How much alcohol intake is “normal”?

I regularly have patients who drink a fair amount of alcohol but do not think they should try to reduce the amount they consume. If I gently try to introduce the idea that maybe the amount they are drinking is a bit on the higher side and maybe they should cut back a little, they give me a variety of rationalizations:
“I used to drink way more than that in college. I have cut down a lot.”
“All my friends drink more than I do.”
“I would have no social life if I did not drink regularly. That’s what we do – we go to the bar.”
And my favorite – “I’m Irish, doc.”
So, it could be of some help to be able to refer to a number. How many drinks is it “OK” to drink? At what point does the alcohol intake become excessive? The obvious and correct answer is that it depends – on the context of the drinking (where, why, when, with whom), what harm it has caused, etc. But I have also found it helpful to refer my patients who drink a fair amount to standard definitions of different thresholds of drinking. It is not a complete solution; I can’t say that simply showing the person a number makes them agree to cut down to that number. But is of partial help to be able to have a number to refer to–to know where the person is and what to aim for.

 
Alcohol
 
Low-risk drinking
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) offers a definition of drinking with a low risk for developing an alcohol use disorder.
This definition limits how much the person drinks in any one day as well as in any one week. The idea is that the person should not “save up” the amount of alcohol he chooses to drink and drink it all on one or two days (e.g., the weekend). Low-risk drinking is defined by NIAAA as:
Men: No more than 4 drinks on any single day AND no more than 14 drinks per week.
Women: No more than 3 drinks on any single day AND no more than 7 drinks per week.
This is the level of drinking that should ideally be a maximum for anyone.
Warning! Low risk does not mean no risk. Some persons with this level of drinking also develop alcohol use disorders.
In contrast to low-risk drinking, two types of excessive alcohol intake have been defined: Binge drinking and Heavy drinking. They are similar but there’s a difference.

 
Binge Drinking (Heavy Episodic Drinking)
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines Binge Drinking as:
A pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL. This typically occurs when in about a 2-hour period, a man has 5 drinks or a woman has 4 drinks.
This definition is not as helpful for clinicians since we are not there with the person to measure the blood alcohol concentration.
A simpler definition of Binge Drinking has been provided by the Substance Abuse and Mental Health Services Administration (SAMHSA):
Drinking 5 or more alcoholic drinks on the same occasion on at least 1 day in the past 30 days.
The NIAAA has suggested that for older adults ages 60 years and up, Binge Drinking should be defined as no more than 3 drinks on any one day for men, and no more than 2 drinks on any one day for women.
So, Binge Drinking does not mean extremely heavy drinking as is commonly thought. Also, Binge Drinking is not the same as having an alcohol use disorder.

 
Heavy Drinking
How is Heavy Drinking different from Binge Drinking? Basically, Heavy Drinking is Binge Drinking relatively frequently. The Substance Abuse and Mental Health Services Administration (SAMHSA) defines Heavy Drinking as:
Drinking 5 or more drinks on the same occasion on each of 5 or more days in the past 30 days.

 
How common are Binge or Heavy Drinking?
In the US, 23% of those who used alcohol at all in 2014 were considered to be binge drinkers and 6% as heavy drinkers. Criteria for an alcohol use disorder were met by about 6.5% of those who used alcohol at all.
It will not come as a surprise that rates of binge or heavy drinking gradually increase during adolescence, peak in the early 20s, and than gradually decrease over the years.
Here’s an interesting fact on attending college and binge/heavy drinking: Those in college are more likely to have binge/heavy drinking than those who are not BUT later in life, those who have completed college are less likely to have binge or heavy drinking.

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