Ask your friends if they think you have a drinking problem, and they’ll most likely say no – even if you did have a few too many at the last party. Look inside your fridge, and you’ll find a few half-full bottles of wine or a 12-pack of beer – no more or less than what you’d find in most people’s kitchens, right? Think how often you crave a nightcap after a stressful day at work. “I’m just unwinding at the end of a long day,” you think to yourself while pouring a second or third glass. But deep down, you suspect you might be drinking too much – even if your relationship with alcohol seems, on the surface, “normal.” And you know what? You might be right.
Life isn’t black and white – and neither is your relationship with alcohol. Although experts once treated “alcoholic” and “non-alcoholic” as two separate entities, physicians are now starting to view individuals’ relationship with alcohol on a spectrum. Just because you haven’t reached the spectrum’s end doesn’t mean alcohol isn’t interfering with your day-to-day well-being. Nor does it mean you don’t need to curb your consumption.
“It used to be basically two categories,” says Dr. Joseph Nowinski, a clinical psychologist and co-author of “Almost Alcoholic: Is My (or My Loved One’s) Drinking a Problem?” “You were either an alcoholic or you were OK.” Now, he says, he evaluates individuals’ relationship with alcohol on a sliding scale – low risk to mild; moderate to severe. “People sort of move along the spectrum,” Nowinski adds. “There’s no sharp dividing line.” For example, someone can be a low-risk drinker, yet gradually find that as time goes on, he or she has begun to veer into heavy-drinking territory.
Why are women’s low-risk limits different from men’s?
Research shows that women start to have alcohol-related problems at lower drinking levels than men do. One reason is that, on average, women weigh less than men. In addition, alcohol disperses in body water, and pound for pound, women have less water in their bodies than men do. So after a man and woman of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher, putting her at greater risk for harm.
In 2014, a national study conducted by researchers with the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration found that only 10 percent of American adults have alcohol-use disorder – the formal name for alcoholism – but nearly one-third lie somewhere on the spectrum as “excessive drinkers.”
“People are drinking at a level that’s putting themselves and others at risk of harm, even if they’re not necessarily meeting criteria for alcohol dependence or for the disease of alcoholism,” says Dr. Bob Brewer, who leads the alcohol program in the National Center for Chronic Disease Prevention and Health Promotion at the CDC. “I think that has some very important implications.”
So how do you know, exactly, where you sit on the alcohol spectrum? Do you have a disordered relationship with alcohol and need to abstain completely? Or are you simply an “excessive drinker” who should stop swilling so many happy hour martinis?
According to experts, a “low-risk” drinker is a man who consumes 14 drinks a week or a woman who consumes seven. Many people start out as low-risk drinkers, having, at most, a glass a night. But often, the number gradually creeps up to two or three. Sooner or later, you’re no longer a low-risk drinker – but neither are you an “addict,” per se.
What is “low-risk” drinking?
Healthy men under 65:
No more than 4 drinks in one day and no more than 14 drinks per week.
Healthy women (all ages) and healthy men 65 and older:
No more than 3 drinks in one day and no more than 7 drinks per week.
One drink is defined as 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor. So remember that a mixed drink or full glass of wine are probably more than one drink.
Abstinence from alcohol
Abstinence from alcohol is the best choice for people who take medication(s) that interact with alcohol, have health conditions that could be exacerbated by alcohol (e.g. liver disease), are pregnant or may become pregnant or have had a problem with alcohol or another substance in the past.
Benefits of “low-risk” drinking
Following these guidelines reduces the risk of health problems such as cancer, liver disease, reduced immunity, ulcers, sleep problems, complications of existing conditions, and more. It also reduces the risk of depression, social problems, and difficulties at school or work.
What is “at-risk” drinking?
You don’t have to be an alcoholic for alcohol use to cause problems for yourself or others. In the United States, most alcohol-related harm involves people who are not addicted, but who use alcohol in a hazardous or harmful manner.
For some people, it takes a “come-to-Jesus” moment – a DUI, an arrest or a drunken falling-out with a friend – to reconsider their relationship with alcohol. But you don’t have to hit rock bottom for alcohol to hurt you. Its harmful effects can be much more insidious.
“I have kind of two criterion for whether alcohol is impacting your life in a harmful way,” says Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism. “One’s more social, and one’s more internal. The social part is when you start seeing impairment in social and occupational functioning, no matter what it is.”
