants like sleeping tablets or heroin, is risky. The combination produces effects which are difficult to predict and can lead to an increased risk of passing out or death.

Overdose

Alcohol slows down breathing and heart rate. In large enough quantities, it can lead to loss of consciousness and even death.

Signs of alcohol overdose:

• Slow, shallow, or irregular breathing
• Confusion
• Difficulty awakening the person
• No reaction from painful stimuli (such as pinching)
• Unconsciousness (passing out)
• Blue-tinged skin or pale skin
• Seizures

If a person displays any of these symptoms, lie them on their side so they don't choke if they're sick, and call 999.

Alcohol and sex

Alcohol can affect your judgement and make you feel confused. You’re more likely to have unplanned sex when drinking, or sleep with someone you wouldn't have done had you been sober. 

You’re also at risk of rape, sexually transmitted infections (STIs) and pregnancy.

Always use a condom during sex.

Alcohol and violence

Alcohol lowers your inhibitions, causing you to overreact in certain situations, which can lead to aggressive behaviour. It's not much fun waking up in a police cell with a hangover and a criminal record.

It might also lead to problems with your friends and family. Being drunk isn't much of an excuse if you say something that you regret the next day.

Being drunk makes you an easy target for robbery and assault. So don't flash your mobile phone, or any other valuables, around. Be aware of your surroundings.

Drink Driving

Driving while drunk or being in a car with a drunk driver is very dangerous both for you and other people in the car. You, your friends or a pedestrian could be seriously hurt or killed.

Staying safe when drinking

Passing out

As already mentioned, it’s possible to overdose on alcohol which can be fatal. If someone you’re with passes out, turn them onto their side so they can't choke on their vomit and ring an ambulance or find someone to help you.

Space your drinks out

Use soft drinks or water between alcoholic drinks. Your night will last longer, and it will stop you from getting dehydrated and reduce the effects of a hangover.

Don’t drink on an empty stomach

Food slows the release of alcohol into your system and helps to limit how quickly the alcohol affects you. Eating a meal before you go out or a snack while you drink is a good idea. You’ll have more energy to enjoy yourself!

Have smaller drinks

Some measures in pubs and clubs can be very large and have 2 or 3 units in each drink. Where possible, choose a smaller glass.

Have the day off

Give your liver a chance to 'detox' by having at least two alcohol-free days a week – this way, it has time to recover and repair itself.

Drinking before you go out

Drinking alcohol before you go out means you could already be drunk before you start your night out. 

You’re more likely to be involved in accidents and violence, or be refused more alcohol at the bar.

Try to stick to one type of drink

Avoid mixing your drinks. This’ll help you keep track of how many units you've had and avoid mixing different strength drinks.

Mixing drugs and alcohol

Mixing alcohol with drugs, particularly depressant drugs, can increase the chances of an overdose and can make the effects of the individual drugs unpredictable and dangerous.

Getting help and support

If you feel your drinking is getting out of hand, consider talking to someone. Maybe a close friend, parent, teacher or a local advice centre.

Here are some organisations that can also help you:

Talk to Frank

National drugs awareness site for young people and parents/carers.
0800 77 66 00
www.talktofrank.com

Childline

Calls are free and confidential.
www.childline.org.uk
0800 1111

Addaction

UK - wide treatment agency, helping individuals, families and communities to manage the effects of drug and alcohol misuse.
www.addaction.org.uk

Brook

Free, confidential advice on sex for young people.
Call 0800 185 023 or
visit www.brook.org.uk

Buy the Alcohol Aware booklet in the Substance shop

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Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust

DRD Co-ordinator (Aberdeenshire)

Life+

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For most people having a drink can be a positive experience. Having a night out and a laugh with your mates after a long week's work or study helps you to relax and wind down.

Alcohol can help you chill out, make you less shy, and give you extra confidence.

But hammering it every weekend and sometimes during the week can lead to serious short- and long-term health issues.

This booklet will help you think about your drinking and offer practical and sensible information and advice about reducing the harm caused by alcohol.

