Drinking less, or stopping

This guide is psychoeducational content. It does not replace a consultation. If you drink every day and in large amounts, do not stop abruptly without medical advice: a severe withdrawal can cause major tremor, confusion, seizures or delirium, and that is a life-threatening emergency. See section 5. If you are thinking about dying, talk about it the same day to your doctor or to a suicide prevention line; in immediate danger, call the emergency services. Never change a prescribed treatment on your own. Allow fifty-five minutes to read.

1. Before you begin

You poured yourself a drink when you came in, as you do every evening. Then a second one while cooking. You did not count the third. This morning you woke at four, heart racing, with that objectless unease that takes two hours to go. You told yourself you would not drink tonight. You had already told yourself that yesterday.

Or none of that: you drink at weekends, reasonably, and someone made a remark that is going round in your head.

Three things, straight away.

Taking stock commits you to nothing. You can read this guide without having decided to change anything at all. Counting what you drink for a week is already a change, and it is often the only one you need in order to begin.

There are not 'alcoholics' on one side and normal people on the other. There is a continuum, from the occasional drink to established dependence, and most people who have a problem with alcohol are somewhere in the middle. Waiting to recognise yourself in the picture of the extreme case wastes ten years.

Stopping abruptly is not always harmless. This is the safety point of this guide, and it is placed first deliberately: if you drink every day and in large amounts, stopping all at once, on your own, can be dangerous. That does not mean you should not stop: it means you should talk to a doctor first.

Who this guide is for

For you if you wonder where you stand, without having decided anything.

For you if you want to cut down and to know whether that is realistic.

For you if you have decided to stop, alone or with help.

For you if you have already stopped and then started again, and want to understand what happened.

If it is someone close to you who worries you, this is not the right guide: read Helping someone close who drinks.

2. Standard units and the guidelines

Counting in glasses means nothing

A 'glass' at home has nothing to do with a measure served in a bar, and a bottle of wine shared between two people is not always divided equally. To find your bearings, a standard unit is used: the amount of pure alcohol contained in a measure served in licensed premises.

In practice, and approximately, one unit corresponds roughly to:

• half a pint of ordinary-strength beer;
• a standard-sized glass of wine;
• a measure of spirits as it is served in a bar.

The exact value of the unit differs from country to country. What counts is not precision to the gram, but counting in the same way every week.

What throws all the calculations out

• Drinks poured at home are on average considerably fuller than standard measures.
• Strong beers can amount to two or three units in a single container.
• Cocktails often contain several measures of spirits, masked by sugar.
• The glass you top up before finishing the previous one is never counted.
• The drink someone buys you is not counted as a drink consumed.

The useful rule: read the strength on the label, estimate the volume, and always count on the high side when in doubt.

The drinking guidelines

Health authorities in many countries publish guidelines, and they have been revised downwards in recent years. The wording differs, but they converge on three ideas.

• Not every day. Plan several alcohol-free days in the week, and do not turn drinking into a daily habit.
• Not too much at a time. Limit the number of units on any single occasion, repeated drunkenness being associated with specific risks.
• Not too much in total over the week. The broadest analyses, including the one published by Angela Wood and her colleagues in 2018 using dozens of cohorts, show that the risk of cardiovascular disease and of death increases beyond weekly levels lower than those previously recommended.

There is no level with no risk at all

This is the position now taken by the World Health Organization. For certain risks, notably certain cancers, the increase is observed even at low levels of consumption. That does not mean that having a drink is dangerous in the sense in which that word is usually understood; it means that the notion of a 'safe threshold' has no foundation, and that the guidelines are risk-reduction compromises, not guarantees.

The old talk about the benefits of wine

The idea that moderate drinking would protect the heart circulated for a long time. More recent analyses, which take account of the fact that the group of 'non-drinkers' often includes former drinkers who are ill, have greatly reduced or removed that apparent benefit. It is not an argument for stopping drinking; it is one for not starting or increasing in the name of health.

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