Rethinking Drinking

Why is being able to “hold your liquor” a concern?

For some people, it takes quite a few drinks to get a buzz or feel relaxed. Often they are unaware that being able to “hold your liquor” isn’t protection from alcohol problems, but instead a reason for caution. They tend to drink more, socialize with people who drink a lot, and develop a tolerance to alcohol. As a result, they have an increased risk for developing alcohol use disorder. The higher alcohol levels can also harm the liver, heart, and brain without the person drinking noticing until it’s too late. And all people who drink need to be aware that even moderate amounts of alcohol can significantly impair driving performance, even when they don’t feel a buzz from drinking.

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. For more information, see Alcohol: A Women’s Health Issue.

Isn’t drinking good for the heart?

For some people, the answer can be “yes,” depending on the amount. Regular light to moderate drinking can lower the risk for coronary heart disease, mainly among middle-aged and older adults (other factors also cut the risk, including a healthy diet and weight, exercise, and not smoking). Heavy drinking can actually increase blood pressure and damage the heart.

Is “low-risk” drinking just another term for “moderate” drinking?

Not exactly—the weekly amounts may be the same, but the daily ones are different, and the recommendations serve different purposes for people with different drinking patterns.

Low-risk drinking, for healthy men under age 65 is no more than 4 drinks on any day and 14 per week, and for healthy women (and men over 65) is no more than 3 drinks on any day and 7 per week.
Moderate drinking, according to the U.S. dietary guidelines, is up to 2 drinks per day for men and up to 1 drink per day for women. (Per week, this corresponds to an upper limit of 14 drinks for men and 7 for women.)

In the United States, most people who drink don’t have a daily, low-level pattern of 1 or 2 drinks per day. Instead, they tend to have less on weekdays and more on weekends and holidays. Some people may look at the weekly limits of 14 or 7 drinks and wonder if they can have them all on one or two weekend days. As shown by the daily low-risk drinking levels, however, from a health standpoint, it’s risky to have more than 4 drinks on any day for men or 3 for women.

It’s important to note that the low-risk drinking levels are not risk free. People who drink lightly to moderately should not increase their intake beyond the moderate drinking guidelines, as this would increase their chances for alcohol-related problems.

Can I do anything to protect my liver from the effects of too much alcohol?

There are no guarantees that anything will protect the liver from too much alcohol. Liver damage from heavy drinking happens in stages. Some relatively mild damage may happen after a single binge drinking episode, but this reverses itself if the heavy drinking stops. If heavy drinking continues, however, liver damage can progress through several more advanced stages, and repair becomes much more difficult, if not impossible. When the damage goes as far as cirrhosis, the only treatment is liver transplant. The best way to protect your liver’s health is by staying within the low-risk drinking limits or — if you already have liver damage or any signs of an alcohol problem — by quitting. Also, it’s best if people who drink avoid acetaminophen (found in Tylenol® and other medications). Even the standard recommended dose of acetaminophen can increase the risk of liver damage, particularly among people who drink heavily.

I am considering cutting down or quitting drinking. How do I begin?

The first step, of course, is to decide whether cutting down or quitting is best for you. See these considerations and discuss different options with a doctor, a friend, or someone else you trust.

Thinking about cutting back? Here are some tips to try, small changes that can make a big difference. Choose two or three to try in the next week or two. It may help to have reminders to reinforce your decision to make a change, such as automated smartphone alerts that you send yourself.

Thinking about quitting? One size doesn’t fit all, and it’s important to find options that appeal to you. Start by visiting the choose your approach page. Here you’ll find links to self-help strategies, a helpful publication about treatment options, and information about professional help and social support.

Changing habits such as smoking, overeating, or drinking too much can take a lot of effort, and you may not succeed with the first try. Setbacks are common, but you learn more each time. Each try brings you closer to your goal. Whatever course you choose, give it a fair trial.

What treatments are available for someone with an alcohol problem?

People commonly think of 12-step programs or 28-day inpatient rehabilitation as the only options for treating alcohol problems. Other choices are available, however. It’s a good idea to start by talking with a primary care doctor to put together an individualized treatment plan. A treatment plan can include:

Behavioral treatments. Counseling led by a health professional aims to change drinking behavior. Types of counseling include cognitive-behavioral therapy, motivational enhancement therapy, and marital and family counseling. It’s important to choose an approach that avoids heavy-handed confrontation, incorporates empathy, and increases motivation while focusing on changing drinking behavior.
Medications. Three medications are currently approved by the Food and Drug Administration to treat alcohol dependence. These medications help people stop or reduce their drinking and prevent relapse. All approved medications are non-addictive, and can be used alone or in combination with other forms of treatment.
Mutual-support groups. People who are quitting or cutting back on their drinking may also find peer support through organizations such as Alcoholics Anonymous and other mutual support groups.

Find a summary of treatment options in the NIAAA publication Treatment for Alcohol Problems: Finding and Getting Help. The good news is that no matter how severe the problem may seem, most people with an alcohol problem can benefit from some form of treatment.

Chapter 11: Alcohol and Tobacco Use