In the United States, it is legal for any adult who is at least 21 years old to purchase and enjoy alcoholic beverages. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that, per a 2015 survey, 86.4 percent of U.S. residents ages 18 and older drink alcohol at some point in their lives. An article from TheWashingtonPost points out that everyone has different drinking habits: 30 percent of American adults do not drink at all, and another 30 percent drink less than one serving of alcohol per week.
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It is often a normal part of life to have a drink with dinner or enjoy an alcoholic beverage with friends or co-workers once in a while. However, there are drinking patterns that are dangerous. The U.S. Centers for Disease Control and Prevention (CDC) calls problematic drinking excessive drinking and classifies these patterns as binge drinking, heavy drinking, and alcohol use disorder (AUD).
In the U.S., 88,000 people die every year from alcohol-related harm, from issues ranging from drunken-driving car accidents to liver cancer. About 1 in 10 working-age adults, between the ages of 20 and 64, die because of alcohol issues. Understanding how much alcohol is too much can help you monitor your own drinking patterns and recognize if a loved one is suffering from alcohol abuse.
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How Much is Too Much?
The CDC and NIAAA clearly state that any amount of drinking has some risks associated with it. There is no such thing as “no-risk” drinking, but you can engage in low-risk drinking. An NIAAA chart shows that women should drink no more than three drinks on any single day while men should drink no more than four drinks on any given day. Consuming more than seven drinks per week for women, and more than 14 drinks per week for men, puts them in danger of more serious health problems. These guidelines are considered the standard for moderate drinking.
It is essential to know the serving sizes of alcoholic beverages before one can practice moderate drinking. One serving of alcohol is equal to:
- 12 oz of beer at 5% alcohol by volume (ABV)
- 8–9 oz of malt liquor at about 7% ABV
- 5 oz of wine at about 12% ABV
- 3–4 oz of fortified wine at 17% ABV
- 2–3 oz of cordial/aperitif/liqueur at 24% ABV
- 1.5 oz of hard liquor/distilled spirits at 40% ABV
A study published in 2018 found there is a point when the amount of alcohol consumed becomes harmful. This occurs with 100 grams per week or about six glasses of wine. This amount on a regular basis can increase the risk of chronic diseases and early death.
Pints of beer, large glasses of wine, and large pours into cocktails are common in dining establishments and bars. Many drink containers sold in stores are larger than the standard serving size. It is easy to pour yourself more than one serving of alcohol at home. This means that you likely drink more than one serving of alcohol per hour, which can lead to intoxication.
Drinking a serving that is slightly larger than recommended does not mean you have a problem with excessive drinking. When your behavior follows specific patterns of consumption, however, you may have a problem with drinking too much.
Excessive Drinking and Addiction to Alcohol
While many people drink regularly, too many people do not know when drinking becomes problematic. There are a few forms of excessive drinking that can be harmful and are considered alcohol abuse, although they are not technically alcohol addiction.
Generally, alcohol abuse occurs when someone drinks too much on occasion, and this behavior leads to other risky behaviors and poor judgment.
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Dependence means the person feels like they need alcohol consistently to get through the day. Addiction is associated with both compulsive overdrinking and consistent drinking.
This form of excessive drinking is most infamous for leading to alcohol poisoning. The CDC defines binge drinking as at least four servings of alcohol in a two-hour timeframe for women and at least five servings of alcohol in the same timeframe for men. In 2015, 26.9 percent of U.S. adults reported binge drinking a minimum of one time in the past month.
Binge drinking is often associated with college students because there is peer pressure to drink a lot at parties to fit in. NIAAA reports that an annual average of 1,825 college students between the ages of 18 and 24 die from unintentional, alcohol-related injuries, like drunk driving. About 696,000 students are assaulted by another student who has been drinking, of which 97,000 students report their assault was sexual assault or date rape.
One in four college students reports academic problems from drinking too much. Students who binge drank at least three times per week were about six times more likely to perform poorly on a test or project compared to their non-drinking peers; they were five times more likely to miss class. The most vulnerable time for binge drinking is the first six weeks of freshman year when students face new social pressure, hectic personal lives, and new academic stresses.
