When heavy or frequent drinkers suddenly decide to quit "cold turkey" they will experience some physical withdrawal symptoms—which can range from the mildly annoying to severe and even life-threatening.

The severity of these withdrawal symptoms is usually dependent upon how "chemically dependent" the chronic drinker has become. Those who drink heavily on a daily basis, of course, have developed a high level of dependency, but even those who drink daily, but not heavily and those who drink heavily but not daily, can also be chemically dependent upon alcohol.1

When someone who has become "alcohol dependent" decides to stop drinking, they will experience some level of physical discomfort. For this reason, it is extremely difficult for them to merely stop drinking "on their own" without assistance and support.

Why "Never Again" Doesn't Usually Mean Never for the Alcohol Dependent

The scenario has been played over and over many times. After a particularly damaging or embarrassing binge, the hungover person will make an oath to never drink again and quite often is sincere about quitting.

But with the onset of withdrawal symptoms also comes the craving for more alcohol. The body is telling the drinker that it "needs" alcohol.

For those who have committed themselves to not drinking again, or forced by circumstances do not have access to alcohol, the struggle to fight the withdrawal symptoms can become a dangerous battle, one that can actually become life-threatening.

Mild Symptoms of Withdrawl

For those who are less chemically dependent, withdrawal symptoms might be as "mild" as getting the shakes or the sweats—or perhaps nausea, headache, anxiety, a rapid heartbeat, and increased blood pressure.1

Although these symptoms are uncomfortable and irritating, they are not necessarily dangerous. But they are often accompanied by the "craving" for more alcohol, making the decision to continue abstinence much more difficult to make.

Even the "morning after" hangover of someone who only occasionally drinks to excess is actually a mild form of alcohol withdrawal from the excesses of the night before as the alcohol content of their blood begins to drop. The symptoms can appear within a few hours after not drinking.

Serious Symptoms of Withdrawal

Within six to 48 hours after not drinking, hallucinations may develop. These usually are visual hallucinations but they can also involve sounds and smells. They can last for a few hours up to weeks at a time.1

Also within this time frame after quitting, convulsions or seizures can occur, which is the point at which alcohol withdrawal can become dangerous if not medically treated. The symptoms may progress to delirium tremens (DTs) after three to five days without alcohol. The symptoms of DTs include profound confusion, disorientation, hallucinations, hyperactivity, and extreme cardiovascular disturbances.2

Getting Treatment for Alcohol Withdrawal

The good news for those who are extremely alcohol dependent, and who wish to quit drinking, all of these symptoms can be alleviated and even eliminated with proper medical treatment.2

Typically, for those who are mildly dependent doses of vitamins (including Thiamine), a proper diet, and hydration will prevent most of the mild withdrawal symptoms from occurring. For the severely dependent, medication can be administered, but only by a physician. One approach is to substitute benzodiazepines such as Librium for alcohol and gradually reduce the dosage until the patient is drug-free.3

You don't have to do it "on your own" to prove anything to anyone. Help is available; take advantage of it. The psychological withdrawal is difficult enough without having to fight the physical symptoms as well.

Until the publication of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), substance issues were generally divided into abuse and dependence. The DSM-5 combines these categories into a single substance use disorder, measured on a continuum from mild to severe.

This change was made to update the idea that abuse was a mild and early phase of the illness and dependence was a more severe manifestation. In reality, abuse can often be quite severe.

Who Is an Alcohol Abuser?

It is still sometimes useful to clarify the distinctions between abuse and dependence. Alcohol abusers can be defined as those who continue to drink despite recurrent social, interpersonal, health, and legal problems as a result of their alcohol use.1

Who Is Alcohol Dependent?

People who are alcohol-dependent exhibit some or all of the following characteristics.1

• Alcohol tolerance: Needing to drink increasing amounts over time to achieve previous effects. For example, you used to drink three cocktails every night, but now you need five to get the feeling you're looking for.​
• Withdrawal symptoms: Experiencing physical symptoms, such as insomnia, tremors, and mood swings. after going for a short period without drinking.
• Drinking to relieve or avoid withdrawal symptoms,such as drinking to stop the shakes or to "cure" a hangover.
• Awareness of the compulsion to drink or craving for alcohol, regardless of whether you admit it to others.
• Drinking larger amounts or over a longer period than intended and making unsuccessful efforts to cut down.

Those with moderate to severe alcohol use disorders generally require outside help to stop drinking. This could include detoxification, medical treatment, professional rehab or counseling, and/or self-help group support.2

How Much Is Too Much?

Are your drinking habits safe, risky, or harmful? Are you abusing alcohol or alcohol dependent? Looking at the aforementioned symptoms can give you an idea of how your drinking may fall into harmful patterns and indicate whether or not you have a drinking problem.

Alcohol Withdrawal Symptoms and Treatment

If you are alcohol-dependent and decide to change your life and quit drinking, you can expect to experience withdrawal symptoms. These discomforts usually peak 24 to 72 hours after your last drink, but they may last for weeks, according to information from the National Institutes of Health.2

Those with mild to moderate symptoms may be able to receive treatment in an outpatient setting. You should ask a loved one to stay with you during this process and you may need to visit a clinician for daily monitoring. If you have moderate to severe symptoms of alcohol withdrawal, you may require inpatient treatment at a hospital or substance abuse facility. Symptoms of severe alcohol withdrawal include:

• Fever
• Hallucinations
• Seizures
• Severe confusion
• Unstable vital signs

The term alcoholism refers to a disease known as alcohol dependence syndrome, the most severe stage of a group of drinking problems which begins with binge drinking and alcohol abuse.

Types of Alcohol Problems

Alcohol problems occur at different levels of severity, from mild and annoying to life-threatening. Although alcohol dependence (alcoholism) is the most severe stage, less severe drinking problems can also be dangerous. Learn more about the different types.

Binge Drinking

Officially, binge drinking means having five or more drinks in one session for men and four or more for women. Another informal definition for binge drinking is simply drinking to get drunk, although this usage is not clinically specific. Binge drinking is the most common drinking problem for young people under the age of 21.

Alcohol Abuse

Binge drinking turns into alcohol abuse when your drinking begins to cause problems in your daily life and the drinking continues anyway—in other words, alcohol abuse is when you continue to drink in spite of continued social, interpersonal, or legal difficulties. Alcohol abuse can result in missing time at school or work, neglecting child or household responsibilities or incurring legal problems including lawsuits from unpaid bills or criminal prosecution for public intoxication, drunk driving, or domestic violence.

Because alcohol impairs your judgment, you're more likely to do "something stupid" under the influence of alcohol than if you were stone-cold sober.

Alcohol Dependence

Alcohol abuse becomes alcohol dependence when drinkers begin to experience a craving for alcohol, a loss of control of their drinking, withdrawal symptoms when they are not drinking and an increased tolerance to alcohol so that they have to drink more to achieve the same effect. Alcohol dependence is a chronic and often progressive disease that includes a strong need to drink despite repeated problems.

Is Alcoholism Inherited?

Alcoholism tends to run in families and a significant amount of scientific research suggests that genetics play a role in developing alcohol problems. But research also shows that a person's environment and peer influences also affect your risk of becoming alcohol dependent. Just having a family history of alcoholism does not doom a person into becoming an alcoholic.1

Getting Help

Alcoholism is a serious condition but if you or someone you love is affected by it, seek help. The National Institute on Alcohol Abuse and Alcoholism's Alcohol Treatment Navigator is a great resource.2 Your primary care doctor or a public health nurse can help steer you in the right direction, or you can visit an open meeting of a 12-step program like Alcoholics Anonymous.

Low alcohol beer and wine have been widely available for several years. Research shows that even regular beer drinkers can't tell the difference between low alcohol beer and the real thing.1

Many people who are reducing the amount of alcohol they are drinking wonder whether low alcohol or alcohol-free beverages are a good substitute for full-strength alcoholic drinks. There are several issues to consider when making this choice.

Have You Ever Had an Alcohol Problem?

This question deserves careful consideration by people who have had a problem with alcohol in the past, or who are currently experiencing problems with alcohol, such as:

• A diagnosis of alcohol abuse, alcohol dependence, or alcohol use disorder
• Binge drinking, or difficulty stopping once you have started drinking
• Problems with self-control when intoxicated
• Becoming aggressive, anxious, or depressed after drinking
• Physical problems as a result of alcohol use, such as liver disease

If you have a problem with alcohol, you may be better off avoiding alcoholic drinks of any kind.2 It is also worth considering avoiding alcohol if one of your parents or siblings has had serious problems with alcohol.

If you fit this category, discuss the idea of replacing some or all of your alcoholic drinks with low alcohol or alcohol-free beverages with your doctor, alcohol counselor, or AA sponsor. Reflect on whether the low alcohol or alcohol-free beverage is really reducing your alcohol intake or whether it could trigger you to drink more3

Placebo and Expectancy Effects

Placebo effects—in the case of drugs, effects that aren’t actually caused by the drug itself—can also occur when people drink low alcohol and alcohol-free drinks. The effects of being intoxicated, such as lowered inhibitions—can be experienced without actually having a lot of alcohol in the bloodstream4

Expectancy also affects how a person reacts to low alcohol or alcohol-free beverages. Research into alcohol expectancies shows that alcohol/drug effects and the cycle of addiction are driven by people getting the effects they expect to get.5

Someone drinking low alcohol or alcohol-free beverage might not consciously expect to become intoxicated. However, the taste and appearance of the drink can trigger expectancy effects, causing the person to behave as if they had consumed a greater amount of alcohol.

