ATLANTA – Sheldon Shiraki sits at the bar in the trendy Fritti restaurant in Atlanta, happily sipping an ice cold cocktail. Asked how many drinks it would take for the government to consider him a “heavy drinker,” he laughs.
“I don’t know — maybe 25 to 30 drinks,” Shiraki says.
“A month?” I ask.
“A week,” Shiraki says with a smile.
“Let me do the math,” his friend Pamela Gjerde says from the next bar stool over. A local, she calls the bartender by name and says she will sip a glass of white wine a couple days a week. For a woman to be considered a “heavy drinker” she thinks she’d have to have 15 to 20 drinks weekly.
They both looked shocked to learn they seriously overestimated the number.
One in 10 deaths among adults between the ages of 20 and 64 are due to excessive alcohol consumption, the Centers for Disease Control and Prevention says in a report released Wednesday. That means some 88,000 people die a year as a result of drinking too much. The majority of those are men — about 70%.
Do you consider yourself a light, moderate or heavy drinker? Health agencies have these definitions to help you understand when your drinking may become a health problem.
Women are considered “heavy drinkers” if they have eight or more drinks a week, according to the CDC. Men can have 14. At 15, you, my friend, are a “heavy drinker” in the eyes of the CDC.
The definition different for women because women’s bodies are typically smaller than men’s. They also metabolize less alcohol in the stomach, meaning more ends up in their blood stream.
A standard “drink,” by the way, is not that big frosty mug or that giant Hurricane glass you kept from Mardi Gras. The CDC says a drink is 12 ounces of beer (5% alcohol content), 8 ounces of malt liquor (7% alcohol content), 5 ounces of wine (12% alcohol content), or 1.5 ounces of 80-proof (40% alcohol content) distilled spirits or liquor — the fancy term for gin, rum, vodka, whiskey etc.
“That seems awfully low,” Shiraki says. “I would think someone is a heavy drinker if they get drunk all the time. Two or three a night wouldn’t do that.”
“That definition is crazy.”
“The definition of ‘heavy drinker’ has evolved over the last 20 years and it is based on scientific evidence about the harmful consequences of drinking too much,” says George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism, who has sat on the committees that create those definitions.
The definition on NIAAA’s website of “heavy” or “at-risk” drinking is the same as the CDC’s.
But the National Survey on Drug Use and Health has another. They say “heavy use” is “five or more drinks on the same occasion, on each of five or more days in the past 30 days.”
So which one is it?
“It’s imprecise and not quantitative. I try to avoid using terms like ‘heavy,’ ‘light’ and ‘moderate’ for that reason in my publications,” says Dr. Arthur Klatsky who has been studying alcohol and its impact on humans for decades. “The problem is everyone always wants to know if they fit into one of those categories.”
Koob says the definitions vary because they’re “not handed down to Moses from God on Mount Olympus.” They are based on epidemiological studies that show the long-term negative consequences of heavy drinking.
The 2012 National Survey on Drug Use and Health found that heavy drinking was reported by 6.5% of the population over 12. That’s about 17 million people. The rate was the same in 2011.
Those number are probably undercounting the real number, both Koob and Klatsky say.
Heaving drinking can lead to chronic diseases, including problems with your liver, throat, larynx and esophagus. It can lead to high blood pressure, psychological problems, and pancreatitis. It even puts you at an increased risk for becoming a victim of violence.
And of course you ultimately risk becoming an alcoholic.
Too much — or not enough?
One in 4 people who fall into the “heavy drinking” category already have an alcohol abuse problem, according to the NIAAA. Binge drinkers — women who drink more than four drinks in an outing and men who drink more than five — are a growing concern.
“The real worry these days is the number of young people who binge drink in college,” Koob says. “We were all 21 once, we all drank, but what this generation considers intoxicated has doubled over the last 20 years.
“Binge drinking has become a disturbing norm.”
Not only does this put students at risk for violence, sexual assault, and all the above mentioned diseases, it can damage their brains. The frontal cortex — the part of the brain that helps you make decisions and control impulsivity — doesn’t develop fully until you are 25. Binge drinking, studies show, can delay development of executive function.
Klatsky says the pattern of when you drink is just as important to your health as the total number. Abstaining much of the week and then having all seven drinks on Saturday is also bad for your health.
In addition to knowing what defines “heavy drinking,” people should also know what “light” and “moderate” drinking is, Koob says.
Studies show the mortality rate for people who drink moderately on a daily basis is actually lower than those who don’t indulge.
“There are health benefits to a lower level of drinking.”
Klatsky says it is more important to focus on the broader issue of alcohol problems than getting caught up in semantics.
“There is an old joke all of us went to medical school used to hear,” Klatsky says. “The definition of something like what is a ‘heavy drinker’ is one more than the upper limit of what the person making the definition drinks.”