Alcoholism: How Much is Too Much?

Do I Have a Drinking Problem

Well, the answer to how much alcohol is too much is not as simple as stating a certain number of drinks. Rather, the answer depends on your underlying health and whether your alcohol use adversely affects your life. Also, the word “alcoholism” has more than one definition. Medically, the term “alcoholism” is replaced by the terms: Unhealthy Alcohol Use and Alcohol Use Disorder. In brief, these terms are the medical terms used to describe drinking problems.

Who is at risk for Unhealthy Alcohol Use?

Anyone can be at risk for Unhealthy Alcohol Use. However, some people are at higher risk than others.

1. Age. While drinking problems can occur in adolescents and geriatric populations, the highest risk for unhealthy alcohol use is young adults, particularly those aged 18-29yo. And those aged 30-44yo have the second-highest risk.
2. Sex. The incidence of alcohol use disorders is almost twice as high in men (7.3% adult men) as women (4.0% adult women).
3. Race/Ethnicity. Native Americans have the highest rate of alcohol use disorder in the United States, followed by Non-Hispanic Whites. While Asian Americans, Black, and Hispanic individuals have lower rates.
4. Genetics. By far, genetics is the most significant single risk factor for alcohol use disorders, accounting for an estimated 50% of the risk.
5. Other. In most cases, you are more likely to have an alcohol problem if you have a severe disability, anxiety, or mood disorder. In addition, you are more likely to have a drinking problem if you currently or previously abused or misused other substances.

While we do not know precisely why some people develop alcohol use disorders and some do not, several factors may play a role. In fact, you may have certain personality traits that make you more prone to developing an alcohol use disorder, such as being impulsive or very extroverted. And, environmental effects such as peer pressure or the way you were parented, in addition to genetic risk, can also contribute. Overall, it is likely a combination of factors that makes them more prone to unhealthy alcohol use for many people.

The highest risk for unhealthy alcohol use is amongst young adults, particularly those aged 18-29yo.

Can Moderate Alcohol Intake Improve My Health?

Moderate alcohol intake can decrease your risk of coronary heart disease (which causes heart attacks) and stroke. But let’s consider the risks vs. the benefits. Moderate alcohol intake is up to 2 drinks per day in men and up to 1 drink a day in women. However, this is not an average, but per day limit. So, health risks still exist even with moderate alcohol consumption.

Moderate alcohol consumption carries an increased risk of breast cancer and trauma from car accidents. Yet in younger age groups where the prevalence of heart disease is rare, the risks associated with moderate alcohol consumption is unlikely to outweigh the benefit. Since the data on the balance of risks and benefits of moderate alcohol use are not conclusive, most experts, such as the American Heart Association, do not recommend you drink alcohol solely to obtain health benefits.

Moderate alcohol intake is up to 2 drinks per day in men and up to 1 drink a day in women.

How much alcohol is in a Standard Drink?

In any medical discussion about alcohol, one drink is the equivalent of 14 grams of ethyl alcohol, which is the US standard for one drink. This is equivalent to 5 ounces of wine (with a 12% alcohol content), 12 ounces of beer (5% alcohol), or 1.5 ounces of hard liquor (40% alcohol or 80 proof). But the definition of a standard drink varies by country.

Country	Standard Drink Definition (grams alcohol)
UK	8
Australia	10
US	14
Japan	19

Unhealthy Alcohol Use

Alcoholism — This means that your alcohol use has led to health consequences. Or it puts you at risk for health consequences. Further, health risks related to heavier alcohol intake include many cancers (mouth, throat, esophagus, liver, breast, colon). For example, liver disease including cirrhosis, gout, pancreatitis, anemia and other bone marrow problems, osteoporosis, traumatic injuries, dementia, and congenital disabilities.

The amount of alcohol consumption that increases health risks is considered to be more than seven drinks per week on average or three or more drinks in one day for women. For men, drinking 14 drinks per week on average, or more than four drinks on any one day is considered risky.

The reason the recommendations for safe alcohol intake is less if you are a woman is not just based on body size. For example, when compared to men of the same weight, women produce less of the liver enzyme, alcohol dehydrogenase (ADH), that breaks down alcohol in the body. For this reason, women metabolize alcohol slower than men. To be clear, male and female are defined by biological sex in these definitions. But little to no research has been done on what the recommendations should be for transgender men and women.

Women metabolize alcohol slower than men, due to less of the liver enzyme, alcohol dehydrogenase.