It's a good idea to reflect on how you are affected by low alcohol and alcohol-free beverages and to consider whether you experience placebo or expectancy effects. Trusted friends are also a good source of information, particularly if you tell them you want an honest opinion of your appearance and behavior.

Low Alcohol vs. Alcohol-Free Beverages

A range of low alcohol and alcohol-free beverages are available. Alcohol-free beverages contain no alcohol at all, while low alcohol beverages have had most of the alcohol removed by osmosis (many still contain up to 0.5% alcohol). There are over 38 different types of low alcohol beer available, and research shows that the difference between these and full-strength beer cannot be determined by tasting.1

Alcohol-free beverages are the better choice for anyone who should avoid alcohol altogether. Low alcohol beverages may be a better choice for people who want to reduce their alcohol intake and prefer the taste and minimal effects of low alcohol beverages.

The issue of taste is quite important—people drink, at least initially, because they enjoy it. If you dislike the taste of the alcohol-free or low alcohol beverage you choose, you are more likely to relapse to the full-strength version. Therefore, less harm may be done by choosing a low alcohol beverage you enjoy than an alcohol-free version you dislike.

"Mocktails" are another alcohol-free option that you might consider if you are craving the taste of your favorite drink. These non-alcoholic cocktails often utilize a combination of ingredients such as vinegar and spices to replicate the flavors of authentic alcohol beverages—but without the actual alcohol.

Harm Reduction for Drivers

Low alcohol or alcohol-free drinks are ideal for moderate drinkers without health problems who intend to drive. This is much safer than the common approach of taking one or two drinks then stopping, which produces more impairment to the cognitive skills important to driving than if you drink low alcohol or alcohol-free beverages.

Because low alcohol and alcohol-free beverages do not dehydrate you to the same extent as full-strength beverages7 (you feel less thirsty after drinking them than you do regular versions), the risk of drinking an excessive amount of low alcohol or alcohol-free beverages is low.

Avoiding Intoxication

Feel embarrassed drinking soft drinks in social situations, but want to avoid intoxication? Low alcohol or alcohol-free beverages are an ideal solution. Vulnerable drinkers, such as young women attending clubs or parties, can stay sober by replacing alcoholic drinks with low or no alcohol alternatives. Or, consider drinking seltzer water with a lime in a cocktail glass.

Purported Health Benefits

Low alcohol beverages, particularly low alcohol red wine, are a good method for incorporating a small amount of alcohol into your diet if you wish to explore the health effects of alcohol reported in many studies.8

Research shows that people are particularly bad at judging home-poured drinks,

Blood alcohol content (BAC) is a measure of the amount of alcohol circulating in your bloodstream. It is expressed in terms of weight (milligrams) per unit of volume (milliliters) and is usually shown as a percentage. Blood alcohol content is used for legal and medical purposes to indicate a person's level of intoxication. 

Blood alcohol content is the amount of alcohol present in 100 milliliters (ml) or its equivalent of 1 deciliter (dL) of blood. For example:

• 80 mg is 0.08 grams
• 0.08 grams of alcohol in 100 ml is 0.08%
• This can also be expressed as 80 mg/dL or a BAC of 0.08

A blood-alcohol content of 0.1 (0.1% or one-tenth of 1%) means that there are 0.10 grams of alcohol for every deciliter of blood in the person's body at the time of the test. Synonyms for BAC include blood alcohol level, blood alcohol concentration, and blood ethanol concentration.

In 49 of 50 states and the District of Columbia, the legal limit for driving under the influence of alcohol is 0.08. In Utah, the legal BAC limit is 0.05.1 Commercial drivers have a limit of 0.04.2 Any detectable blood alcohol content is a violation for individuals under the age of 21.

BAC Levels and Impairment

When alcohol is consumed and absorbed into the bloodstream, it travels throughout the body and to the brain, affecting many cognitive functions and the ability to perform physical tasks. Driving skills can be impaired long before someone reaches the legal limit, but at 0.08 the risk of having a vehicle crash increases dramatically.3

The National Highway Traffic Safety Administration lists these effects on driving at different blood alcohol content levels:4

• 0.02 BAC: You are likely to feel relaxed and have some loss of judgment. You aren't able to quickly track the movements of other vehicles, pedestrians, or animals. You lose some of your ability to do two things at once, so you are more likely to be distracted.
• 0.05 BAC: You begin to exhibit loss of small-muscle control, such as being able to focus your eyes, and you can have lowered alertness. You have even worse ability to track moving objects. Your ability to steer is degraded. If an emergency situation develops, such as needing to brake quickly or maneuver around an unexpected blockage, you are likely to have a poorer response.
• 0.08 BAC: You will usually exhibit poor muscle coordination, loss of balance, slower reaction time, slurred speech, loss of acuity in vision and hearing, difficulty in detecting danger, and impaired judgment, self-control, reasoning, and memory. When driving, you have difficulty with speed control and recognizing and reacting to signals and emergency situations. You have an increased risk of injuries in general, and particularly those related to driving a vehicle.
• 0.10 BAC: At this level, you will have further deterioration of your abilities. It will be hard to maintain lane position and to brake when needed.
• 0.15 BAC: You will have poor muscle control and ability to balance. You are likely to vomit. You will have significant problems in controlling your vehicle and paying attention to your driving and what is happening around you.

Reaching the BAC Limit

Many factors determine your blood alcohol content and the level of impairment you may be experiencing. On an individual level, there is variance due to your weight, body fat percentage, hydration, digestion, and how alcohol affects your body chemistry.4

The alcohol content of the drinks you have consumed, the spacing of the drinks, and the amount of time that has passed since consuming the drinks all influence BAC. Use of medications and other drugs can affect how much impairment alcohol produces.4 In addition, research published in 2015 showed that people are not good at estimating their own BAC or level of impairment, leading to making poor decisions.6

There are many simple weight/gender charts that estimate the number of drinks and the blood alcohol content in one hour. For example, a 120-pound woman can reach a 0.08 BAC level after only two drinks. A 180-pound man can be at 0.08 after four drinks. A "drink" is either one shot of liquor, a five-ounce glass of wine, or one beer.

These estimates should always be used with caution because of the variation in measures and alcoholic content of drinks within different classes of alcohol. For example, some craft beers have twice the alcohol as the typical can of beer, and you may be drinking a full pint (16 ounces) rather than the 12 ounces found in a can.

A Word From Verywell

Enforcing the legal blood alcohol content limit is important for public safety, but you must use caution anytime you consume alcohol and then drive. You will have some impairment from the first drink and it is always best to avoid driving after you have taken a drink.

If you want to make sure you are not exceeding the recommended guidelines for safe alcohol consumption, it helps to know what a standard drink is. Moderate alcohol consumption is defined as up to one drink per day for women, or two drinks for men.1

In the United States, a standard drink is an alcoholic beverage that contains 14 grams of pure alcohol. That is 0.6 fluid ounces of pure alcohol, or about 1.2 tablespoons. Alcoholic beverages are not pure alcohol, so a standard drink is usually more than 0.6 fluid ounces.

One Standard Drink

Alcoholic beverages contain alcohol as well as water and other ingredients, and there is a difference in the alcohol content among beer, wine, and hard liquor. The equivalent of one standard drink is calculated based on the percentage of alcohol in the drink.2

• Beer and wine coolers: Beer and wine coolers are typically 5% alcohol, and a standard drink is 12 fluid ounces.
• Cider: Cider is about 6% alcohol, and a standard drink is about 10 fluid ounces.
• Malt liquor: Malt liquor is approximately 7% alcohol, and a standard drink is 8 to 9 fluid ounces.
• Wine: Table wine can be 12% alcohol, making 5 fluid ounces a standard drink, however other types of wines can be more than 14.5%. Fortified wines, such as sherry or port, are stronger (about 17% alcohol), and a standard drink is 3 to 4 fluid ounces.
• Liqueur: Liqueurs, cordials, and aperitifs are about 24% alcohol. A standard drink is 2 to 3 fluid ounces.
• Spirits: Spirits are typically 80 proof, which means that they contain 40% alcohol. A standard drink, or a shot, of whiskey, gin, vodka, or brandy is 1.5 fluid ounces.

Sometimes, different brands of alcoholic beverages vary in their actual alcohol content. Check the label to know the exact percentage of alcohol in your drink.

Standard Drinks Per Bottle

When you purchase beverages in their containers, rather than in a cup or glass, you will have more than one standard drink. Whether you plan to share among a group, drink by yourself, finish the bottle all at once, or drink it on several different occasions, it is helpful to know how many drinks there are in a container of alcohol.

