How much is too much alcohol over the holidays? A doctor explains

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The holidays are here, as are the parties, happy hours and other get-togethers that often offer abundant mixed drinks, beer and wine.

We all know that too much alcohol is bad for us, but how much is too much? Is it better to drink a lot on one day and then not drink the rest of the week, or to space out the drinks? What are signs that someone has a problem with drinking? And what should people do who want to moderate alcohol intake over the holidays?

To guide us through these questions, I spoke with CNN wellness expert Dr. Leana Wen. Wen is an emergency physician and clinical associate professor at George Washington University. She previously was Baltimore’s health commissioner.

CNN: Why is too much alcohol considered a health hazard?

Dr. Leana Wen: There is abundant research showing that excessive drinking on a regular basis is associated with many chronic illnesses, including heart disease, cancer and early death. In the US, liver disease associated with alcohol is the leading cause of liver transplants. Alcohol use is estimated to cause approximately 178,000 deaths each year. The height of the Covid-19 pandemic saw an average of 488 deaths per day due to excessive alcohol use.

CNN: How much alcohol is too much?

Wen: According to the US Dietary Guidelines for Americans, adults of legal drinking age should not drink more than one drink a day for women and two drinks a day for men on days that they are drinking. The guidelines also emphasize that drinking less alcohol is better than drinking more and that those who do not currently drink alcohol should not start drinking.

Someone who regularly drinks more than this amount should know doing so increases your risk of chronic illnesses and premature death.

In addition, people consuming alcohol should be aware that there are separate, additional risks associated with binge drinking, which is consuming large amounts on one occasion. According to the Substance Abuse and Mental Health Services Administration, binge drinking is defined as four or more drinks on one occasion for women and five or more drinks on one occasion for men.

CNN: Is it better to drink a lot on one day and then not drink the rest of the week, or to space out the drinks?

Wen: Drinking a lot on one day could end up with someone meeting the threshold for binge drinking. Those who binge drink face two sets of additional risks compared with those who space out their drinks. First, a large amount of alcohol places stress on your organs. Second, those who binge drink are at higher risk of injuries like falls, drownings and car accidents.

CNN: Are there benefits to trying to stop alcohol for sober challenges such as Dry January or Sober October?

Wen: Yes. Individuals who regularly drink could benefit from abstaining or reducing their drinking for a period of time. This could help them in a variety of ways: They can take stock of how much they are drinking and better understand the circumstances that make them turn to alcohol. Some people also experience positive effects on their well-being by having better sleep or losing excess weight.

CNN: What are some signs that someone has a problem with drinking?

Wen: Someone who regularly exceeds the recommended weekly intake and/or is binge drinking should be aware that their drinking could have negative health impacts. People should also be aware that there is a condition called alcohol use disorder. Nearly 29 million adult Americans have this condition, which is the most common form of substance use disorder in the US.

Substance use disorder is characterized by loss of control. Once someone starts drinking, they cannot stop, or they get cravings that they feel they must act on. Many people with the disorder find themselves experiencing difficulties with fulfilling work, caregiving and daily life responsibilities due to their alcohol intake. Some individuals with the disorder who try to stop drinking may also experience physical symptoms such as restlessness, sweating and severe nausea.

CNN: What do you advise for people who want to moderate alcohol intake over the holidays?

Wen: I advise people to begin by identifying and setting personal goals. Is your goal to avoid alcohol altogether, to reduce intake on an ongoing basis or to stop drinking large amounts in one setting? How you go about your planning will depend on your goal.

If you want to avoid alcohol altogether and alcohol is a major temptation for you, you may wish to look for social settings where alcohol will not be served. If you have to go to events where alcohol is served, consider telling people close to you to help you with your goal. Ask ahead if there are nonalcoholic drinks that you like; if not, bring your own. Perhaps you could go with a friend or family member who is also abstaining.

If your goal is to cut back on the number of drinks you are consuming on a weekly basis, I recommend that you begin by keeping track of how much you are drinking. There are a number of apps that can help, or you can keep a paper diary.

If, say, by Friday, it looks like you are coming close to exceeding your goal amount, you could work to cut back over the weekend. You could also plan ahead. If you know that next weekend, there will be a few occasions where you plan to drink, you could plan to drink less earlier in the week.

If your priority is to stop binge drinking, the advice above of writing down drinks and planning ahead also applies. In addition, try to identify triggers: What kind of occasions have led you to drink large amounts in the past? If it’s certain parties, consider avoiding them or going in with a goal to have one or two drinks instead of five or six. If it’s when you are depressed or anxious, you may consider seeking help from a mental health professional to address underlying concerns.

I want to add one more note here, which is that people who experience symptoms when they stop or reduce drinking should seek medical assistance. In addition, those who find themselves unable to cut back should contact their primary care provider. There are effective treatments for alcohol use disorder, and no one should be ashamed to seek help.

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