How Much Is Too Much When It Comes to Alcohol?

Imagine you're preparing for a festive get-together. You've laid out an assortment of cheeses, lit a few candles, and you're now deciding on drinks. Wine? Beer? A soft drink? As someone who’s looking to quit or cut back on alcohol, you might wonder — how much alcohol is actually too much? You might be surprised to know that when it comes to alcohol, less is always more. Let's explore the science behind it.

CDC Recommendations Over the Years

Over the last few decades, the CDC has been our go-to for answers about the limits of alcohol consumption. Let's see how their stance on booze has evolved over the decades.

• 1980s. The CDC started recognizing the dangers of heavy alcohol consumption, noting its links to traffic accidents, violence, and various health issues. Their primary focus was on waving a red flag on binge drinking to keep us safe from alcohol-related injuries and accidents.
• 1990s. The conversation expanded to address the potential health benefits of moderate alcohol consumption, particularly related to cardiovascular health. The guidelines of the time acknowledged that moderate alcohol consumption might have some protective effects, especially for older adults. (Spoiler alert — many of these claims have now been debunked).
• 2000s. As research developed, the CDC introduced the concept of “moderate drinking.” The magic numbers? Up to one drink a day for women and up to two drinks a day for men.
  
  Why these specific amounts? The human body breaks down alcohol at a fixed rate, and these recommendations are rooted in how the average person's liver processes alcohol. Consuming more than the CDC's guidelines can lead to a buildup of alcohol in the bloodstream, which affects brain functioning, reflexes, and decision-making. Chronic excessive drinking can also lead to a slew of health issues, including liver disease, high blood pressure, and certain types of cancer.
• 2010s. Plot twist! Just when we thought we had a grip on the alcohol narrative, in this decade we were thrown a curveball. While the guidelines for moderate drinking remained consistent, awareness of the risks associated with even low levels of alcohol consumption continued to grow. Studies began to suggest that no amount of alcohol is entirely safe, leading the CDC to be more cautionary in its communication about potential benefits. By the latter half of this decade, there was a notable shift towards a more holistic approach that takes into account not just the physiological effects but the societal and mental health implications of alcohol consumption.
• 2020s. The message now? Tread carefully. While the CDC continues to focus on the dangers of excessive drinking, they have also shed light on the fact that no drink is 100% risk-free. There has also been an effort to destigmatize alcohol-related disorders and promote more supportive terms such as “alcohol use disorder” instead of “alcoholism” or “alcoholic.”

A Word From the WHO

In addition to the CDC, the World Health Organization has also provided guidelines about alcohol use over the years. As a global organization, the WHO doesn’t provide specific guidelines, instead focusing on publicizing the dangers of excessive alcohol use and encouraging each country to set national guidelines based on its population’s drinking patterns and related harm.

Their data suggests that 58% of all global alcohol consumers partake in heavy episodic drinking, which they define as consuming 60 or more grams of pure alcohol on at least one occasion in the past 30 days. This translates roughly to five or more drinks for men and four or more for women over a 2-hour period.

Alcohol Guidelines Around the World

It should come as no surprise that specific recommendations for alcohol consumption vary by country. This disparity stems from cultural differences, varying research interpretations, and different societal norms. Let’s explore how much alcohol is too much per week according to different guidelines around the globe!

• Australia. In “the Land Down Under,” the advice is to stick to no more than 10 drinks a week, and definitely no more than 4 in a day.
• Canada. Canadian guidelines are even more stringent. As of 2023, the Canadian Centre on Substance Abuse and Addiction suggests that 2 standard drinks per week (or less) is least likely to lead to alcohol-related consequences.
• United Kingdom. The Brits keep it uniform for everyone by recommending drinkers to stick to 14 units a week, ideally spread over at least three days.
• South Africa. South Africans are advised not to exceed 14 units of alcohol a week, making their guidelines similar to those in the UK.
• France. The French, famous for their wine, recommend a maximum of two glasses per day, which shouldn't exceed 10 glasses per week.
• Germany. German guidelines suggest men consume no more than 24 grams of pure alcohol daily (roughly two drinks), and women limit themselves to 12 grams (about one drink).
• Brazil. Brazil advises men to limit their alcohol intake to 21 units per week and women to 14 units per week. The country also places strong emphasis on the dangers of binge drinking.
• India. With a significant portion of the population abstaining from alcohol for religious and cultural reasons, those who do drink are advised to limit their consumption. Guidelines suggest up to two drinks per day for men and one for women.
• China. While traditional beverages like baijiu are popular, moderation is key. Guidelines suggest no more than 25 grams of pure alcohol for men and 15 grams for women daily.
• Japan. In Japan, moderate drinking is characterized as up to one drink per day. However, it's worth noting  that societal norms often influence drinking habits, especially among men, and heavy drinking can sometimes be seen as a bonding ritual.

Recent Twist: A Closer Look

Remember the plot twist we mentioned earlier — the one based on recent studies that challenged the idea that some alcohol might be beneficial? Let’s explore it a bit further.

For years, a glass of wine with dinner or the occasional beer was touted as not just harmless, but even beneficial. Numerous studies suggested that moderate drinking might offer some protection against heart diseases, strokes, and even early death. These studies painted a rosy picture: moderate drinkers might live longer and healthier than heavy drinkers or even teetotalers.