• Beer: There is one standard drink in a regular 12-ounce can or bottle of beer, and one and a half standard drinks in a 16-ounce "tall boy." Another container, referred to as a "40," has 40 ounces of beer, which is the equivalent of three and a half standard drinks.
• Malt liquor: Malt liquor contains more alcohol than regular beer. A 12-ounce can or bottle of malt liquor contains one and a half standard drinks and a 40-ounce container of malt liquor contains four and a half standard drinks.
• Wine: A 750 ml wine bottle contains at least five standard drinks. A bottle of fortified wine, such as sherry or port, contains almost eight standard drinks.
• Hard liquor: A half pint of hard liquor contains four and a half drinks, and one pint contains eight and a half drinks. A fifth(750 ml) contains 17 standard drinks.

Know the Risks

Alcohol consumption puts you at risk of intoxication, which can result in accidents, impaired judgment, or problems such as blacking out, passing out, or alcohol withdrawal.3 Each person has a different response to alcohol, which is dependent on body weight and metabolism.

Drinking many drinks in a short period of time, or drinking when you haven't eaten, can make you absorb more alcohol in your system, increasing its effects. It is important to recognize what a standard drink is and keep track of how much you drink.

Drinking five or more drinks (for males, or four or more drinks for females) on the same occasion is defined as binge drinking. Heavy alcohol use is defined as drinking five or more drinks (for males, and four or more drinks for females) on the same occasion on five or more days within a month.

If you regularly drink more than the recommended guidelines, you may have an alcohol use disorder. You are also at increased risk of developing health problems due to your alcohol consumption.4

Blood alcohol concentration (BAC) is a measurement of the percentage of alcohol that's in your bloodstream after you've been drinking. Your BAC, rather than the exact amount of alcohol you've consumed, will determine the effects the alcohol will have on you. In all states, the legal limit to drive is any number above .08.1

As BAC increases, so does the level of alcohol-related impairment you will experience. While a breathalyzer gives fast results and is often used by police officers who suspect that an individual has been driving while drunk, it is not as accurate as measuring the amount of alcohol in your blood.2

How BAC Is Calculated

To calculate BAC, the amount of alcohol in the bloodstream is measured in milligrams (mg) of alcohol per 100 milliliters (ml) of blood. It is usually expressed as a decimal such as 0.08 or 0.15.

For example, a BAC of 0.10% means that an individual’s blood supply contains one part alcohol for every 1,000 parts blood.

How BAC Affects Impairment

The Centers for Disease Control and Prevention provides the following chart which illustrates how alcohol consumption and BAC can impact behavior, judgment, physiology, and driving ability.3

A standard drink is equal to 14 grams (0.6 ounces) of pure alcohol. Generally, this amount of pure alcohol is found in:

• 12 ounces of beer (5% alcohol content)
• 8 ounces of malt liquor (7% alcohol content)
• 5 ounces of wine (12% alcohol content)
• 1.5 ounces or a “shot” of 80-proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey)

Your blood alcohol level results may be given in different ways, including the percentage of blood alcohol content (BAC). Typical results include:4

• Sober: 0.0% BAC
• Legally intoxicated: .08% BAC
• Very impaired: .08–0.40% BAC. You may have difficulty walking and speaking. Other symptoms may include confusion, nausea, and drowsiness.
• At risk for serious complications: Above .40% BAC. An individual with this blood alcohol level may be at risk for coma or death.

A blood alcohol test is only accurate within 6 to 12 hours after your last drink. If you have concerns about your results, you may want to talk to a health care provider and/or a lawyer.

Although traffic fatalities are lower than they were at the turn of the century, alcohol-related crashes still kill about 10,000 people per year in the United States, with alcohol being a factor in one out of three motor vehicle deaths.1

Despite all the warnings, public awareness and educational programs, and stiffer penalties for violations, people will still get behind the wheel of their vehicles while intoxicated. Drunk driving numbers for high schoolers decreased by half between 1991 and 2012, but teens are still at risk whether they are the drivers or not.2

How Dangerous Is Drinking and Driving?

According to a 2014 study, an adult driver with a blood alcohol concentration (BAC) of 0.08 is seven times more likely to be involved in a fatal motor vehicle crash than a sober driver. Young adult drivers (ages 21-34) with a 0.08 BAC are 12 times as likely to be in a fatal car crash than drivers who haven't had alcohol.4

Basically, the more you drink, the more likely you are to have a fatal accident. The odds of having any vehicle accident, fatal or otherwise, increase at similar rates.5 Here are the cold, hard facts.

Alcohol Increases Your Risk of a Crash

A 160-pound person drinking two 12-ounce beers within an hour would probably have a BAC of 0.04, well below the legal limits of driving under the influence, but 1.4 times more likely to have an accident than someone who is sober.4

One of the problems with setting the legal limit for "drunk driving" at a blood-alcohol content level of 0.08 is it sends the message that if you are not yet legally drunk, you are therefore okay to drive.

Impairment Begins Below 0.08 BAC

The problem lies in the fact that impairment begins long before you reach the 0.08 level. Scientific research explicitly shows that some of the skills that you need to drive safely begin to deteriorate even at the 0.02 blood-alcohol level.6

Is It Safe to Drink Just Two More Beers?

If you had those first two beers that raised your BAC to 0.04 and now you drink two more beers to raise your BAC to 0.08, your likelihood of an accident goes up drastically. At 0.08 BAC, a driver is 11 times more likely than the non-drinking driver to be involved in a crash. As the amount of alcohol in the driver's system rises numerically on the BAC scale, the likelihood of a traffic accident multiplies.7

Now add two more beers to your total, you are up to having consumed a six-pack and have likely passed the 0.10 BAC level. Your likelihood of having an accident is now 48 times higher than the abstainer.

Two more beers: Hey, you've already had a six-pack, two more couldn't hurt, right? Except two more beers could put your BAC close to 0.15, at which point you are 380 times more likely to have an accident.

Play It Smart

Play it smart during weekends and holidays. If you plan to party away from home—and this includes on the water—be sure to appoint a designated driver for the car or operator of the boat.

Consider calling a cab or using a rideshare app to get yourself and your loved ones home safe and protect everyone else on the road. Better yet, if you are going to be drinking away from home, use those options to get to the party so you don't have a car handy that you'll be tempted to drive when your judgment is impaired by alcohol.

Many adults enjoy drinking a few alcoholic beverages, but how can you tell if your alcohol consumption is unsafe? If you're questioning whether your drinking habits are cause for concern, you should know that the threshold for harmful drinking is much lower than you might imagine.

Millions of people drink beer, wine, and spirits without developing a drinking habit that causes problems. However, your alcohol consumption could still put your health and well-being in jeopardy even if you don't develop an alcohol use disorder.

How much alcohol can you drink at a safe level and still be considered a low-risk drinker? How much alcohol consumption would place you in the high-risk group?

Here's what you need to know about the guidelines for alcohol consumption if you are trying to assess your risk.

Men: 4 or Fewer Drinks Per Day

For men, low-risk alcohol consumption is considered drinking four or fewer standard drinks on any single day and less than 14 drinks during a given week. According to the NIAAA, both the daily and weekly guidelines must be met for a person to remain low risk.2

In other words, if you are a man who only drinks four standard drinks per day, but you drink four every day, you are drinking 28 drinks per week—which is twice the recommended level for low-risk alcohol consumption.

Drinking four drinks per day four times a week would also exceed the guidelines.

Women: 3 or Fewer Drinks Per Day

Research has shown that women develop alcohol use disorders at lower levels of consumption compared to men. Therefore, the guidelines for low-risk drinking are lower for women. The NIAAA guideline for low-risk consumption for women is three or fewer standard drinks a day and no more than seven drinks per week.2

Again, both the daily and weekly standards must be met to remain in the low-risk category. If you're a woman who only has two drinks a day but you have two drinks every day, that's 14 drinks per week—twice the recommended amount for low-risk consumption.

Heart Health and Longevity

When considering the NIAAA's consumption guidelines, it's important to note that "low risk" doesn't mean "healthy." In fact, the low-risk category of drinking may not be the best level for heart health. One international study that looked specifically at the risk of cardiovascular disease found that consuming an even lower amount of alcohol may help you live longer.3

The study involved nearly 600,000 adults from all over the world who did not have a history of cardiovascular disease. The participants drank between 0 and 350 grams of alcohol each week (to put this figure in perspective, the recommendation for men in the U.S. is equivalent to 196 grams—about six glasses of wine).

The study found that drinking 100 grams or less of alcohol per week had the lowest risk for mortality.

'Low Risk' Does Not Mean 'No Risk'

There are some situations in which no level of drinking can be considered low risk. Depending on your age, health, and other circumstances, you may need to drink even less—or not drink at all.

A Personalized Approach

The NIAAA guidelines are for the "average" person. Thresholds vary greatly, and there are many factors involved. It's best to take a personalized approach to find a safe level of drinking for you.

Harvard Men's Health Watch suggests that you speak to your doctor to determine how much alcohol is safe for you to consume.4 Your doctor can take your entire medical history into account to make an accurate recommendation.

The amount of alcohol you consume might need to decrease as you age or if you need to keep certain health conditions, like your blood pressure, under control. It's important to keep in mind that what is considered safe and healthy for you might not be the same as it is for someone else.

