
As many people wrap up their “Dry January”, I have been reflecting on new data and related recommendations when it comes to drinking alcohol. This is even more relevant given changes in drinking patterns that we've seen over the past few years, especially during the COVID pandemic where an increase in drinking was seen among both men and women and across all race and ethnic groups as was found in this study. In 2022, 69.3% of Americans reported some alcohol consumption in the previous year, a slight increase from 69% in 2020 and 66.34% in 2018. Additionally, the percentage of heavy drinkers rose to almost 6.3% of those surveyed in 2022, up from 6.13% in 2020 and 5.1% in 2018.
At the same time alcohol intake has been increasing, the data on the relationship between alcohol consumption and health is clearer than ever: even small amounts of alcohol can have significant, negative consequences for our health and well-being. According to recent guidance from the Canadian Centre on Substance Use and Addiction (CCSA), the risk of health harms from alcohol is low for individuals consuming two or fewer standard drinks per week, but it increases significantly with any consumption greater than this. This guidance, published in January 2023, showed the following:
Key Findings: Alcohol and Health Risks
The new guidance emphasizes that "drinking less is better," highlighting the continuum of risk based on alcohol consumption levels:
No alcohol consumption: Offers the greatest health benefits, including improved sleep and lower risks of chronic diseases. It’s also the only safe option during pregnancy or while breastfeeding
1-2 standard drinks per week: Likely to have minimal alcohol-related consequences.
3-6 standard drinks per week: Increases the risk of developing breast, colon, and other cancers.
7+ standard drinks per week: Raises the risk of heart disease, stroke, and other chronic conditions significantly. Each additional drink amplifies these risks dramatically.
These recommendations emphasize that alcohol is more harmful than was previously thought. The main message is simple: drinking less is better.”
The Broader Impact of Alcohol
Alcohol is linked to over 200 medical conditions, according to the World Health Organization (WHO). These include seven types of cancer (breast, colon, prostate, pancreatic, esophageal, and more), liver disease, and various cardiovascular disorders. Beyond health concerns, alcohol consumption is associated with injuries, violence, and other societal harms.
Between 2015 and 2019, excessive alcohol use contributed to approximately 140,000 deaths annually in the U.S., with chronic conditions like liver disease and cancer as the leading causes.
The Science Behind Alcohol’s Effects
When alcohol is metabolized, it is converted into a toxic chemical called acetaldehyde, which is very similar in its effects to formaldehyde. Before acetaldehyde can be metabolized itself, it circulates throughout our bodies damaging DNA and impairing our cells’ ability to impair themselves. This damage is likely the primary driver of alcohol’s carcinogenic and cardiovascular effects.
Because more acetaldehyde circulating around our bodies causes more damage, binge drinking several drinks closer together, increases the concentration of that toxic chemical and the damage it can do.
Additionally, while all types of alcohol are roughly as toxic as others (the alcohol in wine is as toxic as the alcohol in liquor or beer), drinks with higher concentrations of alcohol may have a higher risk of causing cellular damage and cancer in the upper part of the gastrointestinal tract, ie that burn you get from drinking straight whiskey.
Finally, it’s worth noting that some people including females and those in certain ethnic groups, such as those of Asian ancestry, often have more difficulty metabolizing acetaldehyde and are more prone to its toxic effects.
Continuum of Risk
The guidance defines a “standard” drink as:
12 oz of beer, cooler, or cider (5% alcohol)
5 oz of wine (12% alcohol)
1.5 oz of spirits (40% alcohol)
As might be obvious, these amounts are often much less than what is found in many alcoholic drinks commonly offered these days. For example, a typical double IPA is often 16 oz and up to 8% alcohol, which would be close to two standard drinks.
Using the definition of risk offered above, the continuum of risk is:
Low risk: ≤2 drinks per week
Moderate risk: 3-6 drinks per week
High risk: ≥7 drinks per week
What Does This Mean for You?
The new guidance from the CCSA underscores the following:
Avoid binge drinking: Consume no more than two drinks per 24 hours
There are specific situations in which individuals should refrain from consuming alcohol entirely, including:
When planning to drive or operate machinery
While taking medications that interact negatively with alcohol
If managing certain medical conditions
During recovery from AUD or if unable to control alcohol consumption
If under the age of 21
During pregnancy, alcohol use can lead to fetal alcohol spectrum disorders (FASDs), a group of lifelong physical, behavioral, and cognitive impairments caused by prenatal alcohol exposure. No amount of alcohol is safe during pregnancy, when trying to conceive and during breastfeeding.
