If you like to enjoy a beer, glass of wine or cocktail at dinner or when socializing, you are not alone. Two-thirds of American adults have consumed alcohol in the last year, according to 2024 data from the National Survey on Drug Use and Health (NSDUH). Many people are able to enjoy alcohol responsibly, but it’s important to know how to recognize if drinking becomes a problem.
April is Alcohol Awareness Month, a good time to revisit health guidelines around alcohol and set the stage for a healthy relationship with alcohol year-round.
“A lot of us like to enjoy a drink or two,” says Dr. Triwanna Fisher-Wikoff, a family practice physician in Fort Worth. “Moderate, responsible drinking is OK for most people, although folks with certain underlying health conditions may need to avoid alcohol altogether. The danger comes when moderate drinking becomes excessive. Your doctor is here to help you cut back if you need to.”
Excessive Drinking is a Major Health Threat
According to 2020-2021 data from the U.S. Centers for Disease Control and Prevention (CDC), excessive alcohol use causes around 178,000 deaths each year. This represents a significant 29% increase over 2016-2017. Most of these deaths occurred among adults 35 and older, but 4,000 young people – under age 21 – also lose their lives to alcohol annually.
The people who die from excessive alcohol consumption are losing their lives, on average, 24 years early – basically, a third of the average American lifespan. These early deaths are mostly attributed to negative health effects from excessive drinking, such as cancer, heart disease and liver disease. However, a substantial number of deaths are also due to drunk driving.
While there is not a clear reason why alcohol-related deaths jumped so significantly in just a few years, it is believed that the COVID-19 pandemic played a role. The social isolation brought on by the pandemic may have led more people to drink and drink more heavily. Additionally, people were less likely to seek out health care when they became ill during this time.
Alcohol has also become even more widely available in the last few years: we can now order drinks to go through meal delivery services, another development that was spurred on by the pandemic. Whatever the reasons, it is clear that excessive drinking is a serious health threat in this country.
How Does Alcohol Affect Us?
Alcohol, also known as ethanol or ethyl alcohol, is found in beer, wine and liquor. When we drink alcohol, it is absorbed into our bloodstream from the small intestine and stomach. The liver works to metabolize alcohol but can only handle a small amount at a time. If we drink too much for the liver to keep up with, the result is excess alcohol circulating throughout the body. This leads to intoxication.
Alcohol’s intoxicating effects on the body are significant. It serves as a depressant to the central nervous system, affecting the brain, speech and motor reflexes. It slows the body’s response time, can blur vision and make it difficult to walk and talk. The potent effects of intoxication are why it is so dangerous to drink and drive.
Alcohol impacts people differently. Age, gender, weight and how much we have had to eat recently are all factors that affect alcohol’s interaction with our bodies. These factors impact how much alcohol it takes to reach the point of intoxication.
Drinking too much alcohol can result in dehydration, exhaustion, headaches and nausea. These are side effects that can extend to the next day, a condition commonly referred to as a hangover.
Long-term Impacts of Excessive Drinking
Heavy drinking’s negative effect on the body isn’t gone when the hangover goes away, however. Excessive drinking can cause lasting health problems, including:
- Heart disease: Excessive alcohol use is a leading contributor to heart disease. Heart problems related to heavy alcohol consumption include:
- High blood pressure
- Cardiomyopathy (stretching of the heart muscle)
- Stroke
- Arrhythmia (irregular heartbeat). Even one episode of heavy drinking can cause the heart to beat irregularly.
- Liver problems: These include cirrhosis (scarring) of the liver, fatty liver and alcoholic hepatitis.
- Pancreatitis: This is an inflammation of the pancreas that causes digestive problems.
- Cancer: Excessive alcohol consumption is linked to several forms of cancer in men and women, including cancers of the breast, liver, mouth, esophagus, colon and larynx.
- Cognitive problems: Alcohol can change how the brain works, affecting behavior and memory over time.
- Immune system problems: Excessive alcohol consumption compromises the immune system, increasing risk of illness.
- Weight gain: Alcoholic drinks contain a lot of calories and contribute to weight gain.
Who Should Avoid Alcohol
While anyone who drinks needs to limit alcohol consumption to recommended levels, there are some who should avoid drinking altogether, including:
- Anyone under the age of 21
- Anyone who will be driving or operating heavy machinery the same day
- Anyone with a medical condition that alcohol may exacerbate
- Anyone on a prescription medication that interacts with alcohol
- Women who are pregnant. There is no safe level of alcohol that may be consumed during pregnancy. Alcohol use during pregnancy increases the risk of birth defects and other complications.
How Much is Safe to Drink?
Long-standing health guidelines say women should not have more than one drink per day and men should not have more than two.
Why is it that a woman’s drink limit is half that of a man? It has to do with the water content of the human body.
When we consume alcohol, it swims around in the water within our bodies until the liver can catch up and metabolize it. Women have far less water content than men, meaning it takes less alcohol to become intoxicated.
It’s important to note this dynamic is separate and apart from body weight’s effect on our intoxication point: if a woman and man who are the same weight drink the same amount of alcohol, the woman’s blood alcohol content (BAC) will usually be higher.
