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Logo: Rethinking Drinking - Alcohol and your health

Q & As

    Why is being able to "hold your liquor" a concern?

    For some people, it takes quite a few drinks to get a buzz or feel relaxed. Often they are unaware that being able to "hold your liquor" isn't protection from alcohol problems, but instead a reason for caution. They tend to drink more, socialize with people who drink a lot, and develop a tolerance to alcohol. As a result, they have an increased risk for developing alcoholism. The higher alcohol levels can also harm the liver, heart, and brain without the drinker noticing until it's too late. And all drinkers need to be aware that even moderate amounts of alcohol can significantly impair driving performance, even when they don't feel a buzz from drinking.

    Why are women's low-risk limits different from men's?

    Research shows that women start to have alcohol-related problems at lower drinking levels than men do. One reason is that, on average, women weigh less than men. In addition, alcohol disperses in body water, and pound for pound, women have less water in their bodies than men do. So after a man and woman of the same weight drink the same amount of alcohol, the woman's blood alcohol concentration will tend to be higher, putting her at greater risk for harm. For more information, see Alcohol: A Women's Health Issue.

    Isn't drinking good for the heart?

    For some drinkers, the answer can be "yes," depending on the amount. Regular light to moderate drinking can lower the risk for coronary heart disease, mainly among middle-aged and older adults (other factors also cut the risk, including a healthy diet and weight, exercise, and not smoking). Heavy drinking can actually increase blood pressure and damage the heart.

    Is "low-risk" drinking just another term for "moderate" drinking?

    Not exactly—the weekly amounts may be the same, but the daily ones are different, and the recommendations serve different purposes for different types of drinkers.

    • Low-risk drinking for healthy men under age 65 is no more than 4 drinks on any day and 14 per week and for healthy women (and men over 65) is no more than 3 drinks on any day and 7 per week. 

    • Moderate drinking, according to the U.S. dietary guidelines, is up to 2 drinks per day for men and up to 1 drink per day for women. (Per week, this corresponds to an upper limit of 14 drinks for men and 7 for women.)

    In the United States, most drinkers don't have a daily, low-level pattern of 1 or 2 drinks per day. Instead, they tend to have less on weekdays and more on weekends and holidays. Some heavier drinkers may look at the weekly limits of 14 or 7 drinks and wonder if they can have them all on one or two weekend days. As shown by the daily low-risk drinking levels, however, from a health standpoint, it's risky to have more than 4 drinks on any day for men or 3 for women.

    It's important to note that the low-risk drinking levels are not risk free. Light to moderate drinkers should not increase their intake beyond the moderate drinking guidelines, as this would increase their chances for alcohol-related problems.

    What medications interact harmfully with alcohol?

    Some medicines that you might never have suspected can react with alcohol, including many that can be purchased “over the counter” without a prescription. Even some herbal remedies don't mix well with alcohol. The pamphlet Harmful Interactions: Mixing Alcohol with Medicines lists medications that can cause harm when taken with alcohol and describes the effects that can result. It does not include all possible medicines that may interact with alcohol, however. Protect yourself by avoiding alcohol if you are taking a medication and don't know its effect, or talk to your pharmacist or other health care provider.

    Based on the drinking pattern results from your web site, my friends and I are in the “increased risk” or “highest risk” categories. Are you saying we're all drunks or alcoholics?

    Not at all. There's a lot of mistaken “all or nothing” thinking about alcoholism.  Many people assume there are two options:  Either you don't have a problem with drinking, or you're a “total alcoholic” whose life is falling apart. The reality is not a simple black or white, but more of a spectrum with shades of gray. An “alcohol use disorder”—that is, alcohol abuse or alcoholism--can be mild, moderate, or severe. People with an alcohol use disorder can be highly functioning, highly compromised, or somewhere in between. One of the main purposes of this Web site is to help people to become aware of the risks of heavy drinking and the early symptoms of a problem, so they can prevent more serious problems down the road.

    A related "all or nothing" misconception is that all heavy drinkers are automatically alcoholics. Some are, some aren't. Those without problems at this point are still at risk for developing alcoholism and other conditions such as liver disease in the future.

    The concept of risk is sometimes difficult to grasp. An example is high cholesterol, which increases the chances for a heart attack. Similarly, heavy drinking raises the chances for developing alcoholism. Your individual risk depends in part on how much, how often, and how quickly you drink, along with how young you were when you had a first drink, and whether you have a family history of alcoholism.

    In any case, you can reduce your chances for harm in the future. If you do not already have symptoms of an alcohol-related problem, then cutting down to within the low-risk limits is a reasonable first step.  If you already have symptoms of an alcohol problem, it's safest to quit.

    According to the drinking patterns quiz, men have an increased risk of a problem if they had more than four drinks just once in the last year, even if they normally have no (or few) drinks per week. This doesn't make sense.

    The quiz serves two purposes – one is to provide “norms” feedback that lets people know when they're drinking more than most U.S. adults, even if it's just once a year. This helps to counter a commonly held misconception that “everybody” drinks a lot.

    The second purpose is to show how different drinking patterns are linked with different rates of alcohol problems. The simple quiz generates some broad categories of results, and you describe a pattern that's at very low end of increased risk.  For someone who has one heavy drinking day a year and otherwise stays well within low-risk limits, the risk of having or developing alcoholism would be minimal.

    However, if you have more than four drinks within a short period of time on any day, you may run the risk of injuring yourself or others, particularly if you drive too soon after drinking. And if you start to increase the number of “heavy drinking days” over time, your chances for alcohol-related harm will increase as well.

    Can I do anything to protect my liver from the effects of too much alcohol?

    There are no guarantees that anything will protect the liver from too much alcohol.  Liver damage from heavy drinking happens in stages.  Some relatively mild damage may happen after a single binge drinking episode, but this reverses itself if the heavy drinking stops.  If heavy drinking continues, however, liver damage can progress through several more advanced stages, and repair becomes much more difficult, if not impossible. When the damage goes as far as cirrhosis, the only treatment is liver transplant.  The best way to protect your liver’s health is by staying within the low-risk drinking limits or -- if you already have liver damage or any signs of an alcohol problem -- by quitting.  Also, it’s best if drinkers avoid acetaminophen (found in Tylenol® and other medications).  Even the standard recommended dose of acetaminophen can increase the risk of liver damage, particularly among heavy drinkers.  For more information, see this report on alcohol-related liver disease and this advisory on acetaminophen and liver injury.

    . Although we are unable to provide a personal response on this page, we will post answers to questions of general public interest.

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