Gender and age differences: Females face steeper health risks at lower consumption levels, while young people are encouraged to delay alcohol use as long as possible.
Avoid starting or increasing alcohol use for perceived health benefits: it now appears that any alcohol intake is harmful and any reduction in alcohol use is beneficial.
Expert Perspectives
Dr. Peter Butt, cochair of the Canadian guideline project, has noted that the updates were driven by evidence showing that previous guidelines underestimated alcohol’s risks. Dr. Timothy Brennan of the Addiction Institute at Mount Sinai Hospital in NYC has said, “The idea that one or two drinks a day are harmless is outdated. Drinking less is always better.”
International Context
Canada’s updated guidelines align with global efforts to reassess alcohol’s risks and revise recommended, safe amounts downward. Recent reviews in Australia, the UK, and France have similarly highlighted alcohol’s broader health impacts, as has the World Health Organization. Other countries, including the U.S., are likely to follow suit, updating their recommendations based on emerging evidence. To this end, the U.S. Surgeon General recently advocated that warning labels be placed on alcohol containers similar to the warnings already found on cigarettes: Alcohol and cancer: US surgeon general sounds alarm about link | CNN
Understanding Heavy Drinking, Alcohol Misuse, and Alcohol Use Disorder
At times, recreational alcohol use can transition into heavy drinking, alcohol misuse, and alcohol use disorder (AUD). Recognizing this is the key to preventing serious health consequences and getting appropriate help.
What Constitutes Heavy Drinking?
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) provide definitions for heavy drinking:
NIAAA Definition:
For men: Consuming five or more drinks on any day or 15 or more drinks per week.
For women: Consuming four or more drinks on any day or eight or more drinks per week.
SAMHSA Definition:
Heavy alcohol use is defined as binge drinking on five or more days in the past month.
What is Alcohol Misuse?
Alcohol misuse refers to drinking in a way that could cause harm to oneself or others. This includes consuming alcohol in inappropriate situations, excessive amounts, or at harmful frequencies. Binge drinking and heavy alcohol use are both considered forms of alcohol misuse.
Alcohol Use Disorder (AUD)
Alcohol Use Disorder (AUD) is a medical condition characterized by an impaired ability to control or stop alcohol consumption despite experiencing adverse effects. It encompasses what many commonly refer to as alcohol abuse, dependence, or alcoholism. AUD can range in severity from mild to severe, with lasting changes in the brain making individuals more vulnerable to relapse.
Patterns of Drinking Linked to AUD
Heavy drinking and binge drinking significantly increase the risk of developing AUD over time. However, other factors, such as genetics, mental health conditions, and environmental influences, also play critical roles in the development of this disorder.
How to Reduce Your Risk
Reducing alcohol consumption—even slightly—can significantly improve health outcomes. Experts recommend that individuals begin by cutting back on the number of drinks per week, aiming for fewer than two. Even light drinkers can benefit from occasional alcohol-free days.
Practical Tips for reducing drinking:
Track your consumption: Use apps or journals to monitor drinking habits.
Explore alternatives: Opt for non-alcoholic beverages, including at social gatherings.
Set limits for yourself: Limit the number of drinks and frequency of drinking occasions. If you find that you are unable to do so, you may have a problem with controlling your drinking and I'd strongly recommend you speak with someone about your drinking
How to get help if you believe you are drinking too much, having a hard time cutting down, misusing alcohol or believe you may have an alcohol use disorder:
Speak with a trusted family member or friend about your drinking patterns and ask for support around getting help
Speak with a medical provider. They can help assess your drinking with you and discuss support/treatment option. They can also speak with you about medication options, of which there are several, to help you reduce or abstain from drinking
Speak with a substance use counselor or therapist about your drinking and the underlying reasons for this. They can also help develop a plan to reduce or eliminate drinking
Seek out support from a recovery community. All of the resources below can be a place to find more information even before you are ready to reduce or abstain from drinking:
Final Thoughts
January is coming to a close and, for some, so will “Dry January”. But maybe, given the most up to date data we now have, some will also continue their commitment to reduce their alcohol consumption. While the cultural and societal attitudes around alcohol can make reducing drinking challenging, the evidence is clear: drinking less is a simple yet effective step toward better health.
Additionally, recognizing and getting help for heavy drinking, alcohol misuse, and AUD is vital to addressing the dire consequences of heavy alcohol use. I hope that by increasing our knowledge of alcohol related risks, we can make more informed decisions and take steps to be as healthy as we can when it comes to drinking—both for ourselves and those around us. And if you or someone you know is struggling with alcohol misuse or AUD, professional help is available and can be life-changing.