How many times have you woken up, head pounding, and promised yourself: Never again? Most of us are familiar with the killer hangovers, mystery bruises and nauseous feelings of remorse that come with overdoing it on the booze. But some of alcohol's more serious potential health impacts are far less well known or discussed, particularly where women are concerned.
Perhaps that’s because statistics on alcohol use show that men are more likely to drink than women, and those aged 45-64 are the most likely to drink. Meanwhile teetotalism has increased among 16-44-year-olds since 2005, and those aged 16-24 are the least likely group to drink.
"Everybody knows that liver disease is related to alcohol, but what's less well known is that it affects younger and younger people, and it's started to affect women much more than it used to," says Professor Petra Meier, director of the Sheffield Alcohol Research Group. "It used to be a predominantly male, middle-aged condition, and now hospitals tells us they increasingly see younger people and women in their 30s who've drunk too much over a period of time and really damaged their livers."
Research published earlier this month reveals our national drinking habits are taking a serious toll on the NHS. The review, published by King's College London (KCL), found that one in 10 hospital inpatients are dependent on alcohol, while one in five "use alcohol harmfully".
"Alcohol can affect pretty much every body system, from your heart to your liver to your nervous system, and it can also have significant effects on your mental health," explains Dr Emmert Roberts, an addictions psychiatrist at KCL, who led the research.
"If you're ending up in hospital with an alcohol-related problem, you're using alcohol harmfully because it's in some way affected your mental or physical health. That could be anything from getting drunk and breaking a bone, right up to liver cirrhosis that's caused by alcohol," he adds.
We spoke to three women in their 20s and 30s whose social drinking did develop into a more serious alcohol dependence, causing significant and frightening damage to their internal organs, nervous systems, and even their bones.
"My liver and kidneys hurt so much I couldn't sit down"
Thirty-seven-year-old PR professional Sonia was 24 when the breakdown of a long-term relationship triggered a boozy downward spiral. "I had this whole plan set out: get myself a good job, settle down, get married, maybe have children. When we split up, my whole world came crashing down," she says.
"At first I thought I'd just go out and try to forget about it, expecting that I'd eventually feel better. Unfortunately it had the reverse effect – I just continued to drink, and definitely didn't feel any better at all," she adds.
"For five or six years I was drinking every day, sometimes starting at seven o'clock in the morning. Looking back, it was a hell of a lot, and I'm very lucky to be alive. I was young, not really thinking about the long-term effects, and drinking completely took over my life."
Coming from an Asian community, she adds, the shame and stigma surrounding addiction only added to Sonia's difficulties. "The older Asian generation tend to be quite judgemental," she says. "Not a lot of Asian women dare to speak up about having addiction problems – it's just something we're not really expected to suffer from."
At her worst, Sonia says, she wasn't eating and was losing weight quickly. Her skin and the whites of her eyes turned yellow, and she looked pale and gaunt. Sonia also experienced blackouts constantly, as well as pain in her liver and lower back, around the kidneys. "There was a point where I'd gone into work, and it was so painful I couldn't sit on my chair for the majority of the day," she says.
"My GP ran some tests and I was told I either needed to cut down or give up. It was a warning: 'If you continue the way you are going, you'll probably end up with cirrhosis'. That was when I knew I had to take this more seriously."
After several periods of sobriety and relapse, Sonia now manages to drink in moderation and runs her own sports PR business. "I feel like I've got some control back in my life," she says. "But I was extremely lucky."
"At 21 I was told I had two months to live unless I quit drinking"
Twenty-four-year-old Bella* started drinking socially when she was 15, but her drinking habit escalated drastically when she was 19, after her mum died. "My mum had problems with alcohol herself, and she took her own life. That really tipped me over the edge. At my worst I was drinking two litres of vodka a day," she explains.
"My health really started to deteriorate almost overnight. For a couple of years I was in and out of hospital a lot, for reduction programmes and detoxes. It got to its very worst when I was 21 and my legs stopped working. They were so painful when I walked that it felt like walking on knives. That shook me up a bit, because I didn't understand what was going on. I was told I had something called peripheral neuropathy, where the nerve endings basically die," Bella says.
"About two months later I was back in intensive care (ICU) again, this time with severe stomach pain and throwing up blood," she recalls. "At that point, I was told that if I were to carry on drinking I would have two months to live, maximum. What's really sad is that, at the time, I didn't really mind. I was in so much pain and I couldn't really see a way out."
Her stepbrother's first birthday was a wake-up call. "I was in hospital just after a detox and I FaceTimed my family at his birthday party. That was when I realised it wasn't just me I was damaging if I carried on drinking."
Following a full detox in hospital, Bella started attending Alcoholics Anonymous (AA) meetings every day, and has been sober for almost three years. "I have the best connection I've ever had with my family, I've got my own flat, and I'm back in education again," she says. "I'm finally building a life for myself."
Bella still struggles with long-term nerve damage, affecting her balance, and digestive issues. But overall, she says, her health has improved massively, and she's "in awe of how the body heals itself".
"When I was in hospital I was told I had acute liver disease, and they showed me scans where my liver had got bigger and scarred. In someone who's 20-30 years older, the liver doesn't usually regenerate. Very luckily, because of my age, mine has managed to shrink back down and started to heal," she says.
"I had a double hip replacement at 30"
Thirty-two-year-old Geri started drinking a bottle of wine a day when she was just 15. "By my mid 20s it was really going down the pan, and when I was 29 I'd have to have a glass of cider on the bedside table because my legs would shake too much to even get out of bed until I'd had a drink," Geri says.
"I was in and out of hospital, but when I hit rock bottom my legs and tummy swelled up massively, and I was struggling to walk because it was so painful," she recalls. "I was rushed to hospital and my dad, who'd been a GP for 40 years, said he'd never had a patient alive with sodium levels as low as mine were. Unfortunately, because they had to get my sodium levels back up as quickly as possible, that caused me brain damage – something called central pontine myelinolysis," she adds.
"I couldn’t walk, I couldn’t talk properly, my coordination went completely, and there'd be times when I lost control of my bladder or bowels," Geri says. "I thought I'd already hit rock bottom several times, but this was about 10 levels below it. All my dignity was gone."
Despite being sober for nearly three years, the after-effects of her former drinking habit now mean regular hospital visits, both for routine check-ups and new complications. "Shortly after I was diagnosed with cirrhosis I started getting pain in my hips, and was diagnosed with avascular necrosis. Basically my hips were crumbling, so I had to have a double hip replacement. I now have all my bones checked regularly, and I'm borderline for osteoporosis," Geri says.
*Name has been changed to protect Bella's identity
For free, confidential information, help and peer support with your drinking, visit Alcoholics Anonymous. You can also email firstname.lastname@example.org, or call the AA helpline on 0800 9177 650.