A Therapist Speaks: Problematic Drinking Looks Different for Everyone

There’s no one-size-fits-all threshold for when drinking becomes a problem — and why you drink matters.

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tray of drinks

The advice that a glass of alcohol a day is good for you likely doesn't hold up scientifically.

Marti? Sans/Stocksy

“They say some alcohol is actually good for you.”

“I don’t drink that much.”

“I could stop drinking if I really wanted to, so I can’t have a problem. Right?”

As a psychiatrist, I hear all of these things from both clients and friends when they’re thinking out loud about their drinking habits.

The reality is that many people I know personally or treat professionally are confused about how much drinking is too much. Sure, the Centers for Disease Control and Prevention (CDC) has guidelines, which recommend less than two drinks a day for men and less than one a day for women. And there’s a lot of research out there that attempts to nail down what the right amount of alcohol is.

But there’s not a one-size-fits-all amount of alcohol that’s problematic. Everyone has different physical and mental health risk factors that affect this amount. Problematic drinking looks different for everyone.

As we enter the holiday season — a time of increased alcohol consumption — it’s important to recognize just how complex the topic of alcohol use is, and to learn how to tap into your intuition about your own drinking habits.

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The Research on Alcohol Is Complicated

Let’s start with the most confusing part of assessing your own alcohol use — the well-known advice that a glass a day is good for you.

Several studies, including a?study published in the journal Circulation, suggest that moderate alcohol consumption — currently defined as one glass per day for women and up to two per day for men — could have some heart health benefits.

But this does not mean alcohol is good for you overall.

As more research on this topic accumulates, it has become clear that although up to one drink per day could have some heart health benefits, any more can be damaging to the heart. For example, a review article published in Mayo Clinic Proceedings?found that drinking too much alcohol increases your risk of high blood pressure, stroke, and atrial fibrillation, among other serious heart issues.

This means that there may be a very fine line between how much alcohol is good for you versus how much is bad for you.

Not to mention, research on the benefits of alcohol use is mostly limited to the heart and the vessels that carry blood to different parts of the body. Plenty of other research shows that alcohol is bad for most other systems and organs in the body. Just one example: A study published in September 2018 in The Lancet showed that alcohol use increases the risk for several cancers, even at only one glass per day.

In addition to the physical impact, alcohol is tied to a variety of mental health and social issues. These include increased aggression, increased violence, and increased traffic accidents. In the United States, nearly 10,500 people died in alcohol-related traffic accidents in 2016, according to the CDC. This accounted for more than a quarter of all deaths due to traffic accidents.

So even if low levels of alcohol could have benefits for the heart, the overall risks of alcohol likely outweigh the benefits for most people.

Is Alcohol Actually Heart-Healthy?

To complicate matters, whether any amount of alcohol is truly beneficial for heart health has been called into question by experts.

Low levels of alcohol have been shown to relax blood vessels, lower blood pressure, and increase levels of good cholesterol — and wine does contain heart-healthy antioxidants. But, as the American Heart Association (AHA) points out, there are healthier ways, such as exercise, to create healthy blood vessels. And there are healthier foods, such as berries, that contain antioxidants.

Interestingly, research suggests that if you are already engaging in healthy behaviors — like exercising, eating nutritiously, and maintaining a healthy weight — adding alcohol may have no additional benefit for the heart. A study published in the American Journal of Preventive Medicine indicates that studies about the potential health benefits of moderate drinking “should be interpreted with caution” because of the deleterious toll that alcohol can have on the body in excessive amounts.

When it comes to whether a glass of wine a day can be part of a healthy lifestyle, the AHA’s stance is clear: “The American Heart Association does not recommend drinking wine or any form of alcohol to gain potential health benefits.”

Alcohol Guidelines: A Moving Target?

All of this considered, it’s no big surprise that some authoritative health organizations want to amend existing alcohol guidelines.

In advance of the publication of the 2020–2025 edition of the U.S. Department of Agriculture and U.S. Department of Health and Human Services (USDA-HHS) Dietary Guidelines for Americans — a set of guidelines updated every five years — a committee of health experts from the National Academies of Sciences, Engineering, and Medicine recommended that the USDA-HHS reduce its alcohol recommendations to a limit of one glass per day for both men and women.

