7.3: Rethinking Drinking

Does alcohol impact my calorie intake?

Alcoholic beverages are not a component of the USDA Dietary Patterns and the calories consumed are considered discretionary. Alcohol provides 7 calories per gram consumed, and the ingredients in certain mixed drinks, including soda, mixers, and heavy cream, also can contribute to intake of added sugars and saturated fat. Thus, regular consumption of alcoholic beverages can make it challenging for adults to meet food group and nutrient needs while not consuming excess calories.

Why is being able to “hold your liquor” a concern?

For some people, it takes quite a few drinks to get a buzz or feel relaxed. Often they are unaware that being able to “hold your liquor” isn’t protection from alcohol problems, but instead a reason for caution. They tend to drink more, socialize with people who drink a lot, and develop a tolerance to alcohol. As a result, they have an increased risk for developing alcohol use disorder. The higher alcohol levels can also harm the liver, heart, and brain without the person drinking noticing until it’s too late. And all people who drink need to be aware that even moderate amounts of alcohol can significantly impair driving performance, even when they don’t feel a buzz from drinking.

Why are women’s low-risk limits different from men’s?

Research shows that women start to have alcohol-related problems at lower drinking levels than men do. One reason is that, on average, women weigh less than men. In addition, alcohol disperses in body water, and pound for pound, women have less water in their bodies than men do. So after a man and woman of the same weight drink the same amount of alcohol, the woman’s blood alcohol concentration will tend to be higher, putting her at greater risk for harm.

Isn’t drinking good for the heart?

The short answer is, it is unknown whether light-moderate alcohol consumption has positive health impacts, such as decreasing your risk of cardiovascular disease. Many studies have indicated that moderate alcohol consumption has protective health benefits (e.g., reducing risk of heart disease), and others show this may not be true. Thus, there is not a solid conclusion to this question and it warrants more research.

Can I do anything to protect my liver from the effects of too much alcohol?

There are no guarantees that anything will protect the liver from too much alcohol. Liver damage from heavy drinking happens in stages. Some relatively mild damage may happen after a single binge drinking episode, but this reverses itself if the heavy drinking stops. If heavy drinking continues, however, liver damage can progress through several more advanced stages, and repair becomes much more difficult, if not impossible. When the damage goes as far as cirrhosis, the only treatment is liver transplant. The best way to protect your liver’s health is by staying within the low-risk drinking limits or — if you already have liver damage or any signs of an alcohol problem — by quitting.

Also, it’s best if people who drink avoid acetaminophen^[1] (found in Tylenol® and other medications). Even the standard recommended dose of acetaminophen can increase the risk of liver damage, particularly among people who drink heavily.

Quitting or Reducing Drinking

The first step, of course, is to decide whether cutting down or quitting is best for you. If you are thinking about quitting, recognize that one size doesn’t fit all, and it’s important to find options that appeal to you. Changing habits such as smoking, overeating, or drinking too much can take a lot of effort, and you may not succeed with the first try. Setbacks are common, but you learn more each time. Each try brings you closer to your goal. Whatever course you choose, give it a fair trial.

Rethink drinking: Begin by evaluating your own drinking

• Make a list of Pros & cons: What are your reasons for and against making a change?
• Are you ready to change? See what to do if you’re not quite ready to change your drinking.
• To cut down or to quit … Consider which is best for you.
• Create a Change Plan to help you solidify your goal and how you’ll reach it.

Thinking about cutting back on alcohol?

• Review Tips to Try Cutting Back on Alcohol and select two or three to try in the next week or two. It may help to have reminders to reinforce your decision to make a change, such as automated smartphone alerts that you send yourself.

Support for Quitting Drinking

• You do not need to quit on your own, there is support available to help you!
• Try the NIAAA Alcohol Treatment Navigator. The Navigator helps adults find alcohol treatment for themselves or an adult loved one. The Navigator will steer you toward evidence-based treatment, which applies knowledge gained through decades of carefully designed scientific research. If you are seeking help for a teen, check out these recommended adolescent treatment resources. If you are seeking treatment for yourself, you are taking an important step in your route to recovery. You may wish to ask someone you trust to help you through the process and for support along the way.
• Evidence-based behavioral treatments, or “talk therapy,” include:
  • Cognitive-behavioral therapy (CBT).
    • This form of therapy is focused on identifying the feelings and situations (called “cues”) that lead to heavy drinking, and managing stress that can lead to relapse. The goal is to change the thought processes that lead to alcohol misuse and to develop the skills necessary to cope with everyday situations that might trigger problem drinking.
  • Motivational enhancement therapy.
    • This therapy focuses on helping the patient identify the pros and cons of seeking treatment, form a plan for making changes in drinking behavior, build confidence, and develop the skills needed to stick to the plan.
  • Contingency management approaches.
    • This approach is used to reinforce positive behaviors such as abstinence or regular attendance.
  • 12-Step Facilitation Therapy
    • An engagement strategy used in counseling sessions to increase a patient’s active involvement in 12-step-based mutual help groups (such as AA), in addition to professionally-led outpatient treatment. The counselor works with the patient to encourage, review, and reinforce their participation in AA, in a structured process that may include reading assignments, journaling, and setting AA participation goals for the week.