Alcohol and You

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 alcohol use disorder. The higher alcohol levels can also harm the liver, heart, and brain without the person drinking noticing until it's too late. And all people who drink 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.

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.

Some medicines that you might never have suspected can react with alcohol, including many that can be purchased "over the counter" without a prescription. Even some herbal remedies don't mix well with alcohol. The pamphlet Harmful Interactions: Mixing Alcohol with Medicines lists medications that can cause harm when taken with alcohol and describes the effects that can result. It does not include all possible medicines that may interact with alcohol, however. Protect yourself by avoiding alcohol if you are taking a medication and don't know its effect, or talk to your pharmacist or other health care provider.

• Click on What's your pattern? to find out how your drinking pattern compares to those of other U.S. adults.

Not at all. There's a lot of mistaken "all or nothing" thinking about alcohol use disorder. Many people assume there are two options: Either you don't have a problem with drinking, or you're a "total alcoholic" whose life is falling apart. The reality is not a simple black or white, but more of a spectrum with shades of gray. Alcohol use disorder can be mild, moderate, or severe. People with alcohol use disorder can be highly functioning, highly compromised, or somewhere in between. One of the main purposes of this Web site is to help people to become aware of the risks of heavy drinking and the early symptoms of a problem, so they can prevent more serious problems down the road.

A related "all or nothing" misconception is that all people who drink heavily are automatically alcoholics. Some are, some aren't. Those without problems at this point are still at risk for developing alcohol use disorder and other conditions such as liver disease in the future.

The concept of risk is sometimes difficult to grasp. An example is high cholesterol, which increases the chances for a heart attack. Similarly, heavy drinking raises the chances for developing alcohol use disorder. Your individual risk depends in part on how much, how often, and how quickly you drink, along with how young you were when you had a first drink, and whether you have a family history of alcohol use disorder.

In any case, you can reduce your chances for harm in the future. If you do not already have symptoms of an alcohol-related problem, then cutting down to within the low-risk limits is a reasonable first step. If you already have symptoms of an alcohol problem, it's safest to quit.

• Click on What's your pattern? to find out how your drinking pattern compares to those of other U.S. adults.

The quiz serves two purposes – one is to provide "norms" feedback that lets people know when they're drinking more than most U.S. adults, even if it's just once a year. This helps to counter a commonly held misconception that "everybody" drinks a lot.

The second purpose is to show how different drinking patterns are linked with different rates of alcohol problems. The simple quiz generates some broad categories of results, and you describe a pattern that's at very low end of increased risk. For someone who has one heavy drinking day a year and otherwise stays well within low-risk limits, the risk of having or developing alcohol use disorder would be minimal.

However, if you have more than four drinks within a short period of time on any day, you may run the risk of injuring yourself or others, particularly if you drive too soon after drinking. And if you start to increase the number of "heavy drinking days" over time, your chances for alcohol-related harm will increase as well.

There are no guarantees that anything will protect the liver from too much alcohol. Liver damage from heavy drinking happens in stages. Some relatively mild damage may happen after a single binge drinking episode, but this reverses itself if the heavy drinking stops. If heavy drinking continues, however, liver damage can progress through several more advanced stages, and repair becomes much more difficult, if not impossible. When the damage goes as far as cirrhosis, the only treatment is liver transplant. The best way to protect your liver’s health is by staying within the low-risk drinking limits or -- if you already have liver damage or any signs of an alcohol problem -- by quitting. Also, it’s best if people who drink avoid acetaminophen (found in Tylenol® and other medications). Even the standard recommended dose of acetaminophen can increase the risk of liver damage, particularly among people who drink heavily. For more information, see this report on alcohol-related liver disease and this information on acetaminophen (Links to U.S. Food & Drug Administration).

The first step, of course, is to decide whether cutting down or quitting is best for you. See these considerations and discuss different options with a doctor, a friend, or someone else you trust.

Thinking about cutting back? Here are some tips to try, small changes that can make a big difference. Choose two or three to try in the next week or two. It may help to have reminders to reinforce your decision to make a change, such as automated smartphone alerts that you send yourself.

Thinking about quitting? One size doesn’t fit all, and it’s important to find options that appeal to you. Start by visiting the choose your approach page. Here you’ll find links to self-help strategies, a helpful publication about treatment options, and information about professional help and social support.

Changing habits such as smoking, overeating, or drinking too much can take a lot of effort, and you may not succeed with the first try. Setbacks are common, but you learn more each time. Each try brings you closer to your goal. Whatever course you choose, give it a fair trial.

Anyone who is cutting back or quitting drinking is likely to be offered a drink at times when it’s unwanted. Rethinking Drinking has a module or “mini-guide” to help you build resistance skills and stay in control. You’ll learn how to recognize the types of pressure to drink, avoid pressure, and cope with situations you can’t avoid.

As an example, here’s one tip: Have a polite, convincing "no, thanks" ready. The faster you can say no to drink offers, the less likely you are to give in. If you hesitate, it allows you time to think of excuses to go along. See the module for more insights and suggestions, including a worksheet where you can script your ‘no’ to practice for a situation in which the pressure persists.

If you worry about how others will react or view you if you make a change, challenge these thoughts by remembering that it's your life and your choice, and that your decision should be respected.

People commonly think of 12-step programs or 28-day inpatient rehabilitation as the only options for treating alcohol problems. Other choices are available, however. It’s a good idea to start by talking with a primary care doctor to put together an individualized treatment plan. A treatment plan can include:

• Behavioral treatments. Counseling led by a health professional aims to change drinking behavior. Types of counseling include cognitive-behavioral therapy, motivational enhancement therapy, and marital and family counseling. It’s important to choose an approach that avoids heavy-handed confrontation, incorporates empathy, and increases motivation while focusing on changing drinking behavior.
• Medications. Three medications are currently approved by the Food and Drug Administration to treat alcohol dependence. These medications help people stop or reduce their drinking and prevent relapse. All approved medications are non-addictive, and can be used alone or in combination with other forms of treatment.
• Mutual-support groups. People who are quitting or cutting back on their drinking may also find peer support through organizations such as Alcoholics Anonymous and other mutual support groups.

The NIAAA Alcohol Treatment Navigator^® is an online tool that helps focus the search for alcohol treatment to find options that increase the chance for success. The Navigator helps people learn about different types of alcohol treatment options and how to spot quality treatment, as well as linking to databases of providers and recommending questions to ask them. You can also find a summary of treatment options in the NIAAA publication Treatment for Alcohol Problems: Finding and Getting Help. The good news is that no matter how severe the problem may seem, most people with an alcohol problem can benefit from some form of treatment.

Alcohol Awareness Worksheets: Here's where you can evaluate your drinking, decide whether and how to make a change, and find tools to help you stay in control.

• See where you stand
• Decide whether & how to change
• Track what you drink
• Stay in control

Drink Calculators: How much alcohol is really in your drink? How many calories? What's the cost to you per week, month, or year? Find out here.

• Cocktail content calculator
• Drink size calculator
• Alcohol calorie calculator
• Alcohol spending calculator
• Blood alcohol concentration (BAC) calculator

National Institute on Alcohol Abuse and Alcoholism (no date). Questions and answers. Retrieved from https://www.rethinkingdrinking.niaaa.nih.gov/Q-and-As/Default.aspx. Used by permission.