What is “Moderate” Drinking & How Much is “Too Much”?

The Definition of “A Drink”

Before discussing how much drinking is “too much” (i.e., the limits of moderate drinking versus alcohol abuse), first we have to define what we mean by “a drink”.  According to public health agencies in the U.S., a standard drink is defined as a serving that contains approximately 14 grams of ethyl alcohol. As illustrated below, this amount of alcohol is found in a 12 oz serving of beer, a 1.5 oz serving (“shot glass”) of hard liquor (e.g., vodka, scotch, vermouth, brandy, bourbon, rum, etc.), or a 5 oz. glass of wine. Although these drinks are different sizes, each contains approximately the same amount of alcohol and thus each counts as one standard drink.  Cocktails (mixed drinks) often contain 2-3 standard drinks depending on how they are made. A bottle of table wine (750 ml) holds about 5 standard drinks. A “fifth”of liquor (750 ml) contains 17 standard drinks.

The Definition of Moderate Drinking

While no amount of alcohol consumption is considered entirely safe and without risk, “low risk” or moderate drinking has been defined by various health organizations as drinking that does not cause problems or increase the risk of problems for the drinker or for others. Generally speaking, moderate drinkers are able to enjoy the positive effects of alcohol, such as feeling more relaxed and sociable, without exceeding moderate drinking limits and suffering adverse consequences.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and other public health agencies, the limits of moderate (low risk) drinking are generally defined as no more than 4 standard drinks in a single day for a healthy adult man with a maximum of no more than 14 drinks in a given week. The limits for a healthy adult woman are up to 3 drinks in a single day and no more than 7 drinks in a given week. These are not recommended levels of alcohol consumption, but rather the upper limits of what is considered moderate drinking not likely to cause problems, which may be substantially lower for some people. It is estimated that 70% of adults in the U.S. drink within these “low risk” limits, including people who do not drink at all.

Moderate drinking means limiting not only the number of drinks consumed in a given day, but also the rate of drinking so that the drinker’s blood alcohol concentration (BAC) does not rise too quickly or too high. For most people, this means drinking no faster than one drink per half-hour.

Moderate Drinking Limits for Men vs. Women

The separate drinking guidelines for men and women emanate from research showing that women become more intoxicated than men after consuming the same amount of alcohol. This is due in part to significant gender differences between in the activity of an enzyme in the stomach that breaks down alcohol before it reaches the bloodstream. This enzyme is four times more active in males than in females. In addition, women have proportionately more body fat and less water content than men. Because alcohol is more soluble in water than in fat, a given amount of alcohol becomes more highly concentrated in a woman’s body than in a man’s. Research shows that women experience alcohol-related problems at lower drinking levels than men do.

When Does Moderate Drinking Become Problem Drinking?

The answer to this question depends not only on how much alcohol a person consumes, but also on how drinking affects their behavior; i.e., what actually happens when they drink. For example, drinking too much causes some individuals to become irritable, argumentative, and angry, while others become quiet, withdrawn, and depressed. Also, some people develop medical problems related to drinking at much lower levels of alcohol consumption than do others.

For healthy adults, drinking more than the maximum single-day or weekly moderation limits defined above is considered “at-risk” or “heavy” drinking.  About 1 in 4 people who drink above these limits qualify for a diagnosis of Alcohol Abuse or Alcohol Dependence, and the rest are generally at increased risk for developing alcohol-related problems.

When evaluating a person’s drinking pattern, it is important to take into account not only how much alcohol that person consumes on a given drinking day, but also how often he or she has a “heavy drinking” day—that is, more than 4 drinks in a day for men or more than 3 drinks in a day for women. The more drinks consumed in a typical drinking day and the more frequently that heavy drinking days occur over time, the greater the chances of experiencing significant alcohol-related problems.

Problem Drinking  (Alcohol Abuse)

(also known as Harmful or Hazardous Drinking) is defined as alcohol consumption that exceeds the moderation limits as specified above and causes significant problems for the drinker and/or others, even if these problems are not dramatic or severe. For example, drinking that causes hangovers and/or creates conflict with others are potential signs of problem drinking or alcohol abuse. Problem drinkers generally do not experience an overwhelming compulsion to drink, do not drink excessively on a daily basis, are not physically dependent on alcohol, and do not neglect responsibilities at home or work due to drinking. For a list of early warning signs of Problem Drinking (Alcohol Abuse), click here.

Alcohol Dependence (Alcoholism)

This is a much more serious condition. Alcoholic drinkers are typically unable to control their drinking once they start (i.e., they have no “off” switch for drinking) and often continue to drink, despite suffering severe and sometimes life-damaging or irreversible consequences. Many experience cravings, urges, and an overwhelming compulsion to drink. Some alcoholics experience withdrawal symptoms when they try to stop drinking, but others do not. Withdrawal symptoms may include, for example, agitation, extreme anxiety, insomnia, shaking, headaches, and vomiting. Some alcoholics drink every day, but many have an episodic binge pattern in which they drink heavily for one or more days in a row, then stop for days or weeks at a time before starting another binge.  For a list of signs of Alcohol Dependence, click here.