How Much Is Too Much Boozing?
BILL WOLFF, host:
Here's something to think about before you meet your friends at a bar or pour yourself two fingers of scotch on Saturday night. Are you an alcoholic?
The Wall Street Journal asked that question directly of its readers on Tuesday. The paper reported that there is no consensus on the definition of alcoholic. Lots of people drink heavily but would never consider themselves alcoholic.
According to the National Institute on Alcohol Abuse and Alcoholism, 30 percent of us hit the sauce a little too hard at some point in our lives and might never even realized we have a problem.
So continuing the BPP's proud tradition of story theft with credit, we're going to rip this one…
(Soundbite of music)
WOLFF: …from the headlines.
Dr. Mark Willenbring, director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism joins us now to discuss it.
Good morning, Doctor.
Dr. MARK WILLENBRING (Director, Division of Treatment and Recovery Research, National Institute on Alcohol Abuse and Alcoholism): Good morning.
WOLFF: Who - to begin, who diagnoses or defines alcoholism? What organization is responsible for the most widely accepted definition of alcoholism?
Dr. WILLENBRING: In United States, that organization, the American Psychiatric Association, they come out with a diagnostic manual that's called DSM. And the current edition is DSM-IV. And they come out with specific diagnostic criteria.
WOLFF: And do you think that that group is the group that should be doing it? I mean, do you accept…
Dr. WILLENBRING: Oh, absolutely. And in fact, in contrast to what you just said - what was reported in the journal in terms of a consensus, there's actually an international consensus about what constitutes alcohol dependence, which is typically what is called alcoholism. And the World Health Organization also issues a diagnostic manual. And the diagnostic criteria for alcohol dependents are very similar to those in the United States. There's actually quite a consensus about what alcohol dependence looks like.
WOLFF: And is that diagnosis or that definition in flux? Can we expect in the fifth version of DSM, a different definition?
Dr. WILLENBRING: Well, like with any other disease, we're always improving our diagnosis and treatments based on current research. And current research suggests that the current distinction in the United States between two different alcohol use disorders - that is abuse and dependence - doesn't work quite as well as we had expected when DSM-IV was created. So we're looking at whether or not, a single diagnosis of alcohol use disorder makes sense…
WOLFF: I see.
Dr. WILLENBRING: …makes more sense.
WOLFF: And would such evolution in the definition of alcoholism to be alcohol use disorder, as you just put it, would that - do you think encompass more people or fewer people?
Dr. WILLENBRING: I don't think it would do either. What it would do would be -to make it a lot easier for doctors and to improve our ability in terms of treatment and prognosis. And particularly, what we're aware of now - there are degrees of dependent. But, you know, there's a popular stereotype that the alcoholic is a middle-aged white man in skid row or, you know, someone who just, you know, goes off the deep end and drink several every day. That's what we now know is not true. And recent research shows that, in fact, the proportion of people who are dependent, you know, in a given year actually peaks at the ages of 18 to 20, and really is much higher between the ages of 18 and 25, and then drops fairly quickly after the age of 30.
WOLFF: And in your research or in the research generally done on the subject, is alcoholism a disease which is traceable to genetics and biochemistry or is it…
Dr. WILLENBRING: Well…
WOLFF: Go ahead, sir.
Dr. WILLENBRING: …like many disorders, there's a familial component. So, in fact, you know, a person's risks for alcohol dependence is about 50 percent genetic or heredity and about 50 percent environment - very similar to things like heart disease or asthma.
WOLFF: I see. And can you just give us a basic understanding. I mean, I drink alcohol occasionally. I'm really not habitual. But I think, by the classic definition, every once in a while, I drink too much.
Dr. WILLENBRING: Well, right. I think there's two things: there's drinking too much, too fast and there's drinking too much, too often. And a lot of people, especially young people - young people, in general, compared to older adults drink less frequently, but they drink more when they drink. And so, they tend to drink too much. And what - how much is too much? That's a really important question.
Dr. WILLENBRING: And currently, the way we define too much in a given day is more than three drinks in a day for a woman and more than four drinks in a day for a man. So four or more for a woman or five or more for a man is too much. And if that amount is taken in a two-hour period or so, that is - what is commonly called a binge. Well, what that means is, that's enough alcohol on average to get someone up to a level of legal intoxication for driving, for example.
STEWART: Can I ask you a question, Doctor? So you said, three or four drinks in a day, but what if you do that once a month? What if that's your big Saturday night out?
Dr. WILLENBRING: Well, you know, these things are on a continuum, right? So it's like anything else. What we're talking about here is risk, and that's a hard thing for people to really understand. Let me give you an example. I mean, most - if you wear a seatbelt when you go out and drive, most of the time, that won't matter because you're not going to be in a car crash. It's just that if you'd happen to be in a car crash, it really increases your chances of a severe injury or death if you are - if you don't have a seatbelt on.
So it's similar, in a way, to drinking. And so, the more often you drink heavily - that is above these guidelines - and the more, actually, above them, I mean, if you're drinking eight drinks or 10 drinks for example, you know, the increase - the greater is the risk for all sorts of problems.
And let me say that young people suffer disproportionately, not necessarily because they're an alcoholic - pardon me - but because they don't do things like drink driving - excuse me. They will do things like drink driving that will result in, you know, serious injury or death. So it really -even a single incident can produce serious results, although, most of the time it doesn't.
WOLFE: Finally, there have often been studies, which suggest that some moderate drinking on a regular basis might improve your cardiovascular health or some other area of your health.
What is the - is there a current consensus, and if so, what is it, about the idea that a beer or a glass of wine or a one hard alcohol drink per day helps your health?
Dr. WILLENBRING: I'd say there's a pretty good consensus that in - pardon me -in middle age, there's a pretty good consensus that it reduces your risk of heart attack and stroke and possibly of Alzheimer's disease. So - at least in association, and like many of these associations, like other dietary associations, it's hard to clearly infer causality, but in - as a matter of fact, it's probably the case that there is a beneficial effect.
I might also add, just for your listeners, that I think it's very important to understand what a drink is. And you mentioned a beer, a glass of wine or a drink. We're talking about a single shot of 80-proof beverage, whiskey, or five ounces of wine, so there's five drinks per bottle, or a 12-ounce beer.
And the most important thing that people could actually - to start keeping track, to start counting their drinks and to start keeping track. And too many young adults in particular, drink to get drunk. And there are a lot of things that people can do, and there's a lot of stuff on our Web site, if people want to visit it, to - on tips on how to control your drinking if you are going to choose to drink.
WOLFE: Well, Dr. Mark Willenbring of the National Institute of Alcohol Abuse and Alcoholism, thank you very kindly for coming on this morning. We appreciate it.
Dr. WILLENBRING: My pleasure.