Moderate Drinking vs. Alcohol Abuse
It’s true that many sources point to the health benefits of moderate alcohol consumption. The key word here is moderate. Some studies have shown a connection between light to moderate drinking and decreased heart disease. For example, more than 100 prospective studies show that when people’s alcohol consumption is light to moderate, their risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death decreases by 25-40%.1
One theory behind why moderate drinking could protect against heart problems is that alcohol can raise levels of high-density lipoprotein (HDL, or “good” cholesterol). It is a delicate balance, however, and increasing alcohol intake to more than 4 drinks a day can flip any potential benefits by increasing your risk of high blood pressure, heart rhythm abnormalities, heart attack, stroke, and death.1
It’s not just how much you drink overall but how much you drink at a time that plays a role in your risk. Binge-drinking 5 drinks on the weekend isn’t the same as having 1 drink per day Monday-Friday. Moderate drinking and any related health benefits are associated with the regular consumption of small amounts of alcohol.1 Adding to the potential confusion is the fact that the concept of “moderate drinking” is difficult to define and changes across studies and publications. Currently, the Dietary Guidelines for Americans cite no more than 1-2 drinks for men and 1 drink for women per day as “moderate.” In the United States, 1 drink generally means:1
- 5 ounces of wine
- 12 ounces of beer
- 5-ounce shot of hard liquor.
While the exact definition of moderate drinking may be somewhat fluid across different studies, it’s difficult to refute the idea that, when the risks begin to outweigh the benefits, drinking is no longer in moderate territory. 1 It is also worth noting that a 2018 article published in The Lancet found that no amount of alcohol is safe, and that it is a leading cause of mortality and “substantial health loss.”2
While the exact definition of moderate drinking may be somewhat fluid across different studies, it’s difficult to refute the idea that, when the risks begin to outweigh the benefits, drinking is no longer in moderate territory.
In 2017, 140.6 million Americans aged 12 or older were current alcohol users.3 While a large number of these people undoubtedly drink in moderation, many others drink heavily and pay the price.
Drinking heavily can have a number of negative consequences, including:1
- Liver damage.
- Heart problems.
- Increased risk of developing certain cancers.
- Violent behavior.
- Fatal traffic accidents.
- Legal problems/jail.
Heavy drinking doesn’t always have to mean drinking consistently. Binge drinking, for example, refers to the consumption of 5 or more drinks for men or 4 or more drinks for women in about 2 hours. And though it may not entail consistent drinking, binge drinking is linked to its own set of numerous risks including blackouts, vehicle collisions, other unintentional injuries, and alcohol poisoning.4 It may also increase your chances of:4
- Experiencing some form of violence (e.g., intimate partner violence, homicide, suicide, or sexual assault).
- Unintended pregnancy.
- Getting a sexually transmitted disease.
Prolonged alcohol abuse can also lead to alcoholism, or an alcohol use disorder (AUD). Even weekend binge drinking raises your risk of developing an AUD at some point.4 An AUD is marked by a person’s inability to stop drinking in spite of the harm it is causing (health problems, relationship issues, etc.).5
The Extent of the Problem
Alcoholism is a struggle that millions of people, families, and communities have to deal with.1 According to the 2017 National Survey on Drug Use and Health (NSDUH):3
- 7 million were heavy drinkers in the previous month.
- 6 million were binge drinkers in the previous month. This translates to roughly 1 in 4 people aged 12 or older, or 24.5% of the population.
- 1 in 8 current alcohol users were heavy drinkers (11.9%).
- About 1.3 million adolescents aged 12 to 17 admitted to binge drinking in the previous month, equating to 5.3% of all adolescents.
Short-Term Effects of Alcohol
A number of factors influence the effects that alcohol will have on a person; these include the individual’s:6,7
- General health.
- Genetic background.
- Family history of alcoholism.
- History and patterns of alcohol use.
- Exposure (or lack of exposure) to alcohol in a prenatal environment.
The effects of alcohol are wide-ranging. In the short term, memory may be impaired after only a few drinks. If a person drinks a large amount of alcohol in a brief period and on an empty stomach, they are at an increased risk for blackouts. A blackout is defined as a period of time for which a person can’t recall details of events that occurred, or in some cases, any part of the events.
This can be extremely dangerous. When researchers surveyed people with blackout experiences, respondents reported that they later discovered they’d engaged in a number of activities during their blackouts that they would not have participated in if they were fully cognizant, including unprotected sex, driving while intoxicated, and committing acts of vandalism.7
Other short-term effects of alcohol include:7
- Problems walking.
- Slurred speech.
- Blurry vision.
- Impaired reaction time.
- Reduced inhibitions.
The more you drink, the higher your blood alcohol concentration (BAC). Eventually it may get so high that breathing problems, coma, or death occur.6
Many short-term effects of alcohol are amplified when alcohol is consumed in conjunction with other mind-altering substances, both illicit and prescription. People who are using opioids or sedatives, for example, are at a very severe risk of the compounding effects of using these drugs in combination with alcohol (which may include severely depressed breathing, hypotension, coma, and death). If you are taking opioid painkillers or anti-anxiety medications like Valium, even a moderate amount of alcohol can be harmful.8 Your prescribing physician can advise you of the risks.
