Rethinking drinking

So no amount of drinking is without risk?

It's clear we don't have an absolute level where we can say there's no risk. That's been established for a while. The question is, what's the kind of risk that people are willing to tolerate? 

We also don't see any clear-cut health benefit, at any level of drinking, and that is a change.

You know, let's go back about 20 years ago. The dietary guidelines were suggesting that not only was moderate drinking unlikely to be associated with any harms, but that there might actually be some health benefits to moderate drinking. That showed up in the dietary guidelines for a little while, both in terms of overall health benefits and cardioprotective benefits.

Those claims had already been removed, and now it’s clear that when you consider the risk associated with cancer at relatively low levels of drinking, any benefit that may or may not be there for the heart is completely canceled out by the risks associated with cancer and liver disease.

Beyond avoiding heavy drinking to protect against injuries and disease, what’s your advice to people who drink?

I would recommend that people take days off, stay below seven drinks a week and on occasions where they go above one drink a day, try to limit that to two or three drinks. 

Let’s take someone’s mom who has a glass of wine with dinner, and maybe when she’s drinking with friends, a little more—what would you say to her?

I would say, is the glass of wine you're having actually an official standard drink? That would be five ounces. And a bottle is five standard drinks, so if you’re going through more than a bottle a week, you’re having more than five standard drinks a week.

If you’re going out and having two drinks, then maybe there’s two or three days during the week where you don’t drink at all. That would help you get below seven drinks a week.

If you’re concerned about breast cancer risk, I would suggest only drinking two or three times a week and limiting that to one and no more than two drinks.

What about someone who says, "I have a ritual with my friends. On Saturdays, we go drinking, this is how we bond; this is how we relate to each other. But it's definitely more than one or two drinks”?

I think for some people, when they hear the cutoff of seven drinks a week, they think that’s just just reasonable for them at all. They might be drinking 14 drinks a week, or 20 drinks a week.

First, know that reducing from wherever you are is important. If someone’s drinking 20 drinks a week and gets down to 10 drinks a week, that's a very, very meaningful reduction in health risk. You also might feel better.

You can do things like counting your drinks, making sure you’re being very aware. You can also alternate your drinks. So, if you’ve had one beer, maybe the next drink is non-alcoholic. If the rise in your blood-alcohol level is slower, it tends to reduce the craving for that next drink. You might experience some of those sedative effects, and that starts to reduce the rate at which you’re drinking.

You suggest the Rethinking Drinking website for people who aren’t ready for a 12-Step program but are interested in learning more. Are there other sites that might be helpful?

Yes, there is Moderation Management and other online groups like The Phoenix for finding sober events.

Then, of course, there are your primary care providers. There are medications that are effective for changing alcohol use, like naltrexone. And I think some of these things that we hope will be coming online soon, like the GLP-1 agonists that we’ve heard so much about recently for weight loss, seem to also have an effect on alcohol use.