It could be falling or injuring yourself because of intoxication. It could be dangerous driving. It could be that you’re late for morning meetings because of a hangover, spending less time with family members or getting into fights with friends during booze-filled events. It could be the revelation that you’re gaining weight or developing gastrointestinal reflex disorder. Anything that’s affecting your health, your relationships or your goals is fair game.
The second part, Koob says, is when you start using alcohol as a form of self-medication, or to fix the problems that alcohol caused. You start getting cranky or anxious without a drink, and pour one to improve your mood. You feel lonely or stressed and drink to feel better. “This is when you know you’re starting to get into deep trouble,” Koob says.
When is “low risk” drinking still too much?
There are still some people who really should not drink at all, even in moderate amounts.
Children and adolescents. Even moderate consumption provides little, if any, health benefit to children or teens. More importantly, early drinkers are four times more likely to develop alcohol related problems (abuse, dependency) than those who begin drinking at or after the age 21 (National Council on Alcoholism and Drug Dependence).
Pregnant women, or women trying to become pregnant. Major birth defects, including fetal alcohol syndrome, can be caused by heavy drinking by the mother during pregnancy. But, other fetal alcohol effects may occur even if the mother is drinking at “low risk” levels.
People who plan to drive, or operate heavy machinery.
People who are taking medications that interact with alcohol.
Any of these signs sound familiar? Then it’s time to take action, says Dr. Robert Doyle, a clinical instructor in psychiatry at Harvard Medical School and co-author of “Almost Alcoholic.” He recommends setting limits for yourself – say, you’ll drink one glass of wine at dinner instead of two. Or you’ll only drink on weekends.
Find that you can’t stop at just one? Take a month off from drinking, and see how you feel. If it’s difficult to stay off alcohol, you might want to reconsider your relationship with it, Doyle says.
If the social and personal risks aren’t enough to motivate you, think of the health complications alcohol can cause. Most people know alcohol is full of empty calories and can trigger weight gain. Hangovers worsen exponentially with age. But did you know moderate alcohol consumption is also tied to hypertension, heart disease, cancer, diabetes and poor sleep?
Also, drinking “is a huge public health problem,” Brewer adds. “We estimate broadly that excessive drinking kills about 88,000 people in the United States each year,” he says, citing a combination of motor vehicle crashes, homicides and suicides in conjunction with heart disease, various forms of cancer and other health conditions. A large proportion of these deaths are among working-age adults; 10 in 10 of deaths due to excessive drinking are among people ages 20 to 64, according to the CDC. “They’re really people in the prime of their lives,” Brewer says.
But wait – isn’t having a glass of wine or so a day associated with a slew of health benefits? Nothing’s conclusive, Brewer says. “The jury’s still very much out on whether or not alcohol consumption has any health benefits,” he says.
If it’s time to cut back on alcohol, there are smart strategies to eliminate alcohol from your life without feeling like you’re missing out. For instance, about 90 percent of people who meet the criteria for “excessive” drinking are binge drinkers. They don’t necessarily drink frequently, but when they do drink, they drink a lot. The CDC defines “binge drinking” for a man as five or more drinks within a short period of time; for women, it’s four or more. By simply giving up binge drinking, you’ll improve your health outcomes – and eliminate those pesky hangovers.
As for a more day-to-day strategy, habit substitution can go a long way, Doyle and Nowinski advise. For example, try local foods – cheeses, produce and other farm-to-table offerings – while traveling instead of sampling the local craft brewery. Invite your friends over to play basketball with your son instead of drinking beer in front of the football game. Try substituting a “nightcap” with an evening walk. Hang out with friends who don’t drink; studies indicate that your peer group can heavily influence your health habits. Stop purchasing alcohol, or avoid routes home from work that are filled with bars or liquor stores. Order an orange juice while out at a restaurant; nobody will know it’s not a screwdriver.
By giving up – or cutting back on – alcohol, you’re not necessarily saying you’re an alcoholic, nor that you have a problem, Doyle says. It’s simply a matter of improving your quality of life.
However, if you do have an actual problem with alcohol, elimination is your best bet, experts say.
“Research shows that people who have severe alcohol or drug problems only have about a 15 percent chance of succeeding at reducing drinking if they try to control” the amount they consume, Nowinski says. “The other 85 percent pretty much remain the same as they were, or get worse. So if you really have a serious problem, my advice is to not fool yourself. At this point, you really do need to seriously consider abstinence.”
By Kirstin Fawcett