A Word From Verywell

It's a good idea to gauge your current drinking level and assess whether you are regularly exceeding the guidelines for low-risk drinking. You might consider cutting down your alcohol consumption or quitting entirely. If you feel like your relationship with alcohol is interfering with your overall health and well-being, don't hesitate to seek help.

If it has hit you that you are drinking too much and that cutting down or quitting is not as easy as you thought it would be, you may be wondering what other steps you can take to control your alcohol consumption. Many people, including some medical professionals, believe that abstinence is the only way. But medical research has shown that the cold-turkey approach may not be the best way for everyone.

How to Gain Control

Different approaches work for different people and various types of addiction. Some people may be able to quit and never have a drop of alcohol for the rest of their lives. For them, even a glass of wine every now and again could trigger a return to drinking heavily. If you recognize yourself as that kind of drinker, it's important to stay away from alcohol as much as possible.

Many people cut down on their alcohol intake without medical or therapeutic help, although it is advisable to discuss your alcohol intake with your family doctor before trying to change it. It can also be helpful to talk with a counselor who is trained in assisting people with substance use concerns and addiction for their advice and support.

How to Cut Back

If you feel that avoiding alcohol completely is not for you, there are other options. Some people can get control over their drinking and drink safer levels of alcohol without having to quit entirely. If you plan to attempt to control your drinking, there are several steps you should take to assist you in this process.

Establish Your Drinking Goal

Although it is a good idea to think about reducing your alcohol intake, check whether you are a suitable candidate for controlled drinking. Some people shouldn't drink at all, especially if you have a history of addiction problems or a close relative with an addiction or mental health issue.

If you realize you should quit completely, talk to your doctor or addiction counselor about getting help with quitting alcohol and staying sober.2 Depending on how much you have been drinking recently, it may not even be safe or realistic to quit cold turkey, and your doctor can prescribe medications or refer you to a treatment program.

There is no shame in this. Remember, those who struggle with alcohol use disorder want to be able to reduce or moderate their alcohol intake, but it's not always something they can control despite their best efforts. 

Assess Your Current Alcohol Intake

Keep a drinking diary for one week.3 The most straightforward drinking diaries just record how much you drink each day, but the more you can keep track of, the better you will understand your own drinking patterns, and thus be able to control them. For example, every evening (or the following morning, if you forget), write down how many drinks you drank, where you were, and with whom.

Also write down any negative effects or situations that arose that you would like to avoid in the future. For example, "After my third beer, I got into an argument with Ben." This will give you a good idea of the times, places, and people where your drinking tends to become excessive or problematic.

When you have figured out how many drinks you can drink, write it down, along with the drinking time period.

Purchase Alcohol in Small, Measured Amounts

Stocking up on wine, beer, and liquor is the quickest way to sabotage your plan to drink responsibly. For drinking at home, follow these tips:

• Avoid hard alcohol. Switching to drinking less concentrated drinks, like beer or wine over vodka, is one way to reduce alcohol intake.
• Limit your purchases. Buy only the amount of alcoholic beverage that meets your safe alcohol limit, on the day you intend to drink it. If necessary, purchase individual cans or single serving or half-size bottles of wine.
• Only drink after big meals. This will dilute the effect of alcohol consumption and therefore reduce the drive to drink excessively.
• Stick to your schedule. Drink only the amount you wrote down, and at the speed specified. If you want more to drink in between, drink water, or alcohol-free or low-alcohol beverages.
• Try alcohol-free or low-alcohol options. If you know that you'll want more drinks, but not more alcohol, purchase the same amount of alcohol-free or low-alcohol wine or beer.

Watch for Peer Pressure

Look at your drinking diary. If there are any people who encourage you to drink too much, try to avoid them for the first month or so while you get used to your new style of drinking. If you are constantly surrounded by peer pressure to drink, start seeking out new friends or family members who don't drink as much.4

Plan Your Journey Home

Even if you're drinking at a sensible level, you should not drive. Arrange for a ride home with a sober driver, or pre-book a cab or rideshare service. If that is too costly, plan your journey home via public transportation so you know when to leave while the buses or trains are still running. Leave your car at home so you will not be tempted to use it. Get a ride or take a bus or train to your event.

Discover Healthy Alternatives

If drinking has occupied a big part of your social life, it may also be time to explore other activities and hobbies that don't involve alcohol and that focus on self-care. Here are a few ideas to get you started:

• Go for a walk.
• Practice yoga, tai chi, or meditation.
• Snuggle up with a loved one and watch a movie.
• Start or join a book club.
• Take up drawing or photography.
• Try a new type of exercise class.

Seek Help

Talk to your family doctor or an addiction counselor about whether a moderation or abstinence-based approach is right for you.5 If you decide together that moderation is the right goal, there may be a program or support group that will support you in your new lifestyle. There are also medications that can be helpful for people who want to reduce their drinking.

Ask your doctor or counselor for a referral and/or work together to develop strategies for controlling your alcohol consumption and drinking responsibly or quitting all together.6

Quitting substance use suddenly and abruptly, or "cold turkey," carries very significant risks if the drug you are discontinuing is alcohol, a benzodiazepine or an opiate. It is also not advisable if you have been using any drug in large amounts and/or for a long time, because what you have been using may contain one of the high-risk drugs mentioned, or because you may suffer from extreme withdrawal symptoms.

The Appeal of Quitting Cold Turkey

For many addicts, quitting cold turkey is more appealing because it can be easier to avoid the drug entirely than to use moderately when your usual mode is to take the drug in an unrestrained manner. Many feel that they can more easily separate themselves from the world of drug use if they do so completely, avoiding all of the people, places and other reminders of the drug and starting afresh.

Risks

Quitting can be dangerous to do on your own because of the way the nervous system adapts to certain high dependency drugs. Abruptly taking these drugs out of your system can cause a variety of serious and potentially life-threatening medical conditions, including seizures and heart problems.1

Even drugs that have less pronounced physical dependence, such as cocaine, amphetamines, and nicotine, can produce severe and unpleasant withdrawal symptoms that can make life uncomfortable and emotionally difficult.1

Medical Supervision for Drug Abstinence Is Safest

This does not mean you can't become abstinent, but especially if you are quitting alcohol, a benzodiazepine or an opiate, you should quit under the management of a physician, who can give you medication to lessen the effects of withdrawal. Doctors affiliated with the American Board of Addiction Medicine have special training in addiction medicine and are particularly helpful in managing withdrawal safely.

In many cases, a brief time in detox can be the safest option so that medical staff is on hand in case of a medical emergency. The staff can also help with providing nutrition, hydration, and medications intravenously if you are suffering from significant nausea, vomiting, or diarrhea during your withdrawal.1

However, many people are able to detox safely at home or in the community while meeting regularly with their doctor or health professional to ensure they remain well throughout the process. Your doctor may prescribe you different medications depending on the drug you are withdrawing from.

When to Call 911

If you or someone you know is showing signs of a heart attack or seizure while quitting cold turkey, call 911 immediately.Symptoms of a heart attack may include:2

• Shortness of breath
• Chest pain
• Pain or discomfort in the jaw, neck or back
• Weakness, lightheadedness or faintness
• Pain or discomfort in the arms or shoulder
• Nausea
• Vomiting

There is no doubt that people with drug and alcohol addictions feel much better after they quit. There are many stories of recovery that demonstrate how amazing life can feel once you have put your addiction behind you. However, there is often a very difficult stage you will go through before you begin to feel better, which happens right after you quit. This is known as withdrawal.

People who have only used drugs and alcohol for a short time, or who have only taken small doses, may not go through withdrawal. Some experience a hangover or crash after intoxication wears off, which they can sleep off.

If you have not been using for long, and haven’t increased your dose much since your first use, you might be able to quit and feel better right away (without experiencing withdrawal symptoms). People who have been drinking or using for longer, or who have been binge drinking or using drugs in increasingly high doses over a shorter period of time, will often go through a period of feeling quite unwell.

While there are many physical symptoms of withdrawal from the use of alcohol, heroin, meth. and more, withdrawal also has an emotional side. These emotional symptoms can accompany withdrawal from any drug or alcohol. These symptoms occur with behavioral addictions, as well.

Depression

The depressive symptoms that people experience during withdrawal are usually described as worse than everyday sadness, and may share aspects with clinical depression (although it doesn’t usually last as long). People who have just quit drugs sometimes describe it as an empty, hopeless state, where they feel the opposite of the good feelings they felt when they were drinking or high.

Depressive feelings can be accompanied by a lack of energy or enthusiasm for life. Especially if drinking or drugs were central to your life, this can feel a bit scary, like your life ahead is empty without the thrill of getting high or drunk.

People going through withdrawal often have feelings of doom, hopelessness, and low self-worth. They may cry frequently, have difficulty concentrating, and eat and sleep erratically.

If possible, prepare for withdrawal depression before quitting. Supportive people, who you can trust to steer you away from alcohol or drug use, and who won't trigger or upset you, are good to have around. Low-key entertainment such as a batch of your favorite comedy movies—as long as they aren't about drinking, drugs, or partying—and good self-care practices can help to ease this unhappy time.

