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How Much Drinking is Too Much?


How Much Drinking is Too Much?

By Jim Cotter, MD, MPH

On the first Monday of each month, my local newspaper publishes a list of local DUI convictions for the previous month (which of course, I scan carefully for people I may know). Along with the list is a guideline for avoiding a DUI: “if you weigh 150-169 pounds, three drinks in an hour will get you past the legal limit.” Three drinks in an hour? Seriously? That is a lot of alcohol to drink in one hour, maybe even for a whole day. It brings up a good question, is there a safe level of drinking?

The first question to ask is “What is a drink?” The measure for one drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1 ½ ounces of 80 proof spirits. Each provides the same amount of alcohol.

People often describe themselves as “moderate” drinkers. But that can mean different things to different people. The Dietary Guidelines for Americans, 2010, define moderate drinking as one or two drinks a day for a man and one drink a day for a woman or for anyone over 65. Heavy drinking is defined as three or more drinks per day. If Uncle Charlie or Grandma Clarice say they only drink in moderation because they just have a few at lunch and a couple more at dinner, they are probably not moderate drinkers.

How do doctors assess if someone is drinking too much? Usually by asking questions. A common tool for assessing problem drinking habits is the CAGE questionnaire. CAGE asks four simple questions.

  • Have you ever felt you should CUT down on your drinking?
  • Have you been ANNOYED by people criticizing your drinking?
  • Have you ever felt GUILTY about your drinking?
  • Have you ever had a drink first thing in the morning to steady your nerves or cure a hangover (EYE-OPENER)?

If a person answers yes to two or more of these questions, it might mean they have a drinking problem. Many doctors consider a yes answer to the last question enough to indicate a person may have a problem.

Some people should not drink at all. This includes people with the following conditions: alcohol-caused medical problems, a history of alcoholism, those who take medications which may be affected by alcohol, women who are pregnant or considering pregnancy, and those under age 21. For folks in these categories, one drink is too much, even if their CAGE score is zero.

Anyone can ask themselves the CAGE questions. If you do and it shows you may have a problem with alcohol, please talk to your doctor. Every community has support available for people who may have a problem with drinking. If you are worried about your own drinking, or the drinking pattern of someone you love, your doctor can work with you to get the help that may be needed.

In my next column, I will look at whether alcohol might be good for your health.

About Partnership HealthPlan of California (PHC)

PHC is a non-profit community based health care organization that contracts with the State to administer   Medi-Cal benefits through local care providers, to ensure Medi-Cal recipients have access to comprehensive, cost-effective health care. First offering services in Solano County in 1994, PHC now provides quality health care to nearly 505,000 members in 14 Northern California counties - Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Shasta, Siskiyou, Solano, Sonoma, Trinity and Yolo.

 Dr. Jim Cotter is an Associate Medical Director at Partnership HealthPlan of California.