How much alcohol is too much?

If you drink alcohol, you may wonder, “How much is too much?” The question comes up in annual physicals when we ask patients about how often and how much they drink.

Patients also ask us about the health benefits of alcohol, partly because of news headlines like those that highlight the advantages of antioxidants in red wine. (Yes, there are some antioxidants, but you can also find them in fresh berries.)

While you may feel like there’s an upside to an occasional glass of wine, there are also plenty of risks with alcohol consumption, so knowing the details is a good idea.

Defining heavy drinking

The Dietary Guidelines for Americans recommend drinking in moderation or limiting alcohol intake due to associated health risks. Previous guidelines included daily drink recommendations: no more than two for men and one for women. Recommendations also said that no one should consume more than six drinks in one sitting.

Standard measurements for a single drink include:

• 12 oz. of beer
• 5 oz. of wine
• 1.5 oz. of hard liquor

It's important to note that any alcoholic drinks, even less than the recommended maximums, can have an impact on health. To put it another way, any perceived benefits of alcohol won’t outweigh the harms.

Recognizing alcohol misuse

Symptoms that your alcohol use may be a problem can manifest in many ways. Common signs include:

• an inability to stop drinking
• drinking more than intended
• a need to drink to feel normal.

Drinking that causes poor job performance or decision-making, or that damages personal relationships, is also a sign of a serious problem that may require help. 

Dangers of drinking too much

There are immediate concerns about drinking too much that are widely known, including how being drunk can impair your judgment and dull your reflexes, which can put you and people around you at risk. There are also long-term effects of overindulging that may be less obvious but are just as detrimental.

Physical impacts of drinking too much

Alcohol can affect many of your body’s organ systems. Frequent and excessive alcohol use can cause liver damage and failure (cirrhosis), heart disease, arrhythmias like atrial fibrillation, memory loss and permanent balance impairment. It can affect your blood and cause anemia, vitamin deficiencies and electrolyte imbalances. There is also increasing scientific evidence that drinking alcohol can increase the risk of some types of cancer. 

Alcohol’s effect on daily energy, irritability and sexual health is often overlooked, but even drinking that’s under the recommended guidelines can cause many of these problems. Drinking alcohol can also cause significant sleep disturbances and hormone imbalances.

Mental health impacts of drinking too much

Alcohol is a depressant. It not only affects your physical health by altering your body chemistry, but it also affects your mental health and the way you perceive the world around you. You may feel elated or happy when first consuming alcohol, but over time, regular drinking can lead to depression, increased anxiety and poor sleep quality. 

Benefits of reducing alcohol consumption

Your physical and mental health will drastically benefit by staying well under the daily recommendations for alcohol consumption and saving drinks for special occasions.

Many people who stop or cut back on drinking find that they eliminate heartburn, lose some weight that was always hard to shed, and improve many of their relationships. 

By consuming less alcohol, you may notice a host of improvements, including:

• energy
• exercise tolerance
• gut health
• heart health
• sleep.

Men may see improvements in weight and muscle mass that come with better exercise performance. Women may notice improvements in hormonal balance, the effect of exercise and overall health.

Some people find that completely abstaining from alcohol makes it easier for them to reach personal health goals and feel better overall.

Ideas for avoiding alcohol

If you feel social pressure to drink, you’re not alone. Many people do. The good news is that the stigma of being sober at get-togethers is fading, and more people are passing on alcohol in favor of mocktails, soft drinks or ice water.

If you’re worried about parties, consider scripting your “no” for when you may face pushback. Quick, clear responses made with good eye contact can be effective:

• "No, thank you.”
• “I’m not drinking tonight, but thanks.”
• “Thank you, but I’m not drinking right now.”

If someone persists, you might let them know that you’re focused on your health and prefer something other than alcohol.

The 1-2-3 rule

Some people who want to reduce but not eliminate alcohol follow what’s called the “1-2-3” rule for drinks:

• No more than one drink per hour.
• No more than two drinks per occasion.
• No more than three drinks per day.

While this can help with moderation, it overlooks the previously mentioned research that says, for your health, no level of alcohol is safe.

Getting help to deal with drinking

Regulating or eliminating alcohol use requires a good plan and significant commitment.

If you feel like you are unable to stop drinking or you may have a problem drinking, reach out to someone you trust for support. An appointment with your primary care doctor can be a good first step.

There are numerous treatment options, medicines and support groups that can help you navigate what can be a difficult disease. Your health care provider can create a judgment-free zone to discuss your struggles and come up with ideas that may help.