These depressive feelings can be traced to the biological changes taking part in your brain during withdrawal. They are also a clue that your body is swinging back from the excitement and euphoria of your addictive behavior or drug, searching for homeostasis.

Another part is the feeling of let-down, disappointment, and loss that happen when something that felt good or right turns sour and has to be left behind. Think of it as a process of grieving; it is not altogether unhealthy, as the feelings of sadness will help you to come to terms with your decision eventually.

If your feelings of depression make you feel as if you can't cope, see your doctor. Talking to a therapist can also help, as they know many ways to help people overcome feelings of depression. Being able to talk to someone who understands your feelings and takes them seriously can ease your emotional turmoil.

If your feelings of depression continue, you may be experiencing a substance-induced mood disorder, or you may have had a pre-existing mood disorder that was masked by your drug use. Either way, your doctor or therapist can help get you proper treatment.

Anxiety

Anxiety is also usually worse during withdrawal than what you experience during everyday nervousness. It is often more like the experience of having an anxiety disorder, but doesn't normally last as long.

As with depression, some anxiety during withdrawal is to be expected. If you took a drug or drank to help you relax, your body will adjust during withdrawal and you will feel tenser. Also, people who have been using drugs or alcohol to self-medicate may be fearful of what will happen without their usual way of coping.

Anxiety can be physically and mentally uncomfortable. Physical symptoms often make you feel as if something scary is happening. Your breathing and heart rate can increase, sometimes to the point that you feel you can't catch their breath, or that you are having a heart attack, even when you are not.

It is important to remind yourself, and for those around you to remind you, that you are safe, and the anxiety you are feeling is your body is going through a normal healing process. However, if your anxiety symptoms intensify and are accompanied by other physical symptoms, you may be experiencing more significant withdrawal and should contact your physician.

Mood Swings

It is not uncommon for people going through withdrawal to have rapid fluctuations in mood. One minute, you might feel exhausted, with no energy, and as if life is not worth living. The next minute, you could feel like you need to run away because something awful is about to happen.

This back-and-forth can be very draining, both for you and for those around you. It is important to remember that life is worth living, that life will get much better once you have quit, and that you have nothing to fear from putting your addiction behind you.

If your mood swings are interfering with your ability to function, see your doctor. A therapist can also help. There are many techniques you can use to calm your nervous system and challenge the negative thoughts that come along with feelings of depression and anxiety. If mood changes are severe, last longer than other withdrawal symptoms, or include thoughts of harming yourself or suicide, seek help immediately.

Fatigue

As with anxiety and depression, feelings of fatigue are common and normal among people withdrawing from drugs and alcohol. Your body has to recover from the damage that drugs and alcohol do, as well as from lifestyle factors that go along with alcohol and drug use, such as sleep deprivation, sleep disturbance, and over-stimulation.

Fatigue is also a common symptom of depression and an after-effect of anxiety. You are also going to feel tired from the many thoughts and emotions that can overwhelm you when you don't have alcohol or drugs to numb them. With rest and time, these feelings of fatigue will pass.

Withdrawal fatigue is exhausting, but people often try and keep going at their usual pace. Allow your body to recover by taking a break from your usual activities—don't go out socializing for a few days and take some sick leave from work. Get plenty of rest—get enough sleep and practice relaxation skills.

Timing

Once you are through the first week or two of withdrawal, your needs change. This is often a good time to get treatment which will help you understand why you drank or used drugs in the first place, and help set you up for a life without alcohol or drugs. While some people can do this on their own, many benefit from extra support during the first few months after going through withdrawal, to avoid relapse.

A Word From Verywell

Facing depression, anxiety, and other emotional symptoms during withdrawal may be very difficult. It is challenging for almost everyone. However, once you are on the other side, you won't regret it. You have the rest of your life ahead of you that will be free of alcohol or drugs.

The term alcoholism refers to a disease known as alcohol dependence syndrome, the most severe stage of a group of drinking problems which begins with binge drinking and alcohol abuse.

Types of Alcohol Problems

Alcohol problems occur at different levels of severity, from mild and annoying to life-threatening. Although alcohol dependence (alcoholism) is the most severe stage, less severe drinking problems can also be dangerous. Learn more about the different types.

Binge Drinking

Officially, binge drinking means having five or more drinks in one session for men and four or more for women. Another informal definition for binge drinking is simply drinking to get drunk, although this usage is not clinically specific. Binge drinking is the most common drinking problem for young people under the age of 21.

Alcohol Abuse

Binge drinking turns into alcohol abuse when your drinking begins to cause problems in your daily life and the drinking continues anyway—in other words, alcohol abuse is when you continue to drink in spite of continued social, interpersonal, or legal difficulties. Alcohol abuse can result in missing time at school or work, neglecting child or household responsibilities or incurring legal problems including lawsuits from unpaid bills or criminal prosecution for public intoxication, drunk driving, or domestic violence.

Because alcohol impairs your judgment, you're more likely to do "something stupid" under the influence of alcohol than if you were stone-cold sober.

Alcohol Dependence

Alcohol abuse becomes alcohol dependence when drinkers begin to experience a craving for alcohol, a loss of control of their drinking, withdrawal symptoms when they are not drinking and an increased tolerance to alcohol so that they have to drink more to achieve the same effect. Alcohol dependence is a chronic and often progressive disease that includes a strong need to drink despite repeated problems.

Is Alcoholism Inherited?

Alcoholism tends to run in families and a significant amount of scientific research suggests that genetics play a role in developing alcohol problems. But research also shows that a person's environment and peer influences also affect your risk of becoming alcohol dependent. Just having a family history of alcoholism does not doom a person into becoming an alcoholic.1

Getting Help

Alcoholism is a serious condition but if you or someone you love is affected by it, seek help. The National Institute on Alcohol Abuse and Alcoholism's Alcohol Treatment Navigator is a great resource.2 Your primary care doctor or a public health nurse can help steer you in the right direction, or you can visit an open meeting of a 12-step program like Alcoholics Anonymous.

Low alcohol beer and wine have been widely available for several years. Research shows that even regular beer drinkers can't tell the difference between low alcohol beer and the real thing.1

Many people who are reducing the amount of alcohol they are drinking wonder whether low alcohol or alcohol-free beverages are a good substitute for full-strength alcoholic drinks. There are several issues to consider when making this choice.

Have You Ever Had an Alcohol Problem?

This question deserves careful consideration by people who have had a problem with alcohol in the past, or who are currently experiencing problems with alcohol, such as:

• A diagnosis of alcohol abuse, alcohol dependence, or alcohol use disorder
• Binge drinking, or difficulty stopping once you have started drinking
• Problems with self-control when intoxicated
• Becoming aggressive, anxious, or depressed after drinking
• Physical problems as a result of alcohol use, such as liver disease

If you have a problem with alcohol, you may be better off avoiding alcoholic drinks of any kind.2 It is also worth considering avoiding alcohol if one of your parents or siblings has had serious problems with alcohol.

If you fit this category, discuss the idea of replacing some or all of your alcoholic drinks with low alcohol or alcohol-free beverages with your doctor, alcohol counselor, or AA sponsor. Reflect on whether the low alcohol or alcohol-free beverage is really reducing your alcohol intake or whether it could trigger you to drink more3

Placebo and Expectancy Effects

Placebo effects—in the case of drugs, effects that aren’t actually caused by the drug itself—can also occur when people drink low alcohol and alcohol-free drinks. The effects of being intoxicated, such as lowered inhibitions—can be experienced without actually having a lot of alcohol in the bloodstream4

Expectancy also affects how a person reacts to low alcohol or alcohol-free beverages. Research into alcohol expectancies shows that alcohol/drug effects and the cycle of addiction are driven by people getting the effects they expect to get.5

Someone drinking low alcohol or alcohol-free beverage might not consciously expect to become intoxicated. However, the taste and appearance of the drink can trigger expectancy effects, causing the person to behave as if they had consumed a greater amount of alcohol.

It's a good idea to reflect on how you are affected by low alcohol and alcohol-free beverages and to consider whether you experience placebo or expectancy effects. Trusted friends are also a good source of information, particularly if you tell them you want an honest opinion of your appearance and behavior.

Low Alcohol vs. Alcohol-Free Beverages

A range of low alcohol and alcohol-free beverages are available. Alcohol-free beverages contain no alcohol at all, while low alcohol beverages have had most of the alcohol removed by osmosis (many still contain up to 0.5% alcohol). There are over 38 different types of low alcohol beer available, and research shows that the difference between these and full-strength beer cannot be determined by tasting.1

Alcohol-free beverages are the better choice for anyone who should avoid alcohol altogether. Low alcohol beverages may be a better choice for people who want to reduce their alcohol intake and prefer the taste and minimal effects of low alcohol beverages.

The issue of taste is quite important—people drink, at least initially, because they enjoy it. If you dislike the taste of the alcohol-free or low alcohol beverage you choose, you are more likely to relapse to the full-strength version. Therefore, less harm may be done by choosing a low alcohol beverage you enjoy than an alcohol-free version you dislike.

