# U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

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1 Alcohol and your health Research-based information from the National Institutes of Health U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES NIH...Turning Discovery Into Health

4 how MUCh is too MUCh? What counts as a drink? Many people are surprised to learn what counts as a drink. In the United States, a standard drink is any drink that contains about 0.6 fluid ounces or 14 grams of pure alcohol. Although the drinks pictured below are different sizes, each contains approximately the same amount of alcohol and counts as a single drink. 12 fl oz of regular beer 8 9 fl oz of malt liquor (shown in a 12 oz glass) 5 fl oz of table wine = = = 1.5 fl oz shot of 80-proof distilled spirits (gin, rum, tequila, vodka, whiskey, etc.) about 5% alcohol about 7% alcohol about 12% alcohol 40% alcohol The percent of pure alcohol, expressed here as alcohol by volume (alc/vol), varies by beverage. How many drinks are in common containers? Below is the approximate number of standard drinks in different sized containers of regular beer malt liquor table wine 12 fl oz = 1 16 fl oz = 1 22 fl oz = 2 40 fl oz = 3 12 fl oz = 1½ 16 fl oz = 2 22 fl oz = 2½ 40 fl oz = 4½ 750 ml (a regular wine bottle) = 5 80-proof distilled spirits a shot (1.5 oz glass/50 ml bottle) = 1 a mixed drink or cocktail = 1 or more 200 ml (a half pint ) = 4½ 375 ml (a pint or half bottle ) = 8½ 750 ml (a fifth ) = 17 The examples shown on this page serve as a starting point for comparison. For different types of beer, wine, or malt liquor, the alcohol content can vary greatly. Some differences are smaller than you might expect, however. Many light beers, for example, have almost as much alcohol as regular beer about 85% as much, or 4.2% versus 5.0% alcohol by volume (alc/vol), on average. Although the standard drink sizes are helpful for following health guidelines, they may not reflect customary serving sizes. A mixed drink, for example, can contain one, two, or more standard drinks, depending on the type of spirits and the recipe. 2 RethinkingDrinking.niaaa.nih.gov

5 What s your drinking pattern? Using the drink sizes on page 2, answer the questions below: 1. On any day in the past year, have you ever had For MEN: more than 4 drinks? yes no For women: more than 3 drinks? yes no 2. Think about your typical week: On average, how many days a week do you drink alcohol? (a) How much is too much? on a typical drinking day, how many drinks do you have? X (multiply a x b) weekly average = (b) Sometimes even a little is too much Even moderate levels of drinking (up to 2 drinks per day for men or 1 for women) can be too much in some circumstances. It s safest to avoid alcohol if you are planning to drive a vehicle or operate machinery taking medications that interact with alcohol managing a medical condition that can be made worse by drinking pregnant or trying to become pregnant Can you hold your liquor? if so, you may be at greater risk. 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 cause liver, heart, and brain damage that can go unnoticed 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. 3

6 What s low-risk drinking? A major nationwide survey of 43,000 U.S. adults by the National Institutes of Health shows that only about 2 in 100 people who drink within both the single-day and weekly limits below have alcoholism or alcohol abuse. How do these low-risk levels compare with your drinking pattern from page 3? Low-risk drinking limits On any single DAY Per Week Men no more than 4 drinks on any day 14 ** AND ** no more than drinks per week WOMen no more than To stay low risk, keep within BOTH the single-day AND weekly limits. 3 drinks on any day ** AND ** no more than 7 drinks per week Low risk is not no risk. Even within these limits, drinkers can have problems if they drink too quickly, have health problems, or are older (both men and women over 65 are generally advised to have no more than 3 drinks on any day and 7 per week). Based on your health and how alcohol affects you, you may need to drink less or not at all. What s heavy or at-risk drinking? For healthy adults in general, drinking more than the single-day or weekly amounts shown above is considered at-risk or heavy drinking. About 1 in 4 people who drink this much already has alcoholism or alcohol abuse, and the rest are at greater risk for developing these and other problems. It makes a difference both how much you drink on any day and how often you have a heavy drinking day that is, more than 4 drinks in a day for men or more than 3 drinks for women. The more drinks in a day and the more heavy drinking days over time, the greater the chances for problems (see what s the harm? on the next page). 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. 4 RethinkingDrinking.niaaa.nih.gov

