In Western cultures, almost everyone drinks alcohol, sometimes. Many people drink a lot of alcohol very often, and many people drink only occasionally. We are always being told that drinking too much alcohol is not good for our health, but how much is ‘too much’?
Most western countries have Health Guidelines that specify how much alcohol is considered to be too much alcohol, but each country’s recommendations for ‘safe levels of drinking’ are not all the same, but are similar.
Knowing how much is said to be ‘Too Much’ is important information for everyone to know.
It’s never too late to moderate alcohol consumption to what is thought to be a ‘safe’ level of drinking, or to abstain totally from drinking alcohol altogether and improve our health. However, it is always better to stay within so called ‘safe limits’ before any damage has been done to a person’s health, job and family.
In order to know the level of risk we might be taking when we drink alcohol, we all need to have a good idea of what amount of drinking alcohol is
- Probably Safe
- Potentially Harmful
- Definitely Harmful
That is a baseline of knowledge that everyone should know, especially parents, teachers, and children from about the age of 10. Whatever individuals choose to do with that information is a valid personal choice.
If personal choice is also an informed choice, it is always a valid choice. Individuals must take responsibility for their choices and behavior, and the consequences. But it is the responsibility of Governments, educators, and health professionals to make sure that accurate information is always available to anyone and everyone. No one should ever be able to say ‘I didn’t know’.
International Classifications Related to Alcohol Consumption
The World Health Organization ranks alcohol as the 3rd most important risk factor for the global burden of disease and disability (WHO, 2009).
Worldwide, there are 3 terms used by governments and health professionals to describe levels of Non-Dependent alcohol use disorders (problem drinking, but excluding addiction or dependence):
- “hazardous” use
- “harmful” use and
- “alcohol abuse”.
The terminology used to describe different levels of drinking behavior can be confusing.
1. Hazardous Drinking is the “lowest” defined level of problem drinking – also known as At Risk Drinking is defined as
- consumption above the recommended safe limits of alcohol, increasing a person’s risk of harm (NICE, 2011).
The other two terms describe similar, but more serious, levels of drinking, and are applicable where harm (damage) has already occurred, but, the drinker is not “dependent”.
2. Harmful Drinking: damage has already occurred:
based on physical and/or mental damage
”Harmful” alcohol use is a pattern of alcohol use that is actively causing: “physical or mental damage to health. The damage may be, for example, episodes of depression secondary to heavy consumption of alcohol”.
This diagnosis requires evidence that actual damage has been caused to the mental or physical health of the user (SIGN, 2003).
3. Alcohol abuse: damage has already occurred:
this is more or less the same as ‘Harmful Drinking’ but is based on the Social damage, not the physical or mental damage.
- drink driving
- relationship problems
- employment problems
- failing to fulfill obligations – work, family, responsible citizen
- repeatedly drinking in social situations that puts them at risk of physical harm
The levels of alcohol consumption that fit into these 3 Classifications varies slightly around the world, but the guidelines for safe drinking levels are reasonably similar in most countries.
What is a Safe Level of Alcohol Consumption?
A safe level of drinking is based on the study of whole populations, and set by individual Governments, and is
- less than the level of alcohol consumption at which Risk of Harm begins to increase above the risk levels for non drinkers or light drinkers
In fact, the only really Safe Level of drinking is total abstention. Alcohol damages almost every organ in the body, especially the brain and the liver, and especially people under the age of 25, whose brains have not yet fully matured. However, so called Safe drinking, is ‘staying below the amount that is shown to measurably increase your risk for health problems’.
In other words, less than what is described as Hazardous or At Risk Drinking. In theory, if you consume less than At Risk drinkers, you will probably not get damaged by alcohol.
The amount of alcohol that’s included for each Classification is based on the number and frequency of the ‘Standard Drink’.
What is a Standard Drink?
Recommendations are usually expressed in terms of the number of ‘standard drinks’ consumed: daily, weekly, and/or on one-off individual occasions (binge drinking).
However, the definition of what is a ‘standard drink’, is different in different countries:
- A standard drink in USA = 14g ethanol
- A standard drink in Australia =10g ethanol
- A standard drink in UK = 8g ethanol
So guidelines in USA are based on the number of times 14g of ethanol is consumed in a day, or week and/or on a one off occasion – binge drinking.
And the guidelines for the UK are based on the number of times 10g of ethanol is consumed in a day, or week or on a one off occasion – binge drinking.
And the guidelines for Australia are based on the number of times 8g of ethanol is consumed in a day, or week or on a one off occasion – binge drinking.
In all countries, Safe, At Risk (Hazardous), or Harmful/Alcohol Abuse drinking is assessed on ALL of the following:
- The amount of alcohol regularly consumed per day AND
- The amount of alcohol regularly consumed Per week AND
- On one off occasions (binge drinking) – usually on the number of binges in the previous month
It’s the quantity, AND the frequency that counts.
To see how much alcohol and how many Standard Drinks are recommended as Safe, for different countries, please see:
- World Health Organization (WHO). International Classification of Diseases (ICD-10), 2010
- National Institute for Health and Clinical Excellence (NICE). Clinical guideline 115. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence, February 2011
- Department of Education. Pupil health and wellbeing: drug and alcohol misuse [accessed May 2012]