As with all scientific discoveries, however, newer insights can challenge old beliefs. In March 2023, JAMA published a closer examination of the studies linking moderate alcohol consumption to a lower risk of death, suggesting that most did not stand up to scrutiny. The primary concern? Design flaws. Many of the former studies categorized both lifelong abstainers and former drinkers who quit due to alcohol-related health problems under the same umbrella as "non-drinkers." Doing so skewed the results: comparing moderate drinkers to a group that included people who've quit drinking due to its harmful effects on their health created the illusion that the moderate drinkers were “healthier.” 

Is Any Amount of Alcohol Safe?

A landmark global study in the 2018 issue of Lancet added more weight to the idea that moderate drinking might not be as healthy as once thought. Analyzing data from hundreds of thousands of participants, it concluded that the safest level of drinking is actually none at all! Even moderate drinking was linked with increased risks of various ailments, including cancer and injuries. 

The key takeaway? A growing body of evidence suggests that no amount of alcohol is entirely risk-free.

While the occasional drink isn't being labeled as a direct ticket to health issues, it's clear that the previous claims of its health benefits are on shaky ground. The shift is now more towards caution, emphasizing that while an occasional drink might not be harmful for many, it doesn't come with the health perks we once thought.

In the end, the alcohol narrative is a reminder that science is ever-evolving. What's crucial is staying informed and making choices that align with both current research and individual needs. In particular, it’s important to be mindful of the unique vulnerabilities of certain groups, such as pregnant women, adolescents (whose brains have not completely developed and are more likely to suffer serious consequences of alcohol misuse), and the elderly (whose health might be compromised by other conditions).

More Changes on the Horizon

There might be even bigger changes on the horizon when it comes to alcohol recommendations in the U.S.

According to George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism, there has been talk about tightening the guidelines even further — to as little as 2 drinks per week. The new recommendation comes from the U.S. Department of Agriculture (USDA), and it matches the guidelines already established in Canada.

The process of revising the guidelines is set to be completed by 2025, so the verdict is still out.

However, as Koob sums up the future of alcohol guidelines in an interview with The Daily Mail, "I mean, they're not going to go up, I'm pretty sure. So, if [alcohol consumption guidelines] go in any direction, it would be toward Canada."

What Is an "Alcoholic"?

Finally, let’s touch on a sensitive topic that comes up when discussing how much is truly “too much” with respect to booze — the often dreaded words “alcoholic” and “alcoholism.” 

Because the term "alcoholic" can be misleading and stigmatizing, the medical community now uses "Alcohol Use Disorder" (AUD) — a condition characterized by an inability to stop or control alcohol consumption despite adverse social, occupational, or health consequences. It takes into account a spectrum of severity — mild, moderate, or severe — based on the number of symptoms a person exhibits. The shift from the term "alcoholic" to understanding AUD marks a move towards a more nuanced, empathetic, and medically informed perspective on alcohol-related issues.

Here are some of the key indicators of AUD:

• Uncontrolled consumption: drinking more alcohol or for longer periods than intended

• Desire to cut down: persistent desire or unsuccessful attempts to cut down or control alcohol use

• Time spent: spending a lot of time obtaining, using, or recovering from the effects of alcohol

• Craving: a strong desire or urge to consume alcohol

• Impact on responsibilities: recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home

• Interpersonal issues: continued alcohol use despite having social or interpersonal problems caused or worsened by drinking

• Relinquished activities: important social, occupational, or recreational activities reduced or abandoned because of alcohol use

• High-risk usage: using alcohol in situations where it's physically hazardous

• Tolerance: needing more alcohol to achieve the desired effect or finding that the same amount has a reduced effect over time

• Withdrawal symptoms: experiencing withdrawal symptoms when alcohol effects wear off, or consuming alcohol (or a similar substance) to avoid withdrawal symptoms

• Neglect of physical and mental health: alcohol use is continued even though it's known to cause or exacerbate physical or psychological problems

Meeting just two of these criteria in a 12-month period may indicate the presence of AUD, with the severity (mild, moderate, or severe) determined by the number of criteria met.

Action Steps: Navigating Alcohol Consumption

If you're looking to quit or cut back on alcohol, here are seven specific, actionable steps you can take:

• Know your limits. Familiarize yourself with the CDC guidelines or those of your country.
• Opt for non-alcoholic beverages. Try out mocktails, herbal teas, or sparkling waters when socializing.
• Seek support. Join support groups or networks for individuals reducing alcohol consumption (Reframe is a great place to start!).
• Avoid triggers. Recognize what prompts you to drink and try to plan around those situations and people.
• Stay active. Engage in physical activities or hobbies to distract from the desire to drink.
• Educate yourself. Stay up-to-date on recent research on alcohol to keep your motivation high.
• Consult professionals. If you feel you might have AUD, don’t hesitate to seek professional advice!

In the end, how alcohol fits into your life is a personal decision. If you’re considering cutting back or quitting, remember this: the festive get-togethers, celebrations, and activities that you might have previously associated with alcohol will bring you just as much — and possibly more — joy in the future. Every step you take towards reducing your consumption is a victory. Stay informed, seek support, and celebrate the small wins!