Although the USDA-HHS opted not to change the recommendation for this edition of the guidelines, it may consider the change in the future. And per the committee’s suggestion, the USDA-HHS did include information on the negative health consequences, including cancer, thought to be associated with as little as one drink per day.

So How Much Alcohol Is Problematic?

Drinking more than what current guidelines recommend is considered risky alcohol use, and you should cut back. Not being able to cut back is a clear sign of a problem.

But what if you’re someone who stays within the guideline allowed? Is this kind of drinking always okay?

The answer is no. Everyone’s different, and why you drink matters.

We’re all physically and mentally different and have different risk factors for various physical and mental health issues. You may realize that drinking affects you differently than it affects your friends. It may make it harder for you to maintain a healthy weight. It may interrupt your sleep more or make you more susceptible to anxiety, depression, mania, or feelings of panic.

These differences are why it’s important to tune in to how alcohol personally affects you, rather than comparing your habits to the habits of others. It’s wise to discuss your risk factors with your doctor or mental health professional to help you weigh your individual risks and benefits of alcohol use.

The reasons you drink are also important when assessing if your alcohol use is an issue. For example, in my experience, people commonly drink to help them fall asleep, to tone down stress, or to manage uncomfortable emotions, such as anxiety, irritability, or low mood. The problem with this is that alcohol often seems to help in the first hour or so. Ultimately, however, it makes all these things worse, leading to a cycle of continued alcohol use and poorer mental health.

Precarious Alcohol Use Isn’t Always Obvious

As a general rule, if you realize alcohol is serving some kind of function for you — rather than just being something you sometimes have with a meal or when out with friends — this may be a sign of an issue.

If you’re unsure if alcohol negatively impacts you or is serving some kind of purpose for you, try what is known as nonjudgmental curiosity — being curious but not judgmental in your self-assessments. It means questioning your habits without self-criticism, and it’s one of the best ways to learn about yourself.

When reaching for a drink, you can start by asking these questions:

  • Why do I want to drink right now?
  • How am I feeling physically? Psychologically?
  • How much do I want to drink?
  • How much did I actually drink?
  • How do I feel after I drink?

The tricky part is to let yourself answer these questions without additional criticism, such as “I have no self-control” or “I’m useless.”

Continue to do this exercise for several weeks — you could even write it down in a journal or on your phone’s note app. You may see patterns emerge over time. If you realize that you typically reach for a drink when you feel jittery, restless, stressed, sad, or angry, your drinking habits may be problematic.

Similarly, if you find yourself consistently drinking more than you intend to — even if that number is still within the guidelines — try to hold yourself to your intention. If this is too hard, you may want to reach out to your doctor or a mental health professional for help.

The Bottom Line

Experts are beginning to learn that there may not be any good health reasons to drink alcohol. But this does not mean people will never drink.

So instead of limiting your definition of safe alcohol use to a potentially moving target, tap into how alcohol serves you. While you shouldn’t drink more than the recommended amount of alcohol each day, you may discover very good reasons to drink even less, depending on your own body and mind.

Resources We Love

If you think you may have a drinking problem, these resources offer help:

National Institute on Drug Abuse (NIDA)

NIDA is a government institute geared toward advancing research about the reasons for and effects of alcohol and drug use on individuals and the public. It offers a list of research-backed screening tools to assess your own alcohol use. This list also includes questionnaires about the use of tobacco and other substances.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

The NIAAA is a government institute that provides information about alcohol's effects on a person’s health and well-being. It also aims to improve how alcohol-related problems are diagnosed, treated, and prevented through research and related initiatives. Check out the NIAAA’s starter guide for getting help and finding treatment for yourself or for a loved one.

Substance Abuse and Mental Health Services Administration (SAHMSA)

SAHMSA is an agency within the U.S. Department of Health and Human Services that aims to lessen the impact of substance use and mental illnesses on U.S. communities. It offers a facts and resources sheet, which provides more information about what amount of alcohol constitutes one drink, what excessive drinking looks like, and signs of risky or excessive drinking.

Hazelden Betty Ford Foundation?

This foundation is the largest nonprofit treatment provider in the United States for alcohol and drug addiction. If you’re in recovery from alcohol use disorder, check out its recommendations for mindfulness practices that can aid you in your recovery.

Important: The views and opinions expressed in this article are those of the author and not Everyday Health.

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