For many years I've worked with people who have concerns about their use of drugs and alcohol. A question that comes up frequently: “How do I know if I’m drinking too much?” Perhaps they have had one hangover too many, or their friends have begun to express concerns about how much they’re drinking. Even worse, they may have been pulled over for driving under the influence or they may have failed to complete important tasks at work or school due to drinking.
There are some clear and simple guidelines to determine when your patterns of alcohol use begin to edge into the zone that suggests possible (or definite) problems. Let’s take a quick look.
Screening for at-risk drinking
According to the US National Institute on Alcohol Abuse and Alcoholism (NIAAA), “drinking becomes too much when it causes or elevates the risk of alcohol-related problems or complicates the management of other health problems.” Accordingly, health care providers are encouraged to routinely screen patients for patterns of heavy drinking.
Step 1 – Do you ever drink?
The screening process recommended by NIAAA is simple and straightforward. The first question is, “Do you sometimes drink beer, wine, or other alcoholic beverages?” If the answer is no, that’s the end of the screening and it’s presumed that your alcohol use isn’t a problem.
Step 2 – Number of drinks in a day?
If, on the other hand, you do sometimes drink, the next screening question is “How many times in the past year have you had: Five or more drinks in a day (for men), or four or more drinks in a day (for women)?” If you have had one or more days in the past year where you drank five or more drinks (men) or four or more drinks (women), you are considered an “at-risk drinker.”
Step 3 – Average number of drinks per week?
The next step is to determine how many days a week you drink, on average, and how many drinks you have on a typical day. By multiplying the average number of drinking days per week and the typical number of drinks, a weekly drink average is obtained. For example, if you drink three days per week on average and typically have three drinks per day, your weekly average is 3 X 3, or 9 drinks per week.
Step 4 – Assessment for alcohol use disorder
Next, the health care provider will ask you a series of more detailed questions about your use of alcohol over the past 12 months. This allows them to determine if there is a problematic pattern of alcohol use and whether your particular pattern meets the specific criteria to be considered a diagnosable alcohol use disorder.
Understanding drinking patterns and recommended limits
Depending on the results of this screening, the health care provider then provides advice and assistance tailored to either a) at-risk drinking or b) an alcohol use disorder. An important part of this assistance is to provide education about typical adult drinking patterns and recommended maximum drinking limits.
It’s recommended that men age 65 and under should have no more than four drinks in a day and no more than 14 total drinks in a week. For women (and men over 65), have no more than three drinks in a day and no more than seven drinks in a week. Take a second and see how your daily and weekly drinking patterns compare to these guidelines. If you’re over these limits, that’s likely cause for concern.
To further put these numbers into perspective, 72% of US adults never exceed the daily and weekly limits stated above. If you never exceed these limits, you’re in a healthy group where fewer than 1 in 100 adults have an alcohol use disorder.
Additionally, only 16% of US adults exceed the daily drinking limits noted above. If you’ve exceeded the daily drinking limit, you’re in a group where about 20% of adults have an alcohol use disorder.
Finally, only 10% of US adults exceed both daily and weekly drinking limits. If you exceed both of these limits, you’re in a group where almost 50% of adults have an alcohol use disorder.
At this point, you may be breathing a sigh of relief that you don’t seem to be an at-risk drinker, based on these guidelines. If so, that’s terrific. However, if you drink at all, you should continue to monitor your patterns of use and make sure not to exceed the recommended daily and weekly limits.
Also, begin taking small steps to monitor and moderate your drinking. Keep track of how much you drink. Understand that one “standard” drink is 12 ounces of beer, five ounces of wine, or 1.5 ounces of 80-proof spirits. Set a goal to reduce how much you drink so you never exceed the daily or weekly limits. Don’t drink on an empty stomach. Avoid triggers (people, places, situations) where you are more likely to drink excessively. Learn how to say no when offered a drink you don’t want.
What if your drinking pattern exceeds one or both of the recommended daily or weekly limits and you have more significant concerns about how your drinking is affecting you? Seek out help, and do it now. There are many options, including seeing a therapist who specializes in substance use issues, attending an AA (Alcoholics Anonymous) meeting or other support groups, reading reputable self-help books or websites, or checking out more intensive treatment options such as residential substance abuse rehabilitation programs. Remember, help is available, but it’s up to you to take the first step.
Copyright David Susman 2019