Drinking: How Much Is Too Much?

Have you ever wondered if you have a drinking problem? Has anyone suggested that your alcohol use is concerning? When you go out drinking, do you have 4 of 5 drinks, maybe more? Do a couple of glasses of wine eventually turn into the whole bottle? Is there a set time of day when you just have to have a drink?

Over the years, we’ve often fielded the question, “How many drinks is too many?” The short answer is, “It depends.” It depends on a whole host of factors, including the size and strengths of the drinks, your tolerance, any co-occurring psychiatric conditions with which you might struggle, your nourishment/hydration status, and other variables that we’ll touch on below.

According to the DSM-5, someone will meet criteria for an alcohol use disorder when endorsing two or more of the eleven criteria below:

1. Alcohol is often taken in larger amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following: a) A need for markedly increased amounts of alcohol to achieve intoxication or desired effect b) A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following: a) The characteristic withdrawal syndrome for alcohol (refer to criteria A and B of the criteria set for alcohol withdrawal) b) Alcohol (or a closely related substance, such as a benzodiazepine) is taken to relieve or avoid withdrawal symptoms.

As you’ll notice in reviewing these criteria, the DSM does not comment on the number of drinks one must consume (in any given drinking episode or on average) in order to meet criteria for a diagnosis.

Here’s what we think is most important, more so than drink tabulation, when determining if your drinking is problematic:

1. Your relationship to alcohol: Do you feel like it controls you or you it? Do you have trouble stopping once you start? Do have urges to drink? Do you drink to quiet certain feelings, such sadness, anger, or anxiety or to change your disposition when feeling lonely, bored, or keyed up? Is it challenging to cope with these feelings/states without turning to alcohol? Do you feel compelled to drink on occasion? That need for a drink after work, or when the kids are sleeping, or simply to unwind could be an indication that the substance has some control over you, even if you only have a single drink at a time.

2. Consequences of your drinking: What happens when you drink? How do you feel and act during and after you imbibe? Does your drinking negatively impact your ability to function at school or work, at home, or with friends or family? Has it caused problems in relationships? Does drinking cause you to avoid emotions and problems you know you need to face? Does it impact how you sleep or how you feel the next day? Has it affected your health or safety?

In answering these questions, you can get a sense of how problematic your drinking might be. Whether you have a single drink religiously at night or binge drink on weekends, your relationship to alcohol and how it impacts your life are what matter most.

Gatewell specializes in treating alcohol use disorders and can help you assess if your drinking is problematic and, if so, work toward addressing the issue before it becomes more damaging to yourself and those around you.