How Much Alcohol is Too Much? And How It Can Impact Your Health

April is Alcohol Awareness Month. Alcohol abuse is a major public health issue, and there is evidence to suggest that the global pandemic is exacerbating this problem.

How much are Americans drinking?

Alcohol use is prevalent in the U.S. The 2019 National Survey on Drug Use and Health (NSDUH) revealed that the majority of U.S. adults—70%—drank in the past year, with 55% reporting that they consumed alcohol within the past month.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines “low-risk drinking” as no more than three standard drinks on a single day and no more than seven standard drinks per week for women. For men, it is defined as no more than four standard drinks per day and no more than fourteen standard drinks per week. Two percent of individuals who fall into this low-risk drinking pattern meet the criteria for alcohol use disorder [1].

Click here to learn more about what is considered a “standard drink” and whether alcohol can fit into a healthy lifestyle

Binge drinking is defined as roughly five or more drinks within a two-hour period for men, and four drinks for women. Heavy alcohol use is defined as five or more binge drinking episodes in a month [2]. According to the 2019 survey mentioned above, 26% of individuals report engaging in binge drinking, and 6.3% reported partaking in heavy alcohol use [3].

binge-drinking

It's worth noting that while binge and heavy drinking patterns increase the risk of alcohol use disorder, nine out of ten individuals who binge drink do not meet the criteria for alcohol abuse disorder [4].

Unfortunately, alcohol use disorder (AUD) affects over 15 million Americans and appears to be on the rise both in the U.S. and globally. The NIAAA defines alcohol use disorder, a diagnostic term, as “chronic relapsing brain disorder characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.” Factors that increase the risk of AUD include drinking in a binge-like or heavy manner, family history and genetics, drinking at an early age, and mental health conditions. To learn more about AUD, visit the NIAAA’s website.

What happens when you drink too much?

Short-term consequences of excessive alcohol intake include alcohol poisoning, harm to a developing fetus during pregnancy, and impaired memory and judgment, which can lead to injury, violence, and risky sexual behaviors. In the long term, excessive alcohol consumption increases the risk of alcohol use disorder, mental health disorders, and chronic diseases, including heart disease, liver disease, dementia, and several types of cancer [5].

Alcohol consumption is the third leading preventable cause of death in the U.S. A study conducted by the Centers for Disease Control (CDC) found that 88,000 deaths a year can be attributed to alcohol consumption [6]. Furthermore, in a 2016 study, alcohol was found to be a leading cause of death for people age 15-49 years old.

People are drinking more than recommended

The U.S. Dietary Guidelines for Americans (DGA) recommends that individuals who choose to drink limit alcohol to two standard drinks per day for men and one standard drink per day for women. However, recent research suggests that alcohol use, particularly in excess, is increasing. For example, a meta-analysis published in 2018 demonstrated significant increases in alcohol use, particularly in certain demographic groups, such as women. “Substantial” increases in binge-drinking in middle-aged and older adults were also noted [7].

Another prospective study examined patterns of alcohol consumption over time relative to the DGA recommendations. This study, which compiled data from individuals over a fifteen-year period, found that 11.1% of men and 12.3% of women had a mean alcohol intake greater than the DGA recommendations. Furthermore, 73.1% of men and 60.1% of women drank more than is recommended on a typical "drinking day."⁠ In line with other studies, data from this study suggests that the number of women who are drinking in excess of the guidelines is increasing with time; in contrast, the number of men drinking in excess of the guidelines is decreasing. ⁠

Furthermore, compared with one standard drink per day, intake of more than one alcoholic beverage on a "drinking day" was associated with an increased risk of death due to any cause for both men and women.⁠ Mean alcohol intake in excess of the DGA recommendations was associated with increased risk of all-cause mortality and cancer mortality in men and women, and death due to cardiovascular disease/stroke in men.⁠ According to this data, a significant proportion (19-26%) of deaths attributable to alcohol intake could be prevented if Americans followed the recommendations on alcohol intake outlined in the Dietary Guidelines for Americans.

How has alcohol use changed during the pandemic?

At the beginning of the pandemic, there was a staggering increase in national alcohol sales of 54% and online alcohol sales of 262% from the year before. A study published in the Journal of the American Medical Association found that the frequency of alcohol consumption increased by 14% during the early months of the pandemic. What’s more, a 41% increase in heavy drinking was observed in women. Some hospitals are noting an uptick in hospitalizations for alcoholic liver disease [8]. While alcohol sales may be declining from this time last year, they are still significantly higher than they were in 2019 [9].

Are the trends changing?

In contrast to these documented increases in risky drinking behaviors, we are seeing more and more people exploring their relationship with alcohol and engaging in the sober curious movement. Challenges like “Dry January” and “Sober October,” which invite people to take a month-long break from alcohol, are growing in popularity. Younger generations, namely Generation Z, are imbibing less than previous ones when they were the same age [10]. When asked about the reasons for this shift, Gen Zers cited health concerns, costs associated with “going out,” and diminished appeal. Companies are racing to develop non-alcoholic beers, wine, and spirits [11]. Of course, we are also seeing an explosion of non-alcoholic brands and products to keep up with this increase in demand.

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Getting Help

If you're concerned about yourself or a loved one’s alcohol use, talk openly with a healthcare provider. The NIAAA offers reliable online resources, including a Treatment Navigator, which contains information about how to talk with a medical provider, evidence-based treatment options, and cost and insurance coverage. The Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a free and confidential hotline at 1-800-662-HELP (4357) and provides information and treatment referrals in English and Spanish 24/7, 365 days a year. You can find additional information and resources on their website at https://www.findtreatment.gov/.