The short answer to this question is that if someone has a true addiction—defined by the National Institute on Drug Abuse (NIDA) as compulsive drug seeking and use despite negative consequences—then no amount of alcohol consumption is safe for that person.
Yet heavy alcohol use does not always mean a person is addicted to alcohol. Some heavy drinkers do not meet the criteria for addiction and may be able to train themselves to drink in moderation.
In the past, society’s view of alcohol addiction was black and white. There were two kinds of drinkers: alcoholics, and everyone else.
Today, we know that drug and alcohol use (and misuse) occurs on a spectrum, and problem drinking can range from mild to severe.
There’s no question that people who continue drinking despite severe problems—like losing their jobs, alcohol-related health issues, or getting multiple DUIs—need to stop drinking completely (and probably need addiction treatment).
Most drinkers don’t fit this profile, though, and it can be hard to know exactly what constitutes excessive drinking. Is it one drink a day? Two or three? What about occasional binge drinking on the weekends?
It helps to have a baseline. Agencies and organizations that research alcohol and drug use disorders, including the Centers for Disease Control (CDC) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), generally agree on how much is too much when it comes to drinking.1,2
A standard drink is defined as 5 ounces of wine, 12 ounces of beer (5% alcohol content), or 1.5 ounces of spirits.
A study by the CDC found that 90 percent of Americans who drink do not meet the criteria for alcohol dependence.3 (dependence on alcohol means people have withdrawal symptoms when they stop drinking and have developed a tolerance, meaning they must drink more than before to achieve the same effect).
Yet, most of us would probably be surprised to learn that, based on the numbers cited above (more than 14 drinks per week for men and 7 per week for women), 1 in 3 Americans drinks excessively.
So, how do doctors and addiction specialists determine who has a serious problem and who doesn’t? Many refer to the Diagnostic Statistical Manual of Mental Disorders (DSM), which identifies mental disorders and their severity (the medical community now recognizes addiction as a chronic disease, with relapse rates similar to conditions like diabetes and asthma).
The fifth and latest version of the DSM integrates alcohol abuse and alcohol dependence into a single disorder: alcohol use disorder (AUD).
The DSM-5 breaks alcohol use disorder down into mild, moderate, and severe sub-classifications based on a person’s answers to questions about how much they drink, symptoms they experience (like cravings and withdrawal symptoms), and other behavioral issues like drinking despite getting DUIs or being arrested.4
In short, the more symptoms a person has, the greater their risk.
Most of us know that drinking alcohol comes with risks, but it’s surprising how little alcohol it takes to negatively impact our health. Risks of excessive alcohol use include:5
Excessive drinking is also associated with personal problems like relationship issues, legal troubles, problems at work, and many others.
So, back to the question at hand: Is it possible to drink in moderation? At least one study has found that a moderation approach can help some heavy drinkers cut back.6 However, more studies are needed to determine whether a moderation approach is truly effective.
Experts say learning to drink in moderation is possible for some people, but not for others.
People who drink excessively, but who are not physically dependent on alcohol (and who have few or no symptoms of alcohol use disorder), may be able to effectively and permanently moderate their consumption.
Those who answer yes to questions like “In the past year have you wanted a drink so badly you couldn’t think of anything else?” or “In the past year have you given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?” will almost certainly need to completely abstain from drinking.
Heavy drinkers who decide to cut back do so for many different reasons. Some are compelled to slow down after a wake-up call from their doctor about how drinking is impacting their health. Others cut back when they have a major life change like getting married or becoming a parent.
People who are worried that their drinking is getting out of hand can try Drinker’s Checkup, an interactive screening tool that provides feedback based on the information you provide about your drinking.
Those who commit to cutting back often find tools like drinking tracker cards from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) helpful. Support groups like Moderation Management can also work for some people.
Ultimately, though, if moderation doesn’t work, total abstinence may be the only viable option.
People with more severe addictions will need help from a professional alcohol addiction treatment center, especially those who need to detox from alcohol due to physical dependence. It can be dangerous to detox on your own—that’s why reputable alcohol treatment centers provide medically supervised detox care.
Detox is usually just the first step. Addiction specialists recommend continuing in either a residential treatment program or intensive outpatient (IOP) program after detox. These programs typically provide counseling to help those in recovery learn how to identify and cope with triggers and stay focused on overcoming addiction.
Most treatment programs also offer group and family counseling programs, ideal for those who have underlying family issues or past trauma. Many treatment centers also incorporate holistic therapies like meditation, yoga, and gardening into their programs.
RECO Intensive’s Delray Beach outpatient alcohol treatment program provides world-class care overseen by an outstanding team of clinicians and therapists. Our skilled team utilizes intensive therapies and group programs to treat the lingering effects of addiction to help clients create healthy boundaries and pathways for lifelong recovery.
Discover a better life and call our recovery helpline today.