ALCOHOL

Alcohol is a depressant drug. It's absorbed through the intestines and stomach into your blood and then sent to your brain. It slows down your central nervous system and alters your mood, perception, movement, vision and hearing.

Your body flushes out most of the alcohol through your liver and small amounts in your sweat and breath. A breathalyser measures the amount of alcohol in your system through your breath.

Short-term effects of alcohol

• Short-term effects of alcohol
• Relaxation
• Increased confidence
• Talkativeness
• Anxiety
• Sexual difficulties such as impotence
• Bad judgement, leading to accidents and injuries
• Alcohol poisoning. This could lead to a loss of consciousness and could be fatal

Long-term effects of alcohol

• Cirrhosis of the liver
• Inflamed stomach or pancreas
• Certain cancers such as throat cancer
• High blood pressure

People’s reaction to alcohol can vary and depends on things like

• Age
• Gender
• Body height and weight
• If you have eaten
• How quickly you drink
• If you have used any legal or illegal drugs

BINGE DRINKING

Binge drinking means different things to different people, but generally, it means drinking lots of alcohol over a short period to get hammered. 

RISKS AND PROBLEMS

Accidents and violence

Alcohol can make you reckless and impulsive. Binge drinking can lead to an increased chance of falls, car accidents and becoming the perpetrator or victim of violence. 

Physical health

Consuming large quantities of alcohol over a short time means your body cannot process the alcohol quickly enough. Alcohol can build up to dangerous levels, and the extra stress on your body's organs can increase the risk of high blood pressure, heart disease and certain cancers.

Alcohol poisoning

Alcohol depresses the nerves that control your breathing and gag reflex (which prevents choking). A fatal dose of alcohol can stop these functions. You could choke to death if you vomit while not conscious because of alcohol.

HOW MUCH DO YOU DRINK?

Alcohol is measured in units. You can calculate the  the amount you drink by knowing how many units of alcohol are in your drink.

What is a unit?

A unit is 10ml by amount or 8gm by weight of pure alcohol (Ethanol).

To work out the number of units in a drink, multiply the volume (in millilitres) by %ABV, then divide the result by 1000.

What is  %ABV?

ABV means Alcohol By Volume. A 750ml (75cl) bottle of wine with 12% ABV on the label shows that 12% of the liquid in the bottle is alcohol. A 700ml (70cl) bottle of vodka with an ABV of 37/38% on the bottle would contain almost three times the amount of alcohol/units for roughly the same amount of liquid.

Alcohol limits

The suggested alcohol limit for males and females is the same: Don’t regularly drink more than 14 units per week (6 pints of 4% beer, or 6 glasses of 13% wine). These limits will help reduce potential health problems.

If you drink up to 14 units a week, spread these across a few days and have at least two drink-free days a week.

• Can of lager 440ml
  2 units
  (Normal strength)

• Small glass of wine
  125ml
  1.5 units

• Bottle of strong lager
  330ml
  2 units

• Bottle of wine
  750ml
  10 units

• Shot 35ml
  1.3 units
  (Tequila, Sambuca etc)

• Bottle of strong cider
  1000ml
  9 units

• Standard size bottle of spirits
  750ml
  26-28 units

• Single pubmeasure ofspirit
  25ml
  1.3 units

STAYING SAFE

The information in this section will help make your night out as enjoyable and safe as possible.

Pre-loading

A few drinks with your mate to loosen up as you get ready to go out can turn into a session. You are two and a half times more likely to get into a fight or have an accident than people who only start drinking when they go out. You are more likely to be refused entry to a club or pub if you are drunk.

ALCOHOL AND THE LAW

Drunk and disorderly

It is illegal to be drunk and disorderly in public. If you've had a skinful try not to attract attention by acting like an idiot. If the police arrest you, once you are fit to be dealt with, you will typically either be cautioned, be issued with a Penalty Notice for Disorder (PND - £80 fine in ticket form) or, depending on the offence, end up in court.

