When Does Social Drinking Become ‘At-Risk’ Drinking?

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A recent study from Duke University found that a significant portion of baby boomers—22% of men and 9% of women ages 50 and up—were binge drinking on a regular basis, increasing their risk for both long term health problems such as neurological complications and elevated blood pressure, and more acute problems like accidental injury. (Binge drinking, in this particular study, was defined as having five or more drinks at one time in the previous month.)

In June, U.S. health officials reported that binge drinking was up on college campuses, meaning that more kids were at risk of priming themselves for substance abuse problems later in life. And the late July tragedy in which 36-year-old mother Diane Schuler drove the wrong way on a highway, ultimately killing herself and seven others after consuming the equivalent of ten drinks of vodka, turned a trend of lighthearted laughs about cocktail swilling moms deadly serious.

Yet, amid so many examples of unhealthy drinking, it sometimes is hard to tell just what a reasonable relationship with alcohol is. How do you know when your social drinking habits have crossed the line into what experts refer to as “at risk” drinking? TIME asked Dr. Mark Willenbring, Director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

“People get a lot of confusing messages and they don’t really know how to think about drinking in a healthy way,” he says. That apparent absence of good information prompted Willenbring and his colleagues at the NIAAA to create Rethinking Drinking, a project launched this past March whose primary goal is to give people the tools they need to assess the role that alcohol plays in their lives.

The broad strokes about alcohol consumption, Willenbring says, are fairly simple. Low risk drinking, “according to the NIAAA, for men, is no more than four drinks in one day, and no more than 14 drinks in a week.” For women, he says, “it’s no more than three drinks in any day and no more than seven drinks in any week.”

Those figures may seem to contradict recommendations made by the U.S. Department of Health and Human Services, which call for no more than one drink per day for women, and no more than two drinks per day for men, but Willenbring says it’s just that the other guidelines present the number of drinks as a daily average, as opposed to offering two sets of guidelines—by both day and week. “It’s important that both the daily and the weekly limits be considered, because, for example, if a man has four drinks in one day, or has four drinks every day then he’s going to violate the weekly [total for low risk drinking].”

Framing the numbers that way makes more sense for how people consume alcohol in their real lives, Willenbring says. “We think that it’s more useful,” he says. [Most people are] more likely to go out to dinner and have two or three glasses of wine one day, and then not drink for several days.”

It’s when people begin to exceed those levels of consumption that their level of risk rises. “We consider at risk drinking as regularly exceeding those levels—particularly the daily level, that’s the one we really focus on.” When you start to consume more than those amounts per day or per week, your chances for developing alcohol dependence increases dramatically. According to NIAAA data, one in four people who exceed the low risk levels of alcohol consumption suffers from alcoholism or alcohol abuse.

Just what does “at risk” mean in terms of actual likelihood for developing alcohol dependence? In a recent large scale prospective study of more than 40,000 people, researchers found that “people who were at risk drinkers daily or nearly daily had about seven times the risk of developing alcohol dependence compared with low risk drinkers,” Willenbring says. In terms of relative risk, that’s a pretty huge difference. In terms of absolute risk, however, heavier drinkers have less than a 20% chance of developing alcohol dependence—still an alarmingly high figure, he points out. “Most people who have high cholesterol don’t have heart attacks, and most people who smoke don’t get lung cancer,” he says, but that doesn’t mean they’re not at risk. “People don’t understand risks that way.”

So how can you know whether you are a low risk social drinker or possibly venturing into high risk territory? First, it helps to know the real number of “drinks” you consume. All of these recommendations are based on standardized definitions, where one drink equals: 12 oz. of regular beer, 5 oz. of wine or 1.5 oz. (a shot) of 80 proof liquor. Want to know how many “drinks” are in that cosmo or screwdriver? You can use the drink calculator to find out. (Both a cosmopolitan and a screwdriver have the equivalent alcohol of 1.3 standard drinks.)

For anyone unsure of how your alcohol consumption stacks up, another good resource from the NIAAA is a tool that helps you size up what your level of risk is based on your alcohol consumption habits. Plug in how much you drink and how often, and it can help you determine whether your drinking pattern is no risk, low risk, increased risk or highest risk, and fill you in on just what percentage of the population with similar drinking habits actually suffers from alcohol abuse.

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