How much alcohol can you drink before your health risks go up?

Do a few extra drinks a week really make a difference?

In a word, yes. We estimate that among people drinking seven drinks per week, 1 in 1,000 deaths could be attributed to an alcohol-related cause. By nine drinks per week, that proportion had increased to over 1 in 100 deaths. By 14 drinks per week, in both men and women, the estimate of lifetime risk of alcohol-attributable death rose to about 1 in 25. In my opinion, that is a substantial increase in risk and suggests that for everyone, limiting drinking to one drink per day is much safer than limiting drinking to two drinks per day.

Does this align with the government's current advice to just drink less?

It does align with that guidance to “consume less alcohol for better overall health.” Reducing drinking reduces risk.

Why did those latest dietary guidelines see such criticism from experts?

Experts criticized the guidelines for dropping specific guidance on low risk-drinking, which had been part of the guidelines for 45 years. "Consume less alcohol" can have different meanings based on how much one currently drinks. For example, if someone reduces from 21 drinks per week to 16 drinks per week, that is a meaningful change. However, such a person is still at greatly elevated risk of alcohol-related death and disability compared to someone who drinks only three or four drinks per week.

Science has not established that there is a truly “safe” amount of alcohol consumption where there are no health risks, however, given that over half of the adult population in the U.S. chooses to drink, we can and should communicate as precisely as possible what we know about risks at various levels of use. Individuals need to know about the range of risks they may be exposed to by alcohol use, so that they can make informed decisions about the degree of risk they are willing to tolerate.

Based on the findings, what guidance do you have for people who choose to drink alcohol?

Limiting your drinking to one drink per day is good simple advice for most adults, with the very clear exception of during pregnancy when all alcohol use should be avoided. However, we also need to be realistic that some people may not be willing to stick to that daily limit of one drink. For them, I suggest the following: If you choose to drink alcohol, drink no more than seven drinks per week to reduce the health risks of drinking substantially. Minimize the frequency with which you drink two or three drinks and aim never to exceed three drinks on any day regardless of your gender. Regularly take days off from drinking. To minimize cancer risk, consistently stay under these limits. 

For those who are drinking well above these levels, change does not have to happen all at once and cutting drinking in half, no matter where you start, has substantial health benefits. If you want to reduce or stop drinking and struggle to do so, seek help through mutual help groups, your medical provider or addiction specialists. Effective medications, counseling and support programs are available.