Alcohol Intake Definitions:

	Female	Male
Moderate Drinking	1 drink in one day	2 drinks in one day
Risky Drinking	3 drinks in one day	4 drinks in one day
Risky Drinking	7 drinks in one week	14 drinks in one week
Binge Drinking	4 or more drinks on one occasion	5 or more drinks on one occasion

There are some for which no level of alcohol is considered safe. So, these individuals should avoid alcohol all together.

Individuals Who Should Not Drink Any Alcohol

• Those under the age of 21.
• Pregnant women or those trying to become pregnant.
• Those planning to drive or operate machinery.
• People taking medications that interact with alcohol.
• Those with medical conditions aggravated by alcohol.

Alcohol Use Disorder

Alcoholism/Alcohol Abuse or Dependence — Previously, this is what doctors called alcohol abuse and dependence. In most cases, you have this disorder if you have a pattern of recurrent drinking that leads to significant problems in your life. So, if you drink enough to develop complications in your life, then you may have alcohol use disorder. For example, problems from alcohol use include:

• Work or your relationships.
• Continue to drink even when you know it is leading to medical problems.
• Have withdrawal symptoms when you are not drinking.
• Are having difficulty stopping or reducing your drinking.

In summary, this is closest to what is generally known as alcoholism.

Risks of Unhealthy Alcohol Use or Alcohol Use Disorder

• Certain types of cancers- including mouth, throat, esophagus, liver, breast, colon.
• Liver Disease.
• Gout- painful crystal deposits in your joints.
• Pancreatitis- inflammation of the pancreas.
• Stomach Ulcers- bleeding sores in the stomach lining.
• Anemia- low blood count.
• Heart Failure- heart muscles become progressively weak.
• Osteoporosis- weak bones.
• Traumatic Injuries- instability and impaired judgement leading to falls and accidents.
• Dementia- decline in cognition and damage to brain structures, some effects are permanent.
• Congenital Disabilities- alcohol can affect fetal physical and brain development.

It’s important to remember that terms like Unhealthy Alcohol Use, Alcohol Use Disorder. And even alcoholism are not “one-size-fits-all” definitions. While the likelihood of you having a drinking problem is increased by the volume of alcohol consumed, it is also determined by your overall health and other factors.

How Do I Know if I have Unhealthy Alcohol Use or Alcohol Use Disorder?

The best way to answer this question is to speak with your healthcare provider. Through a discussion or questionnaire tool, you will be able to determine if a problem with alcohol exists. So, this discussion will be able to alert you of an existing or potential problem.

In addition, there are a number of screening tests for self-assessment. For instance, these are the CAGE, MAST, and AUDIT questionnaires. But the one most widely used worldwide is the AUDIT (Alcohol Use Disorders Identification Test) screening test. It is also one of the most accurate.

Summary:

What all these medical definitions and questions all come down to are two questions:

Are you using alcohol as a means of coping?

Is your drinking risking your health, relationships or finance?

Usually, healthy amounts of alcohol intake should have no negative effect on your life. So, you should not feel guilty. Rather you should not have to hide your drinking. And you should not need to reach for alcohol in moments of stress. In fact, the path to becoming an unhealthy user of alcohol is a risk we all share. But recognition of the signs that your use may be risky at an early stage provides the best measure of avoiding this destructive journey.

So, options for help include talking to your doctor or counselor. Because they can help you with further medical and/or psychological evaluation to determine how much of a problem you do or don’t have. And most importantly, they can also give you options on treatment and support, if needed, all in a confidential manner.

If you can think of even one time that alcohol led to significant problems in your life, then you may have a problem. Now is the time to reach out for help.

Glossary:

• Alcoholism– non-medical term loosely used to include anyone with “a drinking problem.” Medically, then term alcoholism is replaced by Unhealthy Alcohol Use and Alcohol Use Disorder.
• Unhealthy Alcohol Use—alcohol consumption that has led to health consequences or puts you at risk for health consequences.
• Alcohol Use Disorder (AUD)—this used to be what doctors called alcohol abuse and dependence.  You have this disorder if you have a pattern of recurrent drinking that leads to significant problems in your life. The degree of AUD may be classified as mild, moderate or severe.
• Alcohol Abuse– same as Alcohol Use Disorder
• Binge Drinking- drinking 5 or more drinks for men or 4 or more drinks for women in one occasion.

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Written by: myObMD writing team, March 30, 2020 | Editor: Dayna Smith, MD | Reviewed January 30, 2021 | Copyright: myObMD Media, LLC, 2020

Resources:

• Substance Abuse and Mental Health Services Administration (SAMHSA) 1-800-662-HELP (4357)
• National Suicide Prevention Lifeline 1-800-273-8255.
• National Institute on Alcohol Abuse and Alcoholism, National Institute of Health