Alcohol: How Much Is "Too Much"?

How Much Is "Too Much"?

Drinking becomes too much when it causes or elevates the risk for alcohol-related problems or complicates the management of other health problems. According to epidemiologic research, men who drink 5 or more standard drinks in a day (or 15 or more per week) and women who drink 4 or more in a day (or 8 or more per week) are at increased risk for alcohol-related problems.

Individual responses to alcohol vary, however. Drinking at lower levels may be problematic depending on many factors, such as age, coexisting conditions, and use of medication. Because it isn't known whether any amount of alcohol is safe during pregnancy, the Surgeon General urges abstinence for women who are or may become pregnant.

At-risk drinking and alcohol problems are common. About 3 in 10 U.S. adults drink at levels that elevate their risk for physical, mental health, and social problems. Of these heavy drinkers, about 1 in 4 currently has alcohol abuse or dependence. All heavy drinkers have a greater risk of:

• hypertension,
• gastro-intestinal bleeding,
• sleep disorders,
• major depression,
• hemorrhagic stroke,
• cirrhosis of the liver, and
• several cancers.

Heavy drinking often goes undetected. In a recent study of primary care practices, for example, patients with alcohol dependence received the recommended quality of care, including assessment and referral to treatment, only about 10 percent of the time.

Patients are likely to be more receptive, open, and ready to change than expected. Most patients don't object to being screened for alcohol use by clinicians and are open to hearing advice afterward. In addition, most primary care patients who screen positive for heavy drinking or alcohol use disorders show some motivational readiness to change, with those who have the most severe symptoms being the most ready.