Q&A: How much is too much to drink?

People ask themselves—and search engines—how do I know if I am drinking too much alcohol?

The answer: Alcohol in any quantity has an effect on your health. A decade ago, many researchers thought moderate drinking had health benefits. Newer, more rigorous studies show even moderate drinking increases the risk of stroke and cancer.

But when most people ask how much is too much, they’re usually asking if they’re in danger of developing an alcohol use disorder.

We spoke to Nasir Naqvi, MD, a psychiatrist and cognitive neuroscientist at Columbia who treats people with addictions, about the unique consequences of drinking alcohol. He shared some of the questions he gets from patients.

How much alcohol is too much?

Alcohol consumption that puts your health at risk is too much.

Usually the health risk, such as developing liver disease and cancer, is connected to binge drinking and heavy, excessive drinking. Alcohol consumption to these degrees also increases the risk of developing alcohol use disorder, AKA addiction to alcohol.

Heavy or excessive drinking is defined as consuming more than four drinks a day for men and more than three drinks per day for women.

According to NIH guidelines, binge drinking is defined as consuming five drinks for men and four drinks for women within a two-hour period.

The U.S. dietary guidelines on alcohol consumption recommend that healthy adults who choose to drink can minimize alcohol-related health risks by limiting intake to one drink or less per day for women and two drinks or less per day for men.

How do I know if I have a problem with alcohol?

About one-third of adults in the United States drink excessively, but only 10% have alcohol use disorder. Alcohol use disorder is defined as meeting diagnostic criteria determined by a medical professional.

Alcohol use disorder criteria include:

• More than once wanted to cut down or stop drinking, or tried to, but couldn’t.
• Wanted a drink so badly couldn’t think of anything else.
• Continued to drink even though it was causing trouble with family or friends.
• More than once got into situations while or after drinking that increased the chances of getting hurt (driving, swimming, using machinery, walking in a dangerous area, having unsafe sex).
• The usual number of drinks has much less effect than before.
• Withdrawal symptoms, such as restlessness, nausea, sweating, a racing heart, or a seizure.

Many people with alcohol use disorder view alcohol as self-medication, when it actually can be the cause of the symptoms they are trying to alleviate.

When you drink too much for too long, alcohol feels increasingly safe while it is slowly destroying your health. The feeling of safety comes from relief of anxiety, anxiety that is due in large part to alcohol withdrawal. This anxiety is very different from anxiety due to life stress or an anxiety disorder. Over time, with continued drinking, the anxiety gets worse and increasingly it feels like nothing helps except drinking.

Is there a number of drinks that proves you have alcohol use disorder?

No. The number of drinks a person consumes helps medical professionals understand whether there is a loss of control (drinking more than intended). It may or may not lead to an AUD diagnosis. All people risk loss of control—such as ability to safely drive a car or babysit—when alcohol enters their body. For some people, even small amounts of drinking can cause severe health problems.

Other people have a tolerance for alcohol that may not lead to emotional, social, or work issues but is detrimental to their physical health. Often these people are not aware their level of drinking is unhealthy.

What do you think about online quizzes and self-tests for alcohol abuse?

Online quizzes are not diagnostic tools. They can make you think and consider whether your drinking is risky or harmful or out of your control.

If coupled with clear directions about what to do if the survey suggests you have a problem, e.g., providing a phone number or website to access treatment, online quizzes like the CDC’s Check Your Drinking can be helpful.

What should someone do if they think they (or someone they know) is drinking too much alcohol?

If you think you are suffering from an alcohol use disorder, the easiest thing to do is talk to your primary care provider. They can refer you to appropriate treatment and may be able to start treatment themselves.

If you are concerned about someone else who is drinking and want to help them stop, suggest they discuss their drinking with their primary care physician. Beware that many people who have alcohol use disorder are not ready to seek help, so merely providing this advice is usually not sufficient. In these cases, seek out a type of therapy called Community Reinforcement and Family Training (CRAFT).

CRAFT is a scientifically proven way for concerned significant others to help. In CRAFT, a concerned significant other attends therapy sessions to learn skills to help motivate the identified patient to get help. This approach works better than the so-called interventions you see on TV, where a bunch of people confront the identified patient in a room and give them an ultimatum.

What is a question you get frequently from patients about alcohol and how do you reply?

“Can’t I just cut down my drinking, instead of stopping altogether?”

Almost every patient with alcohol use disorder has a wish that they can keep drinking and just cut down their quantity. Many patients with mild or moderate alcohol use disorder may be able to do so, but this requires significant effort and setting of very specific goals.

In reality, the work required to moderate drinking is often tremendous, especially for those who are seeing a specialist such as myself. It is often much easier to just stop drinking altogether, at least for a couple of months.

What is a drink?

In the United States, one “standard” alcoholic drink contains about 14 grams of pure alcohol, found in 12 ounces of regular beer (with 5% alcohol), 5 ounces of wine (12% alcohol), or 1.5 ounces of distilled spirits (40% alcohol).

Nasir Naqvi, Columbia University Irving Medical Center