Alcohol: How much is too much?

The World Health Organisation is unequivocal on how much alcohol is too much – no level of alcohol consumption is safe for our health. They state that this is because alcohol is a powerful carcinogen, and the risk starts ‘from the first drop of any alcoholic beverage.’

This is a hardline stance, and for those who enjoy alcohol in moderation, the perceived benefits of social drinking can outweigh the potential health risks. However, for people who struggle with addiction, any amount of alcohol can be too much.

The line between problem drinking and safe consumption can be blurry, and this isn’t helped by the fact that safe drinking guidelines can be confusing. Guidelines vary between countries and are based on unit sizes that aren’t globally standardised. Is it possible to definitively state how much alcohol is too much?

UK guidelines

UK drinking guidelines are more complex than people realise. Guidelines are based on units, which are very hard to gauge, especially when drinking out of the home. Public Health England’s ‘Think About Your Drink’ tool states that a unit is half a pint of beer, half a glass of wine, or one shot – but this isn’t very accurate. The strength of the drinks makes a huge difference, and the tool doesn’t state if it’s referring to a small, medium or large glass of wine.

Safe drinking guidelines only apply to adults over 18. Starting drinking early in life negatively impacts brain development and increases the risk of an alcohol use disorder in adulthood.This means no level of consumption can be recommended as safe for people under 18 – but many under 18s drink anyway. The Chief Medical Officer (CMO) states, ‘an alcohol-free childhood is the healthiest and safest option.’

Pregnant women are also advised not to drink at all by the CMO. This has been the subject of some debate as some studies claim that low alcohol consumption during pregnancy is fine and does not cause harm to babies. However, guidelines are intended to be understood by as many people as possible – there is no room for nuance. By discouraging drinking entirely during pregnancy, the guidelines seek to reduce the risk of harm to unborn children as much as possible.

For adults over 18, safe drinking guidelines recommend no more than 14 units a week, spread out over at least 3 days. This is to build drink-free days into the week and minimise binge drinking. This guideline is the same for men and women. Staying within these guidelines is classified as low-risk drinking.

Increasing risk drinking is different for men and women – this level increases the risk of experiencing alcohol-related ill health. Increasing risk drinking is between 14 and 35 units a week for women and between 14 and 50 units for men.

Higher-risk drinking is over 35 units a week for women and over 50 units for men. The guidelines state that people who drink at this level are likely already experiencing health damage from their drinking, even if they aren’t yet aware of it. Treatment of alcoholism will very likely be necessary for anyone drinking at this level.

Binge drinking is also covered in the guidelines – and it is possible to binge drink while still staying under the lower-risk limit of 14 units a week. Binge drinking is classified as drinking enough on a single occasion to get drunk and is technically defined as over 6 units for women and 8 units for men. This is why low-risk guidelines state that consumption should be limited to 14 units spread over at least 3 days – this makes it impossible to exceed the technical definition of binge drinking.

However, the guidelines make no accommodations for height, weight, age (except for under 18s), health status or genetic predisposition to addiction. A technical binge of 8 units in a single session will affect a taller man less than a small man, and older adults, who are frailer, are more affected by alcohol. If alcohol addiction runs in your family, drinking is much riskier. If you aren’t in good health, alcohol is more likely to exacerbate it.

This is another limitation of the guidelines – because they’re standardised to the population, they can’t accommodate nuances. Therefore, it’s important to be aware of your own levels of drinking and listen to your body’s cues.

How much alcohol is too much for you?

Alcohol is the leading cause of ill health, disability and death in people aged 15-49 in England. Many people drink too much alcohol – but how do you assess how much is too much for you?

The guidelines recognise that both volume and frequency of drinking are a problem. For some, it isn’t enough to simply drink less than 14 units a week, especially if these units are consumed over fewer days. Government publications on alcohol prevention also recognise that high consumption in a shorter period is more dangerous than lower consumption over a longer period, particularly for certain cancers.

While it’s unlikely, it is possible to be dependent on alcohol while staying within the safe guidelines of 14 units a week. DSM-V guidelines state that the presence of 2 or more alcohol misuse symptoms indicates alcohol use disorder. Even when drinking under 14 units a week, someone who is psychologically dependent on alcohol to relax or manage their emotions can still experience a preoccupation with drinking and an inability to quit, which would indicate a mild alcohol use disorder.

Cultural issues

Alcohol guidelines are at odds with UK drinking culture, and if someone is comparing themselves to others it’s easy for their problem drinking to fly under the radar.

Among adult men who drink, the average amount of units consumed per week is 14.7 – just above the safe drinking limit. 21% of UK adults drink at a level which puts them at some level of risk of alcohol-related harm. 19% of adults don’t drink at all – so a large proportion of those who do drink do so at levels that are considered potentially harmful.

Because harmful drinking in the UK is normalised, the line between social drinking and harmful drinking can be blurry. It’s important to know the symptoms of alcohol abuse and to listen to your body as well as be aware of the safe drinking guidelines. Increasing tolerance, cravings, finding yourself unable to cut down, and missing obligations are all red flags. If you’re experiencing any of these symptoms, you might need alcohol addiction treatment.

Getting help

If you’re worried about your drinking, help is available. We understand how normalised drinking is in the UK and how alone you can feel when facing your own drinking problems – but you aren’t alone. Reach out today to get the support you need.