Understanding Alcohol Drinking Patterns
You may have seen different terms that describe different patterns of alcohol consumption. These terms are useful in research and in helping people evaluate and make informed decisions about their own drinking patterns. For example, alcohol misuse, which includes binge drinking and heavy alcohol use, over time increases the risk of alcohol use disorder (AUD). It is important to note that harms may be associated with any amount of drinking, and as the amount of alcohol consumed increases the level of harm increases.
Drinking in Moderation
According to the Dietary Guidelines for Americans 2020-2025, adults of legal drinking age can choose not to drink or to limit their intake to two drinks or less in a day for men and one drink or less in a day for women, when alcohol is consumed. Drinking less is better for health than drinking more.
Developed by the U.S. Department of Health and Human Services and U.S. Department of Agriculture, the dietary guidelines provide recommendations on what the average American should eat and drink to promote health and help prevent chronic disease.
Binge Drinking
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines binge drinking as a pattern of drinking that brings blood alcohol concentration to 0.08%—or 0.08 grams of alcohol per deciliter—or higher. For a typical adult, this pattern corresponds to consuming five or more drinks (male), or four or more drinks (female), in about two hours.1 In the United States, a "standard drink" is defined as any beverage containing 0.6 fl oz or 14 grams of pure alcohol.
The Substance Abuse and Mental Health Services Administration (SAMHSA), which conducts the annual National Survey on Drug Use and Health (NSDUH), defines binge drinking as five or more drinks containing alcohol for males or four or more drinks containing alcohol for females on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least one day in the past month.2
High-Intensity Drinking
High-intensity drinking is the consumption of two or more times the gender-specific thresholds for binge drinking. This means 10 or more standard drinks (or alcohol drink equivalents) for males and eight or more for females. High-intensity drinking is consistent with drinking at binge levels II and III. The levels correspond to one to two times (I), two to three times (II), and three or more times (III) the standard gender-specific binge thresholds.3
The Monitoring the Future survey defines high-intensity drinking among adolescents as consuming 10 or more (8th, 10th, and 12th grade) or 15 or more (12th grade only) drinks in a row in the past two weeks.4
Heavy Drinking
NIAAA defines heavy drinking as follows:
- For men, consuming five or more drinks on any day or 15 or more per week
- For women, consuming four or more on any day or eight or more drinks per week
SAMHSA defines heavy alcohol use as binge drinking on five or more days in the past month.2
Alcohol Misuse
Alcohol misuse refers to drinking in a manner, situation, amount, or frequency that could cause harm to the person who drinks or to those around them. Alcohol misuse includes binge drinking and heavy alcohol use.
Alcohol Use Disorder
AUD is a medical condition characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences. It encompasses the conditions that some people refer to as alcohol abuse, alcohol dependence, alcohol addiction, and the colloquial term, alcoholism. AUD can be mild, moderate, or severe. Lasting changes in the brain caused by alcohol misuse perpetuate AUD and make individuals vulnerable to relapse.
Patterns of Drinking Associated with Alcohol Use Disorder
Alcohol misuse—which includes binge drinking and heavy alcohol use—over time increases the risk of alcohol use disorder (AUD). Additional factors also increase the risk of AUD.
What Are Other Harms of Alcohol Misuse?
It is well established that alcohol misuse—including binge drinking and heavy alcohol use—increases the risk of many short- and long-term consequences. These consequences range from accidental injuries to worsened mental and physical health conditions to death. The risk of harm typically increases as the amount of alcohol consumed increases.
For example, a growing body of evidence indicates that alcohol consumption carries risks of certain harms at lower levels of drinking. Research has shown an important association between alcohol consumption and breast cancer—even one drink per day can increase a woman's risk for breast cancer by 5% to 15% compared to women who do not drink at all.5–7 In addition, for individuals who carry certain genetic variants that alter alcohol metabolism, their risk of esophageal cancer appears to increase as the amount of alcohol consumed increases.8–10
During pregnancy, alcohol use increases the risk of fetal alcohol spectrum disorders, which refers to the collective lifelong physical, behavioral, and cognitive impairments that occur due to prenatal alcohol exposure.
There are situations in which some people should avoid alcohol completely, particularly if they:
- Plan to drive or operate machinery, or participate in activities that require skill, coordination, and alertness
- Take certain over-the-counter or prescription medications
- Have certain medical conditions
- Are recovering from AUD or are unable to control the amount that they drink
- Are younger than age 21
- Are pregnant or may become pregnant
To see whether your pattern of alcohol use puts you at risk for AUD, please visit Rethinking Drinking at: RethinkingDrinking.niaaa.nih.gov
References
1 NIAAA. [Internet.] Defining binge drinking. What colleges need to know now. Bethesda (MD): National Institutes of Health; 2007 Nov. [cited 2023 Feb 20]. Available from: https://www.collegedrinkingprevention.gov/sites/cdp/files/documents/1College_Bulletin-508_361C4E.pdf
2 SAMHSA, Center for Behavioral Health Statistics and Quality. Results from the 2023 National Survey on Drug Use and Health: detailed tables: appendix A: key definitions for the 2023 National Survey on Drug Use and Health. [cited 2024 Sep 13]. Available from: https://www.samhsa.gov/data/report/2023-nsduh-detailed-tables
3 Hingson RW, Zha W, White AM. Drinking beyond the binge threshold: predictors, consequences, and changes in the U.S. Am J Prev Med. 2017;52(6):717-27. PubMed PMID: 28526355
4 Miech RA, Johnston LD, Patrick ME, O’Malley PM. Monitoring the Future: National Survey Results on Drug Use, 1975–2023: Overview and Detailed Results for Secondary School Students. Available from: https://monitoringthefuture.org/wp-content/uploads/2024/01/mtfoverview2024.pdf
5 Choi YJ, Myung SK, Lee JH. Light Alcohol Drinking and Risk of Cancer: A Meta-Analysis of Cohort Studies. Cancer Res Treat. 2018 Apr;50(2):474-487. doi: 10.4143/crt.2017.094. Epub 2017 May 22. PubMed PMID: 28546524
6 Bagnardi V, Rota M, Botteri E, Tramacere I, Islami F, Fedirko V, Scotti L, Jenab M, Turati F, Pasquali E, Pelucchi C, Galeone C, Bellocco R, Negri E, Corrao G, Boffetta P, La Vecchia C. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br J Cancer. 2015 Feb 3;112(3):580-93. Epub 2014 Nov 25. PubMed PMID: 25422909
7 Cao Y, Willett WC, Rimm EB, Stampfer MJ, Giovannucci EL. Light to moderate intake of alcohol, drinking patterns, and risk of cancer: results from two prospective US cohort studies. BMJ. 2015 Aug 18;351:h4238. PubMed PMID: 26286216
8 Brooks PJ, Enoch MA, Goldman D, Li TK, Yokoyama A. The Alcohol Flushing Response: An Unrecognized Risk Factor for Esophageal Cancer from Alcohol Consumption. PLoS Med. 2009;6(3):e1000050. PubMed PMID: 19320537
9 Hurley TD, Edenberg HJ. Genes encoding enzymes involved in ethanol metabolism. Alcohol Res Curr Rev. 2012;34(3):339-344. PubMed PMID: 23134050
10 Yang SJ, Yokoyama A, Yokoyama T, et al. Relationship between genetic polymorphisms of ALDH2 and ADH1B and esophageal cancer risk: A meta-analysis. World J Gastroenterol WJG. 2010;16(33):4210-4220. PubMed PMID: 20806441