"Mocktails" are another alcohol-free option that you might consider if you are craving the taste of your favorite drink. These non-alcoholic cocktails often utilize a combination of ingredients such as vinegar and spices to replicate the flavors of authentic alcohol beverages—but without the actual alcohol.

Harm Reduction for Drivers

Low alcohol or alcohol-free drinks are ideal for moderate drinkers without health problems who intend to drive. This is much safer than the common approach of taking one or two drinks then stopping, which produces more impairment to the cognitive skills important to driving than if you drink low alcohol or alcohol-free beverages.

Because low alcohol and alcohol-free beverages do not dehydrate you to the same extent as full-strength beverages7 (you feel less thirsty after drinking them than you do regular versions), the risk of drinking an excessive amount of low alcohol or alcohol-free beverages is low.

Avoiding Intoxication

Feel embarrassed drinking soft drinks in social situations, but want to avoid intoxication? Low alcohol or alcohol-free beverages are an ideal solution. Vulnerable drinkers, such as young women attending clubs or parties, can stay sober by replacing alcoholic drinks with low or no alcohol alternatives. Or, consider drinking seltzer water with a lime in a cocktail glass.

Purported Health Benefits

Low alcohol beverages, particularly low alcohol red wine, are a good method for incorporating a small amount of alcohol into your diet if you wish to explore the health effects of alcohol reported in many studies.8

Research shows that people are particularly bad at judging home-poured drinks,9 so it is difficult to limit yourself to the small quantities recommended before going over into amounts that are more harmful than not drinking at all.

Many adults enjoy drinking a few alcoholic beverages, but how can you tell if your alcohol consumption is unsafe? If you're questioning whether your drinking habits are cause for concern, you should know that the threshold for harmful drinking is much lower than you might imagine.

Millions of people drink beer, wine, and spirits without developing a drinking habit that causes problems. However, your alcohol consumption could still put your health and well-being in jeopardy even if you don't develop an alcohol use disorder.

How much alcohol can you drink at a safe level and still be considered a low-risk drinker? How much alcohol consumption would place you in the high-risk group?

Here's what you need to know about the guidelines for alcohol consumption if you are trying to assess your risk.

Men: 4 or Fewer Drinks Per Day

For men, low-risk alcohol consumption is considered drinking four or fewer standard drinks on any single day and less than 14 drinks during a given week. According to the NIAAA, both the daily and weekly guidelines must be met for a person to remain low risk.2

In other words, if you are a man who only drinks four standard drinks per day, but you drink four every day, you are drinking 28 drinks per week—which is twice the recommended level for low-risk alcohol consumption.

Drinking four drinks per day four times a week would also exceed the guidelines.

Women: 3 or Fewer Drinks Per Day

Research has shown that women develop alcohol use disorders at lower levels of consumption compared to men. Therefore, the guidelines for low-risk drinking are lower for women. The NIAAA guideline for low-risk consumption for women is three or fewer standard drinks a day and no more than seven drinks per week.2

Again, both the daily and weekly standards must be met to remain in the low-risk category. If you're a woman who only has two drinks a day but you have two drinks every day, that's 14 drinks per week—twice the recommended amount for low-risk consumption.

Heart Health and Longevity

When considering the NIAAA's consumption guidelines, it's important to note that "low risk" doesn't mean "healthy." In fact, the low-risk category of drinking may not be the best level for heart health. One international study that looked specifically at the risk of cardiovascular disease found that consuming an even lower amount of alcohol may help you live longer.3

The study involved nearly 600,000 adults from all over the world who did not have a history of cardiovascular disease. The participants drank between 0 and 350 grams of alcohol each week (to put this figure in perspective, the recommendation for men in the U.S. is equivalent to 196 grams—about six glasses of wine).

The study found that drinking 100 grams or less of alcohol per week had the lowest risk for mortality.

'Low Risk' Does Not Mean 'No Risk'

There are some situations in which no level of drinking can be considered low risk. Depending on your age, health, and other circumstances, you may need to drink even less—or not drink at all.

A Personalized Approach

The NIAAA guidelines are for the "average" person. Thresholds vary greatly, and there are many factors involved. It's best to take a personalized approach to find a safe level of drinking for you.

Harvard Men's Health Watch suggests that you speak to your doctor to determine how much alcohol is safe for you to consume.4 Your doctor can take your entire medical history into account to make an accurate recommendation.

The amount of alcohol you consume might need to decrease as you age or if you need to keep certain health conditions, like your blood pressure, under control. It's important to keep in mind that what is considered safe and healthy for you might not be the same as it is for someone else.

A Word From Verywell

It's a good idea to gauge your current drinking level and assess whether you are regularly exceeding the guidelines for low-risk drinking. You might consider cutting down your alcohol consumption or quitting entirely. If you feel like your relationship with alcohol is interfering with your overall health and well-being, don't hesitate to seek help.

What Is Alcohol Use Disorder?

According to the National Institutes of Health, an alcohol use disorder (AUD) is defined as a “chronic relapsing brain disease” that causes a person to drink compulsively despite adverse consequences to daily life and overall health.1

Alcohol use disorder replaced the designations that had previously been separately defined as "alcohol abuse" and "alcohol dependence."

Symptoms

It is common for people to deny that they misuse alcohol. Furthermore, you may not recognize the signs of an alcohol use disorder in yourself or in someone else.

The "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," (DSM-5), published in 2013, has created a list of 11 symptoms that indicate an alcohol use disorder. The more symptoms you have, the more urgent the need for help.

• Alcohol is often taken in larger amounts or over a longer period than was intended.
• There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
• A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
• Craving, or a strong desire or urge to use alcohol.
• Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
• Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
• Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
• Recurrent alcohol use in situations in which it is physically hazardous.
• Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
• Tolerance, as defined by either a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol.
• Withdrawal, as manifested by either the characteristic withdrawal syndrome for alcohol, or alcohol (or a closely related substance, such as a benzodiazepine) taken to relieve or avoid withdrawal symptoms.

Diagnosis

Roughly 15 million people in the United States were diagnosed with an AUD in 2018, including 19.2 million men, 5.3 million women, and 401,000 adolescents ages 12–17.

To be diagnosed with an AUD, individuals must experience two of the 11 criteria of AUD as outlined by the DSM-5 during the same 12-month period. Here's a quick summary of the above criteria:

• Drinking more than intended
• Trying to quit without success
• Increased alcohol-seeking behavior
• Missing work or school due to drinking
• Interference with important activities
• Craving for alcohol
• Drinking despite social or personal problems
• Continued use despite health problems
• Drinking in hazardous situations
• Build up of tolerance
• Withdrawals when trying to quit

Causes and Risk Factors

An alcohol use disorder can result from a combination of genetic, environmental, psychological, and social factors, many of which are still being researched. Some of the most common risk factors include:

• Heavy, chronic drinking:Drinking too much alcohol has been found to alter the parts of the brain responsible for pleasure, judgment, and self-control, which can cause alcohol cravings.2
• Family history:Children of parents with an alcohol use disorder are two to six times more likely than the general public to develop an AUD. This increased risk is likely due genetics as well as environmental and lifestyle influences shared by members of the family.2
• History of trauma:Childhood trauma, including emotional abuse, sexual abuse, physical abuse, emotional neglect, and physical neglect, have all been linked to an increased risk for an AUD in adulthood.3
• Psychiatric disorders:People with a mental health disorder such as anxiety, depression, schizophrenia, and bipolar disorder have been found to have higher rates of misusing alcohol or other substances. In fact, studies show that over one-third of patients with schizophrenia meet the criteria for an AUD diagnosis.4
• Social and cultural influences: Having parents, peers, partners, and other role models who drink regularly may increase a person’s risk of developing an AUD, especially if the person is exposed to heavy drinking at a young age. 

Another important factor that influences the risk of alcohol on the body is nutrition. Alcohol and nutrition can interact in a number of ways—heavy alcohol use can interfere with nutrition while alcohol/nutrition interacts can impact gene expression.5

Types

Alcohol use disorder is sub-classified into mild, moderate, and severe categories.

• Mild: If you have two to three of the 11 symptoms on the list, you could be diagnosed with a mild disorder.
• Moderate: If you have four to five symptoms, you are likely to have a moderate alcohol use disorder.
• Severe: If you have six or more of the symptoms, you have a severe alcohol use disorder.

Treatment

The good news is that most people with AUD can benefit from treatment, which often includes a combination of behavioral treatment, medication, and support. The bad news is that less than 10% of people actually receive treatment6 , often due to fear of stigma or shame, denial or lack of problem awareness, skepticism about treatment, and lack of accessibility to affordable treatment.7

A good first step is talking to your primary care physician, who can assess your overall health, evaluate the severity of your drinking, help craft a treatment plan, refer you to an addiction specialist or treatment program, and determine if you need any medications for alcohol.

Detox and Withdrawal

Depending on the severity of your AUD, you may need to undergo medical detox to help treat the symptoms of alcohol withdrawal, which can range from mild to severe.

Detox can be done on an in-person or outpatient basis and include intravenous (IV) fluids to prevent dehydration and medications to minimize symptoms and treat seizures or other complications of alcohol withdrawal.

