Doctor’s Note: Hammered for the Holidays

The holiday season is once again upon us. During the months of November and December, millions of Americans will share good times and good cheer with family and friends. And in the majority of American families, “good cheer” includes alcoholic drinks. Nearly two-thirds of Americans are alcohol drinkers, a number that has stayed remarkably stable ever since the end of Prohibition. And as a nation we drink roughly twice as much alcohol per week during the holiday season compared to the rest of the year. So how much alcohol is too much? Are we Americans getting hammered for the holidays?

Alcohol-related illness and death have increased dramatically in the U.S. between 2000 and the present day, even though per-capita alcohol consumption has only increased by a small amount and remains much lower than in the 1970s-’80s. This reflects the fact that alcohol-related illness isn’t linked to how much the average person drinks, but how much the heaviest drinkers drink. The top 10 percent heaviest drinkers in the U.S. consume most of the alcohol, and their drinking habits have become more problematic in recent years.

The COVID-19 pandemic of 2020 saw a 25 percent year-over-year increase in alcohol-related deaths, by far the largest such change ever measured. The increase in problem drinking affected women more than men, with a 41 percent increase in problem drinking among U.S. women. A 2022 health survey showed that heavy drinking remained elevated long after the end of COVID lockdowns, with an absolute prevalence increase of 1.19 percent over four years. This may not sound like much, but multiplied by the population of the U.S., it’s 3 million additional heavy drinkers.

What is the definition of heavy drinking? The current U.S. definition is four drinks in one day for women or five drinks for men, occurring at least five days a month. A standard alcoholic drink is 14 grams of alcohol, which is equivalent to 12 ounces of 5 percent ABV beer, 5 ounces of 12 percent ABV wine, or 1.5 ounces of 80-proof liquor. Four to five drinks in one sitting is approximately how much it takes to exceed the 0.08 percent blood alcohol content (BAC) threshold for being legally impaired in most states (Utah’s threshold is 0.05 percent).

It shouldn’t be a surprise to learn that heavy alcohol use is very bad for your health. The CDC estimates that more than 178,000 Americans die of alcohol-related disease each year. This includes acute alcohol poisoning, alcoholic liver disease, alcohol-related cancers, and traffic accidents. Roughly a third of all motor vehicle fatalities involve a drunk driver, accounting for over 13,500 deaths per year. Heavy drinking is unequivocally bad for your health.

What about moderate drinking? The CDC defines moderate alcohol use as no more than two standard alcoholic drinks per day for men, or one alcoholic drink for women. Until recently, many medical textbooks stated that moderate alcohol consumption protected against heart disease. This was largely based on data from the 1960s-1990s showing a “J-shaped curve” of alcohol intake versus risk of cardiovascular death, cholesterol and other blood markers, even overall lifespan. Men consuming up to two drinks a day and women consuming up to one drink a day were modestly healthier than nondrinkers, while those consuming higher levels of alcohol were much less healthy.

These studies popularized the practice of drinking “a toast to your health,” or even calling a glass of wine your “daily medicine.” Drinking red wine for health reasons is especially popular since it contains grape-derived antioxidants like resveratrol. Unfortunately, many of the scientific studies on red-wine health benefits have been tainted by academic fraud.

But even in the larger body of moderate-drinking epidemiology, researchers in recent decades have questioned the appearance of confounding bias in the older “J-curve” data. Moderate drinkers are more likely to be socially active and physically active, and typically have higher incomes than nondrinkers. Some former drinkers only quit drinking because they were medically ill. Most newer analyses that correct for these confounding factors do not show significant benefits from light-to-moderate alcohol use. Some studies show a small amount of harm. Others show no difference. Altogether there is no broadly-accepted consensus on the health effects of moderate drinking.

And that should be a reassuring thought for the holiday season. If you’re a teetotaler, you don’t have to worry that you are missing out on tipsy “medicine.” And if you’re a drinker, feel free to enjoy your favorite drinks. Just do so in moderation.