Alcohol Use & Misuse

Moderation and Knowing Your Limits

Legal age adults who choose to drink should do so responsibly, in moderation and in consultation with their health providers. But what does that mean?

According to the U.S. Dietary Guidelines for Americans, 2020-2025, “Adults of legal drinking age can choose not to drink, or to drink in moderation by limiting intake to 2 drinks or less in a day for men and 1 drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more. There are some adults who should not drink alcohol, such as women who are pregnant.”¹

What is a standard drink? U.S. Dietary Guidelines for Americans define a standard drink as 12 fluid ounces of regular beer (5% alcohol), 5 fluid ounces of wine (12% alcohol), and 1.5 ounces fluid ounces of 80 proof distilled spirits (40% alcohol).

This definition of a standard drink is widely used by federal agencies, including the National Institutes of Health (NIH); Centers for Disease Control and Prevention (CDC); Substance Abuse and Mental Health Services Administration (SAMHSA); and U.S. Department of Agriculture (USDA). The National Highway Traffic Safety Administration (NHTSA) and Department of Defense (DoD), as well as state/local health and traffic safety officials also include information on standard drinks as part of their alcohol education materials (e.g., most state-issued driver’s manuals include this information).

So, how many standard drinks are in that can or bottle you are planning to open? Use the “Standard Drink Calculator” to easily calculate.

Responsible Consumption

The National Institutes of Health (NIH) research findings include that, “alcohol’s effects vary from person to person, depending on a variety of factors, including:

• How much you drink
• How often you drink
• Your age
• Your health status
• Your family history”

Further, NIH research also finds, “[a]s you drink, you increase your blood alcohol concentration (BAC), which is the amount of alcohol present in your bloodstream. The higher your BAC, the more impaired you become by alcohol’s effects.” ²

Responsible consumption means ensuring that you are hosting and attending drinking occasions in a responsible manner, understanding how alcohol impacts your blood alcohol concentration (BAC), and arranging for a safe ride home. More information about responsible consumption practices can be found at Responsibility.org.

Curious about how different factors affect your BAC? Check out Responsibility.org’s Virtual Bar – a tool to help you better understand how your gender, height, weight, the food you eat, and other variables can affect your BAC.

Drinking responsibly also means hosting responsibly when serving alcohol, ensuring that guests are not over-served, have ample food, have plenty of non-alcohol beverage choices, and have a safe ride home. For more resources, visit the Alcohol Resources and Services page.

Alcohol Misuse, Alcohol Overdose, and Alcohol Use Disorders

An important aspect of responsible alcohol consumption is understanding what harmful alcohol consumption looks like. This includes binge and excessive drinking, alcohol overdose, underage drinking, and alcohol abuse.

Alcohol Misuse and Excessive Drinking

NIAAA defines alcohol misuse as, “[d]rinking in a manner, situation, amount, or frequency that could cause harm to users or to those around them. For individuals younger than the legal drinking age of 21, or for pregnant females, any alcohol use constitutes alcohol misuse.”³

Excessive drinking is a form of alcohol misuse. According to the CDC, “[e]xcessive drinking includes binge drinking, heavy drinking, and any drinking by pregnant women or people younger than age 21.”

CDC provides the following definitions for these categories:

• “Binge drinking, the most common form of excessive drinking, is defined as consuming
  • For women, 4 or more drinks during a single occasion.
  • For men, 5 or more drinks during a single occasion.
• Heavy drinking is defined as consuming:
  • For women, 8 or more drinks per week.
  • For men, 15 or more drinks per week.”⁴

The CDC states that, within the larger category of excessive drinking, “[b]inge drinking is the most common, costly, and deadly pattern of excessive alcohol use in the United States,” and that, “binge drinking is a harmful risk behavior associated with serious injuries and multiple diseases. It is also associated with an increased risk of alcohol use disorder.”

However, CDC clarifies that, “[m]ost people who binge drink do not have a severe alcohol use disorder, and that, most people who drink excessively are not alcoholics or alcohol dependent.”⁵

Beyond these definitions, the CDC advises that, “[d]rinking is a problem if it causes trouble in your relationships, in school, in social activities, or in how you think and feel. If you are concerned that either you or someone in your family might have a drinking problem, consult your personal health care provider.”⁶

Alcohol Overdose

At the extreme, excessive drinking can result in alcohol overdose. Anyone who consumes too much alcohol too quickly may be in danger of an alcohol overdose, according to the NIH. This is especially true for individuals who engage in binge drinking. The NIAAA defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent—or 0.08 grams of alcohol per deciliter—or higher.⁷

An alcohol overdose occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions—such as breathing, heart rate, and temperature control—begin to shut down. Symptoms of alcohol overdose include mental confusion, difficulty remaining conscious, vomiting, seizure, trouble breathing, slow heart rate, clammy skin, dulled responses such as no gag reflex (which prevents choking), and extremely low body temperature. Alcohol overdose can lead to permanent brain damage or death.⁸

The Surgeon General’s Report on Alcohol, Drugs, and Health provides additional information on alcohol overdose deaths:

Overdose deaths are typically caused by consuming substances at high intensity and/or by consuming combinations of substances such as alcohol, sedatives, tranquilizers, and opioid pain relievers to the point where critical areas in the brain that control breathing, heart rate, and body temperature stop functioning….The CDC reports more than 2,200 alcohol overdose deaths in the United States each year—an average of six deaths every day. More than three quarters (76 percent) of alcohol overdose deaths occur among adults between ages 35 and 64, and 76 percent of those who die from alcohol overdose are men. ⁹

Alcohol Use Disorder (AUD)

The NIAAA provides the following definition:

Alcohol use disorder: A chronic brain disorder marked by compulsive drinking, loss of control over alcohol use, and negative emotions when not drinking. AUD can be mild, moderate, or severe. Recovery is possible regardless of severity. The DSM-IV, published by the American Psychiatric Association, described two distinct disorders—alcohol abuse and alcohol dependence—with specific criteria for each. The fifth edition, DSM-5, integrates the two DSM-IV disorders into a single disorder called AUD, with mild, moderate, and severe subclassifications.¹⁰

The CDC offers additional information about severe AUD:

“A severe alcohol use disorder, previously known as alcohol dependence or alcoholism, is a chronic disease. Some of the signs and symptoms of a severe alcohol use disorder could include:

• Inability to limit drinking.
• Continuing to drink despite personal or professional problems.
• Needing to drink more to get the same effect.
• Wanting a drink so badly you can’t think of anything else.”

AUD can affect anyone, and it is critical to talk to your health providers about your alcohol consumption.

NIAAA provides the following information about treatment for AUD: “The good news is that no matter how severe the problem may seem, evidence-based treatment with behavioral therapies, mutual-support groups, and/or medications can help people with AUD achieve and maintain recovery.”NIAAA goes on to specify that, “[s]everal evidence-based treatment approaches are available for AUD. One size does not fit all and a treatment approach that may work for one person may not work for another. Treatment can be outpatient and/or inpatient and be provided by specialty programs, therapists, and doctors.” ¹¹

Questions about alcohol use or abuse? Resources are available: 

Everyone should discuss their consumption with their health providers, who can help determine what is best for them based on their individual factors. If you or someone you know is misusing alcohol, the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline provides free, confidential, 24/7 treatment referral and information services for those facing mental and/or substance use disorders. Additional resources and services can be found on the Alcohol Resources & Services page.