Drinking less, or stopping

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. No single figure sets this limit for everyone: the most reliable guide is the signs of withdrawal. Shaking, sweating, nausea or intense anxiety when you are not drinking, needing a drink in the morning, a previous attempt to stop that brought on hallucinations or a seizure: if any of these signs sounds familiar, or if you drink every day and are unsure, this applies to you. That does not mean you should not stop: it means you should talk to a doctor first.

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 — France sets the maximum at two a day, Australia at four — 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 large studies that followed hundreds of thousands of drinkers for years, show that the risk of cardiovascular disease and of death increases beyond weekly levels lower than those previously recommended: for mortality, from around 100 grams of pure alcohol a week. This is also the order of magnitude adopted by several countries, including France and Australia: no more than ten 10-gram units a week.

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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