Alcohol use can also have serious consequences for expecting and breastfeeding mothers and their babies, including fetal alcohol syndrome.9 Prenatal alcohol exposure is the leading cause of birth defects. Even light-to-moderate drinking can cause problems in a child’s learning and behavior that can last throughout their lifetime. If you are pregnant, any amount of drinking is risky, and all types of alcohol can harm your child. The idea that just a little wine or beer is ok during pregnancy is a myth.10
A hangover is an umbrella term that refers to the unpleasant physical and mental symptoms that arise after a bout of heavy drinking. It is unclear whether a hangover results from alcohol’s direct effects, its aftereffects, or both.11
Physical symptoms of a hangover include:11
- Muscle aches.
- Increased thirst.
- Redness of the eyes.
- Sensitivity to light and sound.
- Fatigue but decreased ability to sleep.
- Decreased ability to concentrate.
- Mood changes (depression, anxiety, etc.)
- Increased blood pressure.
- Rapid pulse.
Long-Term Effects of Alcohol
Heavy, long-term drinking can take a toll on the body and mind and lead to:1,7
- Weight gain.
- Problems with coordination.
- Nerve damage.
- Inflammation of the liver (alcoholic hepatitis).
- Scarring of the liver (cirrhosis).
- Cancer of the liver.
- Increase blood pressure.
- Damage of the heart muscle (alcoholic cardiomyopathy).
- Disruption of the healthy growth of new brain cells.
In addition to liver cancer, heavy use of alcohol has also been linked to several other cancers, including cancer of the:1
Alcohol Tolerance and Dependence
Consistent alcohol use may also lead to tolerance. Tolerance develops as a person begins to no longer respond to alcohol in the way they did at first. What most people don’t know is that there are different types of tolerance outlined below:12
- Functional tolerance: When the brain adapts to the disruptive changes caused by alcohol. Chronic drinkers who have developed a functional tolerance won’t appear to be intoxicated even after consuming heavy amounts of alcohol and when their BACs are high. Because the individual doesn’t feel drunk, they may drink more. Over time, this may increase the risk of organ damage and lead to the development of severe physical dependence.
- Acute tolerance: Although tolerance is something that usually develops over time, in some cases a person may show signs of tolerance in just one episode of drinking. The person may show a greater sign of impairment at the start of drinking than at a later point, even if their BACs are equal. Acute tolerance is an adaptation not to alcohol’s effects but to the feeling of intoxication. Someone who has shown an acute tolerance may end up drinking more and experiencing serious adverse consequences, such as alcohol poisoning.
- Environment-dependent tolerance: Research has shown that when drinking is always done in the same environment and associated with the same cues, a person may develop tolerance faster.
- Learned tolerance: People can develop learned tolerance while practicing specific tasks under the influence of alcohol. For example, if a person always drinks at work and learns how to do a specific task well while under the influence, they may not show any difference in quality compared to an employee who is not intoxicated. With regard to driving drunk, this can be extremely dangerous. People who regularly drive intoxicated may feel confident in their ability to drive their normal route, but learned tolerance does not apply to any new scenarios or unexpected events, for example, an unexpected lane closing, a wrong-way driver, an object in the road, or any other situation that requires your full and unimpaired attention.
As drinking continues, the body may adapt in such a way that it essentially begins to require alcohol just to perform normally. Once this happens, the person is said to be alcohol-dependent. Without drinking, they may go through withdrawal, which can be extremely serious, producing life-threatening complications such as seizures and delirium tremens, or “DTs”.13 Both tolerance and dependence are among the clinical diagnostic criteria for an alcohol use disorder.
Signs of an Alcohol Use Disorder
Chronic alcohol use can lead to an alcohol use disorder, or AUD. In order for a person to be diagnosed with an AUD, they must have experienced 2 or more of the following in the past year.14
- I feel withdrawal symptoms as the effects of alcohol wear off: including trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure.
- I have to drink more than I once did to get the effect I want (i.e., tolerance).
- I continue to drink even though it makes me feel depressed, adds to another health problem, or makes me black out.
- I have found myself in situations while or after drinking that increased my chances of getting hurt: swimming, walking in a dangerous area, driving, using machinery, or having unsafe sex.
- I gave up or cut back on activities that were important or interesting to me so I could drink.
- I continue to drink even though it is causing trouble with family and friends.
- Drinking, or having a hangover, often interferes with taking care of my home or family, fulfilling my job duties, or attending to my academic responsibilities.
- Often, I want a drink so badly I can’t think of anything else.
- I spend a lot of time drinking or feeling sick after drinking heavily.
- More than once I wanted to cut down or stop drinking but couldn’t.
- I have had times when I ended up drinking more, or longer, than I intended.
