Answers for Amber

Hey, Amber…

Are your ears burning? I’ve been talking about you and your appearance on Oprah several months ago. I thought you asked a great question:

I am hoping that someone can tell me, if I have 3 drinks, you’re OK, if I have 4 drinks, you’re not OK. I want somebody to tell me exactly where that line is.

And it seemed to me the answer you got was muddy.

I’m not a professional, but I’ve got some relevant experience, and somehow I’ve become an alcohol-issues geek. For what it’s worth (take it or leave it as you wish), I’ll take a shot at clearer answers to your question.

Abuse and dependence

First of all, there are two broad categories of problems folks run into with their drinking: Abuse and dependence.

Alcohol abuse

describes folks who continue drinking despite having recurring problems (legal, health, social, family, relationship) or despite the fact that their drinking creates hazards to themselves or to others. The problems caused by alcohol abuse can occur without us being addicted or dependent, and in fact, there are four problem drinkers for every alcoholic.

Alcohol dependence

is problem drinking plus either high tolerance or withdrawal symptoms. That is what you heard a lot about on the Oprah show. It’s real, it sometimes sneaks up on folks, but I disagree with those who suggest that it is never possible to see it coming.

Does abuse lead to addiction?

It can, but this large 5-year study (580K PDF) suggests it generally doesn’t.

Drinking by the numbers

Is it OK to have 3 drinks, but not 4? Actually, you’re in the ball park with those numbers, but as an intelligent woman you won’t be surprised to hear it’s not quite that simple.

If you want to be very safe,

the USDA

recommends that you have no more than one (233K PDF, pg 40) drink per day (the limit is two for guys).

In Britain,

the recommended guideline is about twice that (360K PDF, pg 3) for women and slightly higher for men.

A 1995 study

found that problem-free drinking occurred at levels of up to 3 drinks per day for women, with a max of 12 per week (4/day, 14/week for guys), with some non-drinking days each week, and

Moderation Management

(MM), a group of folks concerned about their drinking, also recommends 3/day but 9/week. Guidelines set by government ministries in

Italy, Denmark, Spain, and Japan

are closer to the 3/day mark; other countries are closer to the one/day limit suggested by the USDA.

Tailoring drinking to life

Maybe the bigger question for each of us than “What is a problem?” or the scientific stuff surrounding the various numbers is “What is important to me?” We each must answer that question for ourselves, but we may find it helpful to ask, “Why not have alcohol-free days?” “What matters most to me?” “How is my drinking contributing to my quality of life?” “Subtracting from it?”

The answers that work best for you aren’t going to be the answers that work best for me. No surprise there; it’s a matter of examining our values and shaping our lives to fit them.

Making changes

It’s not unusual for us to take a look at our lives and decide we want to make things different. Typically, though, we don’t make the big changes by snap decision, just because they make sense to us intellectually. Sustained change tends to come from working through healthy ambivalence as we navigate recognizable stages of change. The MM folks recommend trying out periods of abstinence as one way to explore change, but they also point to the benefits of reducing harm, which I’ve found helpful at times when optimal solutions were temporarily beyond reach.

I couldn’t really tell where things were at for you (not that it matters, given that I’m a layperson in this area), but from the bit that I heard, I’m guessing I’ve got you beat when it comes to not-so-smart drinking habits. The thing is, you and I know that we’re both responsible for and capable of doing what’s necessary to live sensibly. That means being willing to admit that we sometimes get off-track (or at least, I do) and have to adjust our course.

Summing up

I gotta admit, Amber, I feel a little silly dumping all of this to somebody who showed up on the TV several months ago. Is this a geeky thing to do, or just plain dorky?

Ah, well, you can probably tell from my website that I care about these kinds of issues, a bunch. You raised a simple, very valid, question that I’ll bet millions of other folks watching that day would have liked answered, and a golden opportunity was missed to put solid information in people’s hands.

I hope you are well, and I’d love to hear from you or anyone else on the show that day.

—Steve