Behavioral Treatment

A big part of AUD recovery is working with a trained professional to better understand your relationship with alcohol and to learn how to cope with daily living without alcohol. Behavioral treatment can also help with any co-occurring mental illnesses contributing to the AUD.

• Cognitive behavioral therapy: aims to teach you to recognize and avoid the situations in which you are most likely to drink and to cope with other problems and behaviors that may lead to alcohol misuse.
• Motivational enhancement therapy: aims to help you build your confidence and motivation to stop drinking.
• Family therapy: aims to help families become aware of their own needs and prevents substance misuse from moving from one generation to another.
• Brief interventions: aims to get the person to reduce their level of drinking or change their harmful pattern of drinking.

Medications

There are currently three medications approved by the FDA for the treatment of an alcohol use disorder. While not all people will respond to medication, many find it helpful in reducing cravings and maintaining abstinence, especially when combined with behavioral treatment and support.

• Naltrexone (Revia, Depade, Vivitrol): reduces the craving for alcohol
• Acamprosate (Campral): reduces post-acute withdrawal symptoms during the early stages of alcohol abstinence
• Disulfiram (Antabuse): causes unpleasant symptoms such as flushing, nausea, vomiting, and headache when you drink alcohol

Support Groups

Online and community-based recovery groups can also be helpful during alcohol withdrawal and addiction treatment. A support group, like Alcoholics Anonymous or SMART recovery, can help you feel less isolated and provide an opportunity to learn from and connect with others with similar problems and shared experiences.

Coping

In addition to getting appropriate AUD treatment, there are things that you can do on your own that will make it easier to cope with and sustain your recovery.

Recognize Your Triggers

Understanding what might trigger you to relapse and having a plan in the place for such triggers is important for staying sober during and after treatment for an AUD.

Some common triggers may include:

• Stress
• Emotional distress
• Environmental cues that result in cravings
• People who are still using drugs or drinking
• Relationship troubles
• Job or financial problems

Practice Self-Care

A big part of recovery is building resilience toward life stressors without turning to alcohol, and practicing self-care (focusing on your physical, social, mental, and spiritual well-being) can help. Taking steps to care for your mind and body will better equip you to live your best sober life.

Seek Support

Social support from friends and family as well as online or in-person support groups can help prevent feelings of isolation and shame and provide a sense of security and hope about your sober future. Family members and loved ones can also benefit from this type of support and may consider groups like Al-Anon and Alateen.

Quitting substance use suddenly and abruptly, or "cold turkey," carries very significant risks if the drug you are discontinuing is alcohol, a benzodiazepine or an opiate. It is also not advisable if you have been using any drug in large amounts and/or for a long time, because what you have been using may contain one of the high-risk drugs mentioned, or because you may suffer from extreme withdrawal symptoms.

The Appeal of Quitting Cold Turkey

For many addicts, quitting cold turkey is more appealing because it can be easier to avoid the drug entirely than to use moderately when your usual mode is to take the drug in an unrestrained manner. Many feel that they can more easily separate themselves from the world of drug use if they do so completely, avoiding all of the people, places and other reminders of the drug and starting afresh.

Risks

Quitting can be dangerous to do on your own because of the way the nervous system adapts to certain high dependency drugs. Abruptly taking these drugs out of your system can cause a variety of serious and potentially life-threatening medical conditions, including seizures and heart problems.1

Even drugs that have less pronounced physical dependence, such as cocaine, amphetamines, and nicotine, can produce severe and unpleasant withdrawal symptoms that can make life uncomfortable and emotionally difficult.1

Medical Supervision for Drug Abstinence Is Safest

This does not mean you can't become abstinent, but especially if you are quitting alcohol, a benzodiazepine or an opiate, you should quit under the management of a physician, who can give you medication to lessen the effects of withdrawal. Doctors affiliated with the American Board of Addiction Medicine have special training in addiction medicine and are particularly helpful in managing withdrawal safely.

In many cases, a brief time in detox can be the safest option so that medical staff is on hand in case of a medical emergency. The staff can also help with providing nutrition, hydration, and medications intravenously if you are suffering from significant nausea, vomiting, or diarrhea during your withdrawal.1

However, many people are able to detox safely at home or in the community while meeting regularly with their doctor or health professional to ensure they remain well throughout the process. Your doctor may prescribe you different medications depending on the drug you are withdrawing from.

When to Call 911

If you or someone you know is showing signs of a heart attack or seizure while quitting cold turkey, call 911 immediately.Symptoms of a heart attack may include:2

• Shortness of breath
• Chest pain
• Pain or discomfort in the jaw, neck or back
• Weakness, lightheadedness or faintness
• Pain or discomfort in the arms or shoulder
• Nausea
• Vomiting

How many drinks are in common containers?

A U.S. standard drink is defined as any beverage containing 0.6 fluid ounces or 14 grams of pure alcohol (also known as an alcoholic drink-equivalent). Below is the approximate number of U.S. standard drinks or alcoholic drink-equivalents in different sized containers of:

Do you drink cocktails or an alcoholic beverage not listed above? If you’re curious and willing to do a little research on your beverage’s alcohol content, you can use Rethinking Drinking's calculators to estimate the number of U.S. standard drinks (alcoholic drink-equivalents) in a cocktail or container.

What are the different drinking levels?

The 2015-2020 Dietary Guidelines for Americans defines moderate drinking as up to 1 drink per day for women of legal drinking age and up to 2 drinks per day for men of legal drinking age.

When is moderate drinking still too much?

It's safest to avoid alcohol altogether if you are:

• Taking medications that interact with alcohol
• Managing a medical condition that can be made worse by drinking
• Underage
• Planning to drive a vehicle or operate machinery
• Participating in activities that require skill, coordination, and alertness
• Recovering from alcohol use disorder or unable to control the amount they drink
• Pregnant or trying to become pregnant

What are binge and heavy drinking?

Binge drinking is a pattern of drinking that brings blood alcohol concentration (BAC) to 0.08 percent or higher. This typically occurs after 4 drinks for women and 5 drinks for men—in about 2 hours.

Heavy alcohol use is defined as more than 4 drinks on any day for men or more than 3 drinks for women.

Drinking excessively, which includes binge drinking and heavy alcohol use, increases your risk of harmful consequences, including AUD. The more drinks on any day and the more heavy drinking over time, the greater the risk.

Why do women face higher risks?

Studies show that women start to have alcohol-related problems sooner and at lower drinking levels than men do and for multiple reasons. On average, women weigh less than men. Also, alcohol resides predominantly in body water, and pound for pound, women have less water in their bodies than men.

This means that after a woman and a man of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration (BAC, the amount of alcohol in the blood) will tend to be higher, putting her at greater risk for harm. Other biological differences may contribute as well.

What are the risks?

Injuries. Alcohol use increases your chances of being injured or even killed. Alcohol is a factor, for example, in about 60 percent of fatal burn injuries, drownings, and homicides; 50 percent of severe trauma injuries and sexual assaults; and 40 percent of fatal motor vehicle crashes, suicides, and fatal falls.

Health problems. Drinking can cause a number of health problems and is associated with over 200 diseases and injury-related conditions. Studies have shown that one drink a day increases the risk of breast cancer in women. Research has also shown that alcohol misuse increases the risk of liver disease, cardiovascular diseases, depression, and stomach bleeding, as well as cancers of the oral cavity, esophagus, larynx, pharynx, liver, colon, and rectum. They may also have problems managing conditions such as diabetes, high blood pressure, pain, and sleep disorders. And they are more likely to engage in unsafe sexual behavior, putting themselves and others at risk for sexually transmitted diseases and unintentional pregnancies.

Birth defects. Prenatal alcohol exposure can result in brain damage and other serious problems in the baby. The effects are known as fetal alcohol spectrum disorders, or FASD, and can result in lifelong physical, cognitive, and behavioral problems. Because it is not yet known whether any amount of alcohol is safe for a developing baby, women who are pregnant or may become pregnant should not drink.

Alcohol use disorder. Alcohol use disorder is a medical condition that doctors can diagnose when a patient's drinking interferes with their daily life. Some signs are: continuing to drink even though it is causing trouble with your family or at work, drinking more than you intended, having to drink more than before to get a desired effect, being unable to stop drinking after repeated attempts, or continuing to drink even though it makes you feel depressed or anxious. Learn more about the symptoms of AUD. Any of these symptoms may be a cause for concern. The more symptoms one has, the more urgent the need for change.

Beyond these physical and mental health risks, frequent heavy drinking also is linked with personal problems, including losing a driver's license and having relationship troubles.

What are symptoms of alcohol use disorder?

A few mild symptoms — which you might not see as trouble signs — can signal the start of a drinking problem. It helps to know the signs so you can make a change early. If heavy drinking continues, then over time, the number and severity of symptoms can grow and add up to "alcohol use disorder." Doctors diagnose alcohol use disorder when a patient's drinking causes distress or harm. See if you recognize any of these symptoms in yourself. And don't worry — even if you have symptoms, you can take steps to reduce your risks.

