As we enter the New Year many of you have probably made a resolution. Mine is related to a previous post on not putting off having fun. Often these resolutions deal with getting more exercise, eating more, drinking less, or stopping smoking. I thought over the next few days I’d comment on each of these issues. Today I’ll address drinking too much.
First what’s too much? Hey, I like a nice beer or glass of wine, so what’s the problem. Most experts agree that for men drinking less than 4 drinks on a given day, and less than 14 drinks on a given week, and for women less than 3 drinks on any given day, and less than 7 drinks in a week, is probably safe. (no sexism here, just men metabolize alcohol faster and are generally bigger people) There is even some evidence that moderate amounts of alcohol may have beneficial effects on HDL cholesterol and heart disease. None-the-less alcohol abuse is the third leading cause of preventable premature death in the US. (behind tobacco use and poor eating and exercise lifestyles) Most experts differentiate between at-risk-drinking, alcohol abuse, and alcohol dependence. At risk drinking is defined as drinking above the 3-4 drinks in a day more than 12 times a year. This is estimated to apply to about 21% of Americans. Most people in this category just need to drink less and be careful not to put themselves in a position to have life-altering consequences. (driving, handling firearms, etc.) Often they can just modify their drinking behavior, and do not need to abstain.
Alcohol abuse (5% of Americans) and alcohol dependence (4% of Americans) together constitute what are called alcohol use disorders. Here is a table from an article in American Family Physician July 1, 2009.
Diagnostic Criteria for Alcohol Abuse and Dependence
| Abuse: Patient must meet one or more criteria without meeting criteria for dependence | |
| Determine whether, in the past 12 months, the patient’s drinking has repeatedly caused or contributed to the following: | |
| Risk of bodily harm (drinking and driving, operating machinery, swimming) | |
| Relationship trouble (family or friends) | |
| Role failure (interference with home, work, or school obligations) | |
| Run-ins with the law (arrests or other legal problems) | |
| Dependence: Patient must meet three or more criteria | |
| Determine whether, in the past 12 months, the patient has experienced the following: | |
| Not able to stick to drinking limits (repeatedly exceeded them) | |
| Not able to cut down or stop drinking (repeated failed attempts) | |
| Spent a significant amount of time drinking (or anticipating or recovering from drinking) | |
| Continued drinking despite problems (recurrent physical or psychological problems) | |
| Spent less time on other matters (activities that had been important or pleasurable) | |
| Shown an increase in tolerance (needed to drink more to produce the same effect) | |
| Shown signs of withdrawal (tremors, sweating, or insomnia when trying to quit or cut down) | |
note: The threshold criterion for any alcohol use disorder is a dysfunctional pattern of substance use causing clinically significant impairment or distress.
In general people who meet the criterion for alcohol use disorders need to obtain help to find a way to abstain from alcohol. Your physician can help you find resources to move toward this goal.
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This is the level felt to be safe medically, meaning unlikely to lead to cirrhosis of the liver, withdrawal symptoms on stopping drinking, and a low chance of other complications. None-the-less this is a about 2-300 calories a day, making an annual weight difference of about a pound every 2 weeks if nothing different is done to change eating or exercise behavior. That’s over 25 lbs a year!
It seems like 14 drinks a week or less is alot for men!