Although binge drinking is usually associated with young people, new survey data shows that binge drinking among older adults is on the rise as baby boomers age into retirement. Older women in the U.S., in particular, are increasingly binge drinking. Between 1997 and 2014, older men binge drank at about the same rate while binge drinking among older women increased, on average, 2 percent every year.
Younger boomers, between the ages of 60 and 64, are drinking significantly more compared to this age group in previous generations. This can be very dangerous for both men and women because it increases the likelihood of falls, which risk brain trauma, and broken bones and injuries that take longer to heal in older adults compared to younger people.
Additionally, older adults are more likely to take prescription medications. Mixing alcohol with pain relievers, heart medication, cholesterol medication, or psychiatric prescriptions can be dangerous, increasing the risk of overdose on these substances and decreasing the medications’ effectiveness.
In contrast to binge drinking, people who drink heavily tend to drink regularly. Rather than drinking too much at a party or work event, heavy drinkers drink a couple of beverages on most days. Per the CDC, heavy drinking is eight or more drinks per week for women, which is slightly more than one drink per day, and 15 or more drinks per week for men, or just over two drinks per day. About 7 percent of U.S. adults reported drinking heavily in the past month in 2015.
The article in TheWashington Post found that, while 60 percent of U.S. adults rarely drink, if ever, 10 percent of American adults drink very heavily. This amounts to as much as 74 drinks per week, which is more than 10 servings of alcohol per day.
Heavy drinking may not cause acute or immediate problems, but on a long-term basis, consistent alcohol consumption will damage the body. Certain conditions can result, such as:
- Heart disease
- Stroke or blood clots
- High blood pressure
- Digestive problems like ulcers
- Cancer of the breast, mouth, esophagus, colon, throat, or liver
- Other liver damage like cirrhosis
- Mental health problems like depression or anxiety
Developing a pattern of heavy drinking can lead to alcohol dependence, which is when the body relies on the presence of alcohol to feel stable. While dependence on alcohol and alcoholism–or alcohol use disorder–are not the same thing, they are closely correlated.
Originally called alcoholismandthen alcohol addiction, alcohol use disorder (AUD) is the pattern of compulsively drinking too much, too often. Per the National Survey on Drug Use and Health (NSDUH) in 2015, there were 15.1 million adults and 623,000 adolescents (ages 12 to 17) in this country who had AUD.
NIAAA found that about 20 percent of college students meet the criteria for AUD. About 10 percent of schoolchildren have parents with AUD. Less than 10 percent of people struggling with AUD get the treatment they need.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition(DSM-5) defines AUD according to these 11 criteria:
- Drinking more than you wanted to
- Trying more than once to cut down on drinking without success
- Dedicating a good amount of time to drinking and/or being sick after drinking
- Wanting to drink so badly that you cannot think of anything else
- Drinking too much or being hungover interferes with your ability to take care of your home, job, school, or family
- Knowing that drinking is causing problems with your family or friends and drinking anyway
- Getting into situations after drinking that increase your risk of injury, like driving drunk
- Giving up activities or hobbies so you can drink more often
- Experiencing increased sadness or stress from drinking but doing it anyway
- Feeling like you must drink more to get drunk
- Experiencing withdrawal symptoms when you are not able to drink
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Stages of Alcohol Abuse
Many people struggle with drinking too much at parties or feeling like they always need a drink after work to relax. While binge drinking and heavy drinking are problematic, they do not equal alcohol use disorder. However, having symptoms of both of these forms of excessive drinking can indicate an AUD. Bingeing or drinking every day may be a sign that you are developing an AUD.
There are some general stages of AUD. They are:
- Occasional drinking: Any problem drinking begins with the introduction of alcohol – getting tipsy the first time and enjoying the relaxation or pleasant feelings. This quickly progresses to drinking at parties, with friends, or sometimes alone, but drinking is still occasional. However, the person will begin to test their limits regarding how much it takes to get drunk and how sick they feel after drinking. There may be a handful of incidents of binge drinking, which are likely to trigger regret. Drinking alone will increase in frequency until it becomes heavy drinking.