Alcohol addiction is understood by most addiction-related organizations as a chronic disease.15 After repeatedly using alcohol, a person may become addicted and unable to stop drinking even if they suffer severe health problems or personal losses such as unemployment, bankruptcy, breakup, divorce, removal of children from the home, arrests, or other adverse consequences related to their compulsive alcohol consumption.14
If you develop significant levels of alcohol dependence and you stop drinking or severely cut down on your use, alcohol withdrawal can begin. Symptoms of alcohol withdrawal are dangerous and can include the following:13
- Rapid heartbeat (tachycardia).
- Elevated blood pressure.
- Shaking (tremors).
- Sleep disturbances.
- Delirium tremens.
In addition to the predominantly physical signs of withdrawal above, it is common for a person to experience a number of symptoms that create psychological discomfort. These symptoms include:13
- Dysphoria (sense of unease or dissatisfaction).
- Inability to experience pleasure (anhedonia).
Many of the physical withdrawal symptoms will subside after a few days; however, the psychological symptoms like anxiety and dysphoria may persist for longer periods of time and add to the risk of relapse back to heavy drinking.16
Because withdrawal can be very serious, even life-threatening, medical detox is the safest way to overcome a physical alcohol dependence. During alcohol detox, medications may be used to keep you stable and decrease the likelihood of seizures. In the case of a medical emergency, you’ll be surrounded by professionals who will vigilantly monitor your symptoms and act immediately, should complications arise.13 Medical detox is the frequently the first step in a person’s recovery from alcohol addiction, and it is often followed by inpatient or outpatient treatment.
Treatment After Detox
Alcohol addiction treatment may take place in either an inpatient or outpatient setting. In both forms, intensive counseling and therapy help patients find positive ways of dealing with the stress and pressures that led them to abuse alcohol. Rehab may also include group therapy and support groups such as Alcoholics Anonymous (AA).
Ethanol (alcohol) is abused at a higher rate than any other drug among treatment program attendees, as reported by a 2017 survey from Recovery Brands.
Nearly 70% of people who took the survey went to treatment to get help with a drinking problem, and a surprising 52.87% of those who responded reported seeking treatment for a problem with alcohol more than any other substance. No matter how many substances of abuse there are, the one that causes the most extensive harm is ethanol.
Residential treatment programs lasting from 30 days to 90 days and beyond are available throughout the country. Amenities will vary, but many luxury programs are situated in beautiful locales such as near the beach or in the woods to make your experience in treatment a peaceful and calm one. Sometimes, inpatient rehab will include medical detox at the start of the program so there is a seamless transition from withdrawal management to ongoing treatment efforts.
Outpatient treatment is another option that serves as either an alternative to inpatient rehab or as a step-down level of care once an individual’s rehab stay comes to an end. Outpatient treatment tends to be less time intensive and more affordable and allows the individual to live at home and attend to daily responsibilities outside of treatment hours. Because living at home at the start of recovery can be challenging for someone faced with the daily temptations of using, outpatient treatment may not be the ideal form of care for someone struggling with a severe alcohol addiction or who faces many triggers and lacks a supportive network.
When you are ready to find a treatment center you can browse through an online directory of programs. You may want to create a list of questions you have before calling, such as:
- What insurance do you take?
- How much does treatment cost?
- What is the average length of stay?
- Are private rooms available?
- What is the typical schedule?
- What therapies do you use?
- Where can I read staff bios and profiles?
Alcoholism can destroy your health and your life. Reach out for help today. Recovery from addiction is possible with the right treatment.
- Harvard School of Public Health. (n.d.). Alcohol: Balancing Risks and Benefits.
- GBD 2016 Alcohol Collaborators. (2018). Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet, 392(10152), 1015-1035.
- Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
- Centers for Disease Control and Prevention. (2018). Fact Sheets – Binge Drinking.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). Overview of Alcohol Consumption.
- National Institute on Alcohol Abuse and Alcoholism. (2004). ALCOHOL’S DAMAGING EFFECTS ON THE BRAIN.
- University of Michigan. (n.d.). The Effects of Combining Alcohol with Other Drugs.
- Centers for Disease Control and Prevention. (2018). Basics about FASDs.
- The American College of Obstetricians and Gynecologists. (2015). Alcohol and Women.
- Swift, R., & Davidson, D. (1998). Alcohol hangover. Alcohol Health Res World, 22, 54-60.
- National Institute on Alcohol Abuse and Alcoholism. (1995). Alcohol Alert.
- Center for Substance Abuse Treatment. Detoxification and Substance Abuse Treatment. Treatment Improvement Protocol (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131. Rockville, MD: Center for Substance Abuse Treatment, 2006.
- National Institute on Alcohol Abuse and Alcoholism. (2016). Alcohol Use Disorder: A Comparison Between DSM-IV and DSM-5.
- National Institute on Drug Abuse. (2018). The Science of Drug Use and Addiction: The Basics.
- National Institute on Alcohol Abuse and Alcoholism. (n.d.). Alcohol Dependence, Withdrawal, and Relapse.