7 How much do U.S. adults drink? The majority 7 out of 10 either abstain or always drink within low-risk limits. which group are you in? 19 % 9 % Drinking patterns in U.S. adults drink more than both the single-day limits and the weekly limits drink more than either the single-day limits or the weekly limits highest risk increased risk 37 % always drink within low-risk limits Low risk How much is too much? 35 % never drink alcohol What s the harm? Not all drinking is harmful. You may have heard that regular light to moderate drinking (from ½ drink a day up to 1 drink a day for women and 2 for men) can even be good for the heart. with at-risk or heavy drinking, however, any potential benefits are outweighed by greater risks. injuries. Drinking too much increases your chances of being injured or even killed. Alcohol is a factor, for example, in about 60% of fatal burn injuries, drownings, and homicides; 50% of severe trauma injuries and sexual assaults; and 40% of fatal motor vehicle crashes, suicides, and fatal falls. health problems. Heavy drinkers have a greater risk of liver disease, heart disease, sleep disorders, depression, stroke, bleeding from the stomach, sexually transmitted infections from unsafe sex, and several types of cancer. They may also have problems managing diabetes, high blood pressure, and other conditions. Birth defects. Drinking during pregnancy can cause brain damage and other serious problems in the baby. Because it is not yet known whether any amount of alcohol is safe for a developing baby, women who are pregnant or may become pregnant should not drink. Alcohol use disorders. Generally known as alcoholism and alcohol abuse, alcohol use disorders are medical conditions that doctors can diagnose when a patient s drinking causes distress or harm. In the United States, about 18 million people have an alcohol use disorder. See the next page for symptoms. 5

14 Support for quitting The suggestions in this section will be most useful for people who have become dependent on alcohol, and thus may find it difficult to quit without some help. Several proven treatment approaches are available. one size doesn t fit all, however. It s a good idea to do some homework on the Internet or at the library to find social and professional support options that appeal to you, as you are more likely to stick with them (see also Resources on the inside back cover). Chances are excellent that you ll pull together an approach that works for you. Social support one potential challenge when people stop drinking is rebuilding a life without alcohol. It may be important to educate family and friends develop new interests and social groups find rewarding ways to spend your time that don t involve alcohol ask for help from others when asking for support from friends or significant others, be specific. This could include not offering you alcohol not using alcohol around you giving words of support and withholding criticism not asking you to take on new demands right now going to a group like Al-Anon Consider joining Alcoholics Anonymous or another mutual support group (see Resources). Recovering people who attend groups regularly do better than those who do not. Groups can vary widely, so shop around for one that s comfortable. You ll get more out of it if you become actively involved by having a sponsor and reaching out to other members for assistance. Feeling depressed or anxious? It s common for people with alcohol problems to feel depressed or anxious. Mild symptoms may go away if you cut down or stop drinking. See a doctor or mental health professional if symptoms persist or get worse. If you re having suicidal thoughts, call your health care provider or go to the nearest emergency room right away. Effective treatment is available to help you through this difficult time. 12 RethinkingDrinking.niaaa.nih.gov

16 Ready to begin? If so, start by filling out the change plan below or online at the Rethinking Drinking web site, where you can print it out or it to yourself. If you are cutting down as opposed to quitting, you can use the drinking tracker cards on the next two pages. Change plan goal: I want to drink no more than drink(s) on any day and no more than drink(s) per week (see page 4 for low-risk limits) or I want to stop drinking timing: I will start on this date: Reasons: My most important reasons to make these changes are: Strategies: I will use these strategies (see pages 10 11): People: The people who can help me are (names and how they can help): Signs of success: I will know my plan is working if: Possible roadblocks: Some things that might interfere and how i ll handle them: 14 RethinkingDrinking.niaaa.nih.gov

17 Drinking tracker cards If you want to cut back on your drinking, start by keeping track of every drink. Below are two sample forms you can cut out or photocopy and keep with you. Either one can help make you aware of patterns, a key step in planning for a change. The 4-week tracker is a simple calendar form. If you mark down each drink before you have it, this can help you slow down if needed. The drinking analyzer can help you examine the causes and consequences of your drinking pattern. Try one form, or try both to see which is more helpful. These are also available on the Rethinking Drinking Web site. 4-week tracker goal: no more than drinks on any day and per week. Week starting Su M t W th F Sa total / / / / Drinking analyzer Ï Thinking about a change? Date Situation (people, place) or trigger (incident, feelings) type of drink(s) Amount Consequence (what happened?) 15

18 Drinking tracker cards (continued) These are the same cards as on the previous page. If you cut one out, you will have the drinking analyzer on one side and the 4-week tracker on the other side. Drinking analyzer Date Situation (people, place) or trigger (incident, feelings) type of drink(s) Amount Consequence (what happened?) 4-week tracker goal: no more than drinks on any day and per week. Week starting Su M t W th F Sa total / / / / 16 RethinkingDrinking.niaaa.nih.gov

20 T H AND HUMAN SERVICES USA DEPARTMENT OF HEAL NIH Publication No Published 2010

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