- Increased drinking: The person knows their limits at this point, but will find more excuses to drink – socializing, work events, holidays, meals, or due to stress. Regular drinking will surpass moderation.
3. Problem drinking: Regular drinking increases until the person cannot control how much they drink or when. Cravings may feel intense. They are more likely to feel withdrawal symptoms when they cannot drink. They also may feel sick after drinking too much and start to skip work, school, or social events to drink more. Their group of friends may change to people who drink a lot. The quality of their work may suffer, their loved ones may be worried or stressed, and they may experience mood swings while drinking or as alcohol wears off.
4. Alcohol dependence: The person feels sick when they’re not drinking. The person is aware that there are adverse effects from drinking too much, but they cannot stop. They may try to stop or cut back, but they are not able to. At the same time, their body has developed a tolerance for alcohol, so they need to drink more to feel normal.
5. Alcohol addiction: Drinking goes beyond feeling pleasure or relaxation, or even just drinking a serving of alcohol because of a craving. The person loses control over their drinking. They may drink all the time, even sneaking alcohol before breakfast, during work or school, or in dangerous situations. They drink every day and often more than they want to. They spend more money on alcohol than they intend because they need a constant supply
Treatment for Alcohol Use Disorder
In 2018, the American Psychiatric Association (APA) created new clinical guidelines for treating alcohol use disorder. The guidelines reiterate the importance of available pharmaceutical interventions to manage AUD, which must be prescribed alongside behavioral therapy.
Typically, addictions such as AUD are treated with medically supervised detox and rehabilitation as the two foundational steps. This is considered evidence-based treatment, and it involves working with medical professionals to reduce the risk of relapse and change behaviors around drugs and alcohol, using the latest research and science to create an appropriate treatment plan.
Withdrawal symptoms from alcohol are typically uncomfortable. They include shaking, tremors, anxiety, nausea, vomiting, rapid heartbeat, irritability, confusion, high blood pressure, insomnia or other sleep disturbances, headaches, and sweating. For most people, these symptoms will dissipate within 10 days. However, some people develop alcohol withdrawal syndrome (AWS), a condition that extends the discomfort of withdrawal and boosts the risk of relapse.
Some people who drank a lot of alcohol for a long time are at risk of deliriumtremens, or DTs, a condition that may involve delirium or severe confusion, fever, sensitivity to stimuli such as light or sound, deep sleep lasting for a day or two, extreme agitation and changes in mental function, hallucinations, and seizures. The risk of AWS and delirium tremens means anyone struggling with AUD must get help from medical professionals to safely detox. It is not safe to attempt to detox from alcohol on your own.
In instances of delirium tremens, you may receive a prescription for a benzodiazepine medication like Valium to ease withdrawal symptoms. There are additional pharmacological approaches to reduce cravings for alcohol and maintain abstinence after detox. APA’s new guidelines recommend either naltrexone or acamprosate to reduce cravings after detox as needed. They also advise that clinicians avoid disulfiram unless absolutely necessary because of the medication’s effects on the heart.
Successful, long-term recovery requires changes in behavior. This means you must understand what compulsions look like, what triggers them, and how to avoid these triggers and manage other stresses to prevent drinking. Rehabilitation programs, both residential and outpatient, offer therapy sessions with groups and on an individual basis to discuss these problems and solutions that work.
The National Institute on Drug Abuse (NIDA) reports that remaining in treatment for an adequate amount of time is crucial to recovery, and the organization recommends three months (90 days) based on the science of behavioral change. Cognitive behavioral therapy, motivational enhancement therapy, and 12-steps programs have all been shown to be effective approaches to AUD rehabilitation.
Once a rehabilitation program is complete, ongoing commitment to recovery is essential. Mutual support groups, individual therapy, and complementary treatments that support sobriety can be key to a successful aftercare plan.
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