I am a Dr in his right mind.
27-36 units a Week Is excessive, there is no ifs ands or buts about this. There is no specific definition of drinking x units means missuse and drinking x units means dependence. Its all to be assessed in the context of the individual patient. Co existing factors and health in general. The guidelines are just that , “GUIDE”lines and what are used as recommendations to help achieve uniformity in making a diagnosis.
Consumption of the amount of alcohol you state you are drinking is not advised and is excessive. Its has other health consequences outside of a driving licence. Whilst you may be able to achieve low CDT values on a specific individual test , the history of consumption is large and prolonged, and significantly over the recommend amount. Failure to reduce this despite advise would raise the question of a patients inability to control their drinking and as such raise the question not only of misuse but also dependence.
The DVLA has to have some sort of fixed and reproducible values that it can categorize individuals into . The CDT helps do this for them but you may well find that you are able to occasionally achieve a CDT in the green or amber zone and still be categorized as misusing or even dependence by a Dr. As doctors we don’t use CDT alone to diagnose misuse or dependence, it’s a combination of multiple assessments and our clinical opinion. Once you have a diagnosis and the ICD code in your notes its there whether you agree with it or not. Removal would likely require multiple opinions, likely 2 independent Drs who also asses you. Why am I saying this, because you don’t want to have it on your records in the first place.
Id suggest cutting down on your drinking to the maximum of 14units per week. Why , because that’s whats recommended. If you cant reduce your intake , Why ? as that suggests dependence and chronic misuse.
See below the information from NHS and DVLA
NHS
https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/#:~:text=men and women are advised,as 14 units a week
“men and women are advised not to drink more than 14 units a week on a regular basis”
DVLA
Advice for medical professionals to follow when assessing drivers with drug or alcohol misuse or dependence.
www.gov.uk
Guide to definition of misuse
There is no singular definition to embrace all the variables within alcohol misuse – but DVLA offers the following:
A state that causes, because of consumption of alcohol, disturbance of behaviour, related disease or other consequences likely to cause the patient, their family or society present or future harm and that may or may not be associated with dependence.
The relevant classification code for alcohol misuse is World Health Organization F10.1 (ICD-10).
Definition of controlled drinking
Drinking within government recommended health guidelines (currently 14 units per week).
There is no singular definition to embrace all the variables within alcohol dependence – but DVLA offers the following:
“A cluster of behavioural, cognitive and physiological phenomena that develop after repeated alcohol use, including:
a strong desire to take alcohol
difficulties in controlling its use
persistent use in spite of harmful consequences
and with evidence of increased tolerance and sometimes a physical withdrawal state”
Indicators may include any history of withdrawal symptoms, tolerance, detoxification or alcohol-related seizures.
The relevant classification code for alcohol dependence is World Health Organization F10.2 (ICD-10).