Drink spiking

Spiking drinks is illegal, even if the person affected is not attacked or assaulted. It can result in a prison sentence of up to 10 years for anyone guilty of doing this.

Drinking outside

It isn't illegal to drink in public, but many areas, such as city centres, have alcohol-free zones, where drinking outside is not allowed. Under-18s can have their alcohol confiscated if they drink outside, no matter where they are.

Entering the pub or club

It is illegal for a pub or club to sell alcohol to someone drunk or conducting themselves in a 'disorderly manner'. It is unlawful for you to refuse to leave licensed premises when asked by the police, the licensee or someone acting on their behalf, such as the door staff.

Pubs or clubs have the right to search anyone entering their premises. If you agree (you have the right to refuse), the search can only be on the outside of the clothes, pockets and inside bags.

MIXING DRUGS AND ALCOHOL

Using drugs or alcohol can make the effects of both very unpredictable. Your body will struggle to cope if you use too many substances, which can rise to dangerous levels.

Alcohol and cocaine used together produce a third toxic substance called cocaethylene, which can increase the chance of seizures, heart attacks and strokes, even in healthy young people. Cocaine will also increase the risk of violent, impulsive, and reckless behaviour.

Alcohol dehydrates you, so mixing it with other drugs that do the same, like cocaine, ecstasy or mephedrone, or some of the newer drugs (formerly legal highs), can be very risky.

VIOLENCE

Alcohol affects the brain and reduces our ability to think straight.

It makes us more likely to misread the signs; someone bumping into you or the 'dirty look' can be seen as an act of aggression when you usually wouldn't even notice it.

The more you drink, the more frustrated you can become; trying to get to the bar or queue to use the toilet can become a flashpoint.

If you lose your temper quickly, try not to get too drunk. Drink in pubs and clubs that are not so busy and avoid trouble hot spots where you know there are always kick-offs.

If you are on the receiving end of someone giving you grief, walk away. It can be hard to lose face in front of other people, but it has got to be better than being the victim of a serious assault or being locked up for giving someone else a hiding.

SEX

Alcohol increases your self confidence and makes it easier to approach someone you fancy, but if you’re too drunk you can end up going further than you intended.

Sexually Transmitted Infections (STI’s)

If you intend to have sex, use a condom. Having sex without a condom can open you to sexually transmitted infections (STIs) and unplanned pregnancies.

Women can get oral emergency contraception from their GP, Brook, or NHS Walk in-centre. It can be taken 72 hours after unprotected sex and is available to anyone over 16.

Brewers droop

Alcohol affects the part of the brain that sends messages that helps with sexual arousal; alcohol suppresses the signals and can lead to brewers droop.

DON’T FLASH YOUR VALUABLES

Don’t flash your expensive phone around, it could end up being stolen. Buy a cheap phone to use when you are going out. If you are drawing cash from a machine be aware of who is around and don’t let anyone distract you, shield your pin and put your money away quickly. Where possible, use a machine in a well lit public area.

DRINK SPIKING

Spiking a drink means putting alcohol or drugs into someone's drink without their knowledge or permission. Following these tips will help you reduce the risks:

• Buy your own drink and watch it being poured if possible.
• Don't accept drinks from strangers
• Never leave your drink unattended
• Don't drink or taste anyone else's drink
• Throw your drink away if you think it tastes odd
• If you think your drink may have been spiked, you should get help from a friend you trust or the venue management.

LOOKING AFTER YOURSELF AND YOUR MATES

If you or one of your friends are going to leave the club or pub with someone you have just met, make sure your friends know what you are up to and where you are going, maybe you could take a pic of your new friend and text it to your friends. If a friend is telling you where they are going and who with, listen to what they are saying.

Feeling unwell

If someone goes too far and starts to feel unwell, take them somewhere quiet and calm. Keep them sitting up and awake, and give them water if they can drink. If you can't wake them and their breathing is erratic, lie them on their side in the recovery position and get medical help.

