Substance use “limits” and their implications for health

Low-Risk Drinking Limits

Low-Risk Drinking Limits

According to epidemiologic research, men who drink more than 4 standard drinks in a day (or more than 14 per week) and women who drink more than 3 in a day (or more than 7 per week) are at increased risk for alcohol-related problems. Individual responses to alcohol vary, however. Drinking at lower levels may be problematic depending on many factors, such as age, coexisting conditions, and use of medication. Because it isn’t known whether any amount of alcohol is safe during pregnancy, the Surgeon General urges abstinence for women who are or may become pregnant. An illustration that can be used to explain these limits to patients is provided courtesy of Academic Edge, Inc.

There are no defined low-risk drinking limits for children, adolescents, or women who are or may be pregnant.

Gender and Drinking Limits

  1. Research shows that women are at an increased risk when drinking above low-risk limits and develop other health problems at lower drinking levels than men because:
    • Alcohol disperses in body water and women have less water in their bodies than men do.
    • If a man and woman of the same weight drink the same amount of alcohol the woman’s blood alcohol concentration will tend to be higher putting her at greater risk for harm.
  2. Alcohol may produce different end-organ damage in women than in men (in areas such as breast tissue).

When is “Low-Risk” Drinking Still too Much?

Although “Low-Risk” establishes a general threshold above which it is increasingly dangerous to consume alcohol, it functions more as a guideline than as a hard and fast rule; there are several situations for which it is safest to avoid alcohol altogether:

  • Taking medications that interact with alcohol
  • Managing a medical condition that can be made worse by drinking such as uncontrolled diabetes, high blood pressure, and other chronic illnesses
  • Underage
  • Planning to drive a vehicle or operate machinery
  • Pregnant or trying to become pregnant

What About Other Substance Use?

other drugsIt is important to remember that the concept of “low-risk” use is currently limited to alcohol consumption.

There is little research to support “safe” or “low-risk” limits on other substances such as tobacco, marijuana or other drugs (that are used non-medically).

For substances other than alcohol, therefore, clinicians cannot provide advice that indicates a certain level of non-medical use is no risk or even low risk. Our patients may seek re-affirmation that their ‘minimal’ recreational use of a ‘safe’ drug is okay, but providers cannot, of course, provide this validation. Instead, we can turn to motivational interviewing strategies, which will be discussed later, to help the patient explore their use and ways they might cut back or abstain altogether.