In the past year, have you (check all that apply and click the "Feedback" button, below):

• Had times when you ended up drinking more, or longer, than you intended?
• More than once wanted to cut down or stop drinking, or tried to, but couldn't?
• More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
• Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
• Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
• Spent a lot of time drinking? Or being sick or getting over other aftereffects?
• Continued to drink even though it was causing trouble with your family or friends?
• Found that drinking—or being sick from drinking—often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
• Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
• More than once gotten arrested, been held at a police station, or had other legal problems because of your drinking?
• Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, restlessness, nausea, sweating, a racing heart, or a seizure? Or sensed things that were not there?

How can you reduce your risks?

Options for reducing alcohol-related risks include:

• Staying within the limits provided in the 2015-2020 Dietary Guidelines for Americans. If you need to cut down, see Tips to try.
• Taking steps to be safe when you drink (see box, below).
• Quitting drinking altogether. See Choose your approach.

For some people, it can be difficult to decide whether to cut down drinking or quit altogether. To help decide which route is right for you, see To cut down or quit.

If you sometimes drink more than limits provided in the 2015-2020 Dietary Guidelines for Americans, but don't feel ready to make a change, see Pros and cons and Ready... or not. Don't wait for an injury or a crisis, however. When it comes to changing risky drinking, sooner is better than later.

To cut down or to quit ...

If you're considering changing your drinking, you'll need to decide whether to cut down or to quit. It's a good idea to discuss different options with a doctor, a friend, or someone else you trust.

Quitting is strongly advised if you:

• Try cutting down but cannot stay within the limits you set.
• Have had alcohol use disorder or now have symptoms.
• Have a physical or mental condition that is caused or worsened by drinking.
• Are taking a medication that interacts with alcohol.
• Are or may become pregnant.

If none of the conditions above apply to you, then talk with your doctor to determine whether you should cut down or quit based on factors such as:

• Family history of alcohol problems
• Your age
• Whether you've had drinking-related injuries
• Symptoms such as sleep disorders and sexual dysfunction

Planning for change

Even when you have committed to making a change, you still may have mixed feelings at times. Making a written "change plan" will help you to solidify your goals, why you want to reach them, and how you plan to do it.

A sample form is provided below. After filling it in, you can print it or email it to yourself.

• I want to drink no more than drink(s) on any day and no more than drink(s) per week (see low-risk drinking limits ) .
• I want to stop drinking.

Possible roadblocks: Some things that might interfere and how I'll handle them:

• Roadblocks:
• How I'll handle them:

Tips to try

Small changes can make a big difference in reducing your chances of having alcohol-related problems. Whatever strategies you choose, give them a fair trial. If one approach doesn't work, try something else. But if you haven't made progress in cutting down after 2 to 3 months, consider quitting drinking altogether, seeking professional help, or both.

Here are some strategies to try, and you can add your own at the end. Check off perhaps two or three to try in the next week or two. Then click List my choices, and you can print or email them to yourself.

• Keep track. Keep track of how much you drink. Find a way that works for you: Carry a drinking tracker card in your wallet, make check marks on a kitchen calendar, or enter notes in a mobile phone notepad or personal digital assistant. Making note of each drink before you drink it may help you slow down when needed.
• Count and measure. Know the standard drink sizes so you can count your drinks accurately. Measure drinks at home. Away from home, it can be hard to keep track, especially with mixed drinks, and at times, you may be getting more alcohol than you think. With wine, you may need to ask the host or server not to "top off" a partially filled glass.
• Set goals. Decide how many days a week you want to drink and how many drinks you'll have on those days. It's a good idea to have some days when you don't drink. People who always stay within the low-risk limits when they drink have the lowest rates of alcohol-related problems.
• Find alternatives. If drinking has occupied a lot of your time, then fill free time by developing new, healthy activities, hobbies, and relationships, or renewing ones you've missed. If you have counted on alcohol to be more comfortable in social situations, manage moods, or cope with problems, then seek other, healthy ways to deal with those areas of your life.
• Avoid "triggers." What triggers your urge to drink? If certain people or places make you drink even when you don't want to, try to avoid them. If certain activities, times of day, or feelings trigger the urge, plan something else to do instead of drinking. If drinking at home is a problem, keep little or no alcohol there.
• Plan to handle urges. When you cannot avoid a trigger and an urge hits, consider these options: Remind yourself of your reasons for changing (it can help to carry them in writing or store them in an electronic message you can access easily). Or talk things through with someone you trust. Or get involved with a healthy, distracting activity, such as physical exercise or a hobby that doesn't involve drinking. Or, instead of fighting the feeling, accept it and ride it out without giving in, knowing that it will soon crest like a wave and pass. Also, see the short module to help you handle urges to drink.
• Know your "no." You're likely to be offered a drink at times when you don't want one. Have a polite, convincing "no, thanks" ready. The faster you can say no to these offers, the less likely you are to give in. If you hesitate, it allows you time to think of excuses to go along. Also, see the short module to help you build drink refusal skills.

My own strategies:

• Include my own strategy #1? My own strategy 1#
• Include my own strategy #2? My own strategy #2

Reminder strategies

Change can be hard, so it helps to have concrete reminders of why and how you've decided to do it. Some standard options include carrying a change plan in your wallet or posting sticky notes at home. Also consider these high-tech ideas:

• Fill out a change plan, email it to your personal (non-work) account, store it in a private online folder, and review it weekly.
• Store your goals, reasons, or strategies in your mobile phone as short text messages or notepad entries that you can retrieve when an urge hits.
• Set up automated mobile phone or email calendar alerts that deliver reminders when you choose, such as a few hours before you usually go out. (Email providers such as Gmail and Yahoo mail have online calendars with alert options.)
• Create passwords that are motivating phrases in code, which you'll reinforce each time you log in, such as 1Day@aTime, 1stThings1st!, or 0Pain=0Gain.

Many binge drinkers and heavy drinkers decide that they want to start drinking responsibly. But with all the information out there about the dangers of alcohol, it can be difficult to know where to start.1 You can learn how to drink responsibly in simple steps.

Establish Your Drinking Goal

Although it is a good idea to think about reducing your alcohol intake, check whether you are a suitable candidate for controlled drinking. Some people shouldn't drink at all, especially if you have a history of addiction problems or a close relative who has or had an addiction or mental health problems.

If you realize you should quit completely, talk to your doctor about getting help with quitting alcohol and staying sober.2 Depending on how much you have been drinking recently, it may not even be safe to quit cold turkey, and your doctor can prescribe medications to make it safer and help you cope with alcohol withdrawal. If you are a good candidate for controlled drinking, think about your goal and write it down.

Assess Your Alcohol Intake

Keep a drinking diary for one week.3 The most straightforward drinking diaries just record how much you drink each day, but the more you can keep track of, the better you will understand your own drinking patterns, and thus be able to control them.

Every evening (or the following morning, if you forget), write down how many drinks you drank, where you were when you were drinking, and with whom. Also write down any negative effects or situations that arose that you would like to avoid in the future, for example, "After my third beer, I got into an argument with Ben." This step will give you a good idea of the times, places and people where your drinking tends to become excessive or problematic.

Calculate Your Safe Limit

Your safe alcohol limit is based on your blood alcohol concentration and is the amount of alcohol you can drink in a single drinking session. It is based on several factors, including your sex, weight, and how quickly you drink.4 When you have figured out how many drinks you can drink, write it down, along with the drinking time period.

Purchase Small Amounts

Stocking up on wine, beer, and liquor is the quickest way to sabotage your plan to drink responsibly. For drinking at home, follow these tips:

• Buy only the amount of alcoholic beverage you identified in step 3, on the day you intend to drink it.
• Purchase individual cans or single serving or half-size bottles of wine if necessary.
• Purchase the same amount of alcohol-free or low-alcohol wine or beer If you know you will want more drinks, but not more alcohol.

Plan Your Journey Home

Even though you will be drinking at a sensible level, you will still be impaired and should not drive. Arrange for a ride home with a sober driver, or pre-book a cab.

If that is too costly, plan your bus journey home so you know when to leave while the buses are still running. Leave your car at home so you will not be tempted to use it. Get a ride or take a bus to your drinking event.

Pace Yourself

Drink only the amount you wrote down in step 3, and at the speed specified. If you want more to drink in between, drink water or alcohol-free or low-alcohol beverages.

Watch for Peer Pressure

Look at the drinking diary you completed in step 2. If there are any people who encourage you to drink too much, try to avoid them for the first month or so while you get used to your new style of drinking. If you are constantly surrounded by peer pressure to drink, start making new friends who don't drink as much.5

Other Options

It's possible you may have an alcohol problem, in which case, talk to your doctor about getting help.2 The Sinclair Method (TSM) is a relatively new and someone controversial method for helping people drink less that involves taking an opioid antagonist medication (naltrexone) about an hour before drinking.

The medication blocks the euphoric effects of alcohol, which is thought to help people cut back on their drinking. You may also find it helpful to join a self-help recovery group. Learn more about how to find a support group near you and how to choose one that is right for your needs.

How to Control Your Alcohol Intake and Drink More Responsibly

By 

Elizabeth Hartney, BSc., MSc., MA, PhD 

 Medically reviewed by 

John C. Umhau, MD, MPH, CPE 

Updated on September 17, 2020

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