These guidelines are meant as limits each day – they are not averages! In other words, if a man only drinks on Fridays and Saturdays, he cannot safely drink seven drinks those two days. The recommended limit is still two drinks per day, no matter how often he drinks alcohol.
What is a Drink?
This may seem like a question with an obvious answer, but it’s one that needs to be explored.
“A drink” is not just how much wine, beer or liquor happens to be poured in your glass or beer mug. A standard drink refers to a specific amount of alcohol – 0.6 ounces, or 14 grams.
With that metric in mind, the following servings are equal to one drink:
- A 12-ounce beer (approximately 5% alcohol content). Note that some beer, such as an IPA, have higher alcohol content.
- A 5-ounce glass of wine (12% alcohol content)
- A 1.5 ounce shot of liquor, such as whiskey, vodka or tequila (40% alcohol content)
“Try to be mindful of these numbers when you are pouring a drink at home or you’re out and about,” advises Dr. Daniel Tran, a family medicine physician in Fort Worth. “If you’re at a sports bar and have two pints of beer, that’s 32 ounces – nearly three drinks. If you order a 9-ounce pour of Cabernet sauvignon to go with your dinner, you’re being served two drinks.”
Excessive Drinking
Excessive drinking is generally classified a couple of different ways, neither of which are mutually exclusive.
- Binge drinking is when a person consumes a large amount of alcohol at one time. Five drinks for men and four for women within a two-hour period is considered binge drinking. These also represent the number of drinks, on average, that causes a person’s blood alcohol level to rise to 0.8 percent, at which point a person is considered legally intoxicated. Keep in mind, everyone is different and it’s possible to become legally intoxicated after fewer drinks.
- Heavy drinking, as defined by the CDC, occurs when a man has 15 or more drinks within one week and a woman has 8 or more drinks within a week.
While binge drinking and heavy drinking are harmful to our health and should be avoided, they do not necessarily indicate the medical definition of an alcohol use disorder. In fact, the CDC reports that 90% of people who are heavy drinkers and/or binge drinkers do not meet the criteria for a severe alcohol use disorder.
“Even if someone does not have alcohol use disorder, excessive drinking is still bad for them,” explains Dr. Lynne Tilkin, a Fort Worth family practice physician. “Heavy drinking increases the risk for numerous chronic health problems, such as cancer. Binge drinking can lead to poor judgment and decision making, injury and even death.”
Drinking’s Effect on Older Adults
Do you feel like alcohol affects you differently than it did 10 or 20 years ago? That’s not your imagination – our bodies process alcohol differently as we age.
For one, adults tend to start losing muscle mass after age 30. Our muscles are where much of our body water resides. Less muscle means less water, which means reduced capacity to disperse alcohol. All of this leads to inebriation faster. It also means the two glasses of wine you could once handle just fine may now result in a hangover.
Compounding this problem is that the liver works less efficiently as we age. It’s slower to break down alcohol, so it remains in your system longer,
Finally, the older we get, the more likely we are to be taking medication on a regular basis. Many medicines interact negatively with alcohol and may exacerbate its impact on the body.
Alcohol Use Disorder
Alcohol Use Disorder (AUD), also known as alcoholism or alcohol dependence, is classified as a chronic brain disease. Signs of AUD include compulsive alcohol consumption, a lack of control over the amount of alcohol consumed and a craving for alcohol when not drinking.
AUD can be influenced by heredity, so sometimes people have limited ability to control their desire for alcohol. If someone is dependent on alcohol, they need professional help and should not be afraid to seek it. Removing the stigma associated with AUD is one of the most important things that can be done to get more people the help they need.
While there is not a clear-cut test or exam to diagnose AUD, there are a number of characteristics people with the disorder tend to exhibit:
AUD Treatment
“It’s normal for some patients to have difficulty stopping drinking on their own,” says Dr. Lindsay Brooks, an internal medicine physician in Fort Worth. “Not only can your doctor help, we want to help! Alcohol affects everyone differently, and there is absolutely no shame in talking with us. In fact, it’s a clear example of personal responsibility and bravery.”
Common treatments for AUD include behavioral treatments, prescription medication and mutual support groups. These include groups such as Alcoholics Anonymous, which provide peer support to help people quit drinking.
Youth and Alcohol
Among the many things parents worry about for their children are the dangers of alcohol. Alcohol is the most used drug among American youth. According to the 2024 NSDUH, 21% of youth ages 12-17 have consumed alcohol.
Even more alarming, 16% of high school students reported riding with a driver who had been drinking. The good news is the percentage of youth drinking and binge drinking has declined over the last few decades.
It is important parents talk with their teens about the dangers of alcohol and the reasons to avoid it. Parents must also be mindful of their own drinking habits around their kids. Studies show that young people are more likely to drink if they see adults binge drinking. “The most important thing we can do as parents is model good behavior – our kids are always watching and learning from us,” says Dr. William Bass, a Fort Worth family practice physician.
Ask for Help
If you’ve noticed your alcohol consumption has increased over time and you are exceeding one or two drinks a day, that’s a warning sign that it is time to slow down – or stop. Some people arrive at that realization and can cut back just fine on their own. Others need more help. If you think you may drink too much, make an appointment to visit with your physician today. He or she is there to help you.
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
The U.S. Centers for Disease Control and Prevention