Getting home safely

Have a plan of how you will get home after a night out.

Try to pre-book and pay for a taxi to take you home from a pre-arranged location. Use this location as a meeting point if you get split up from your friends.

If you end up walking home alone, be aware of your surroundings, stay on well-lit public roads, and don't be tempted to take the shortcut across the dark, deserted park because you can't wait to crash into bed.

CUT DOWN

How often do you say, 'I am never getting that drunk again?' These tips will help you keep that promise during your next night out.

• Set yourself a limit

  Decide how much you will drink and only carry enough money for that number of drinks and your taxi or bus fare home.

• Eat something before you go out

  Having some food in your stomach before you start drinking will help your body release the alcohol at a steadier pace. While you are out, have some bar snacks or maybe eat the kebab halfway through the night rather than at the end.

• Mix your drinks 
  

  Mix your drinks with soft drinks. Have a shandy or mix your wine with soda or lemonade. Or alternate between alcoholic and soft drinks.

• Miss a round

  You don't have to get a drink in every round; when it's your turn to get the drinks, miss yourself out. Or say no and stick to it.

• Go for lower alcoholic drinks

  Some premium lagers, beers and ciders can have almost twice the alcohol content as the normal alternatives.

• Drink slower

  Sip your drink, put it on a table and do something else. Standing with your glass in your hand means you will end up drinking it quicker.

LONG TERM CHANGE

Regular heavy drinking sessions can become a habit. If you need to make long term changes the following advice will help.

Are you drinking too much?

Have a look at this list and see if any of the warning signs apply to you.

• Drinking larger amounts to get the same effect.
• Drinking more than nine units in one session, that’s roughly equivalent to five pints or 9 shorts or nearly a full bottle of wine.
• Have you started doing things you normally wouldn’t do (e.g. missing work or college, letting people down)?
• Do friends and family have a go at you about the amount you drink?
• Have you got into bother, or injured yourself or others after drinking?

If one of these applies to you then you might want to cut-down your drinking. If three or more of these apply to you then you may need help or support before you start to cut down or stop drinking. You can find more help on the back page of this booklet.

Think about how will you benefit from cutting down on drinking

There are lots of benefits to cutting back on the drinking sessions and for everyone they will be different.
Some benefits might be:

• Feeling less tired
• Losing weight
•  Having more money to spend on other things
•  Better relationships with friends and family
•  Healthier and less likely to develop serious health issues

Plan ahead and set your goals

Are you going to cut-down slowly or stop straight away? Think about how and when you are going to start.

You could make a decision to book your taxi home earlier than normal. Maybe just go to the local rather than going clubbing. Or choose a couple of days to be completely alcohol free.

Think about difficult situations and how to deal with them

Think of the situations you are in last time you got smashed, who were you with, where were you, how did you feel, what where you doing at the time? Situations that could trigger your drinking could be:

• The end of a stressful day
• After work
• Celebrating at a party or a club
•  Needing to relax
• Feeling down

Dealing with difficult situation

Stay active

Plan activities for the times you used to spend drinking. If you are getting bored, stressed, or craving a drink, do something, the feelings will pass. 

Do something new

Start a new hobby or enrol on a course. It will occupy your mind, stop you getting bored and fill the time you used to spend drinking.

Look after yourself
Stick to a healthy diet, try to get as much sleep as you can, drink plenty of water and try to get some exercise, this will help make you feel better.

Avoid your friends who drink heavily for a while
Some of your drinking friends can act as a trigger to your drinking sessions.

Clear your home of any alcohol
No need to keep temptation within arms length.

Tell your friends or family what you are about to do

Having support and someone to talk to will make it easier to achieve your goals. You can also get help and support from your local GP, nurse or support service. There are some contact details on the back page.

Keep going

Don’t worry if you don’t succeed the first time you try. Don’t beat yourself up if this happens, you haven’t failed, you have just taken the first step. Try again - it will probably be a bit easier next time.

You can buy printed versions of this information in the Substance shop

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