A Therapist Speaks Candidly: Problematic Drinking Looks Different for Everyone

(Allison Young, MD) - There’s no one-size-fits-all threshold for when drinking becomes a problem — and why you drink matters.

“They say some alcohol is actually good for you.”


“I don’t drink that much.”


“I could stop drinking if I really wanted to, so I can’t have a problem. Right?”


As a psychiatrist, I hear all of these things from both clients and friends when they’re thinking out loud about their drinking habits (Allison Young, is a board-certified psychiatrist specializing in evidence-based lifestyle interventions for the management of mental distress).


The reality is that many people I know personally or treat professionally are confused about how much drinking is too much. Sure, the Centers for Disease Control and Prevention (CDC) has guidelines, which recommend less than two drinks a day for men and less than one a day for women.


There’s a lot of research out there that attempts to nail down what the right amount of alcohol is. But there’s not a one-size-fits-all amount of alcohol that’s problematic. Everyone has different physical and mental health risk factors that affect this amount. Problematic drinking looks different for everyone.

The Research on Alcohol Is Complicated

Let’s start with the most confusing part of assessing your own alcohol use — the well-known advice that a glass a day is good for you.


Several studies, including a study published in the journal Circulation, suggest that moderate alcohol consumption — currently defined as one glass per day for women and up to two per day for men — could have some heart health benefits. But this does not mean alcohol is good for you overall?


As more research on this topic accumulates, it has become clear that although up to one drink per day could have some heart health benefits, any more can be damaging to the heart. For example, a review article published in Mayo Clinic Proceedings found that drinking too much alcohol increases your risk of high blood pressure, stroke, and atrial fibrillation, among other serious heart issues.


This means that there may be a very fine line between how much alcohol is good for you versus how much is bad for you.


Not to mention, research on the benefits of alcohol use is mostly limited to the heart and the vessels that carry blood to different parts of the body. Plenty of other research shows that alcohol is bad for most other systems and organs in the body. Just one example: A study published in September 2018 in The Lancet showed that alcohol use increases the risk for several cancers, even at only one glass per day.


In addition to the physical impact, alcohol is tied to a variety of mental health and social issues. These include increased aggression, increased violence, and increased traffic accidents.


In the United States, nearly 10,500 people died in alcohol-related traffic accidents in 2016, according to the CDC.


This accounted for more than a quarter of all deaths due to traffic accidents.


So even if low levels of alcohol could have benefits for the heart, the overall risks of alcohol likely outweigh the benefits for most people.


Is Alcohol Actually Heart-Healthy?

To complicate matters, whether any amount of alcohol is truly beneficial for heart health has been called into question by experts.


Low levels of alcohol have been shown to relax blood vessels, lower blood pressure, and increase levels of good cholesterol — and wine does contain heart-healthy antioxidants. But, as the American Heart Association (AHA) points out, there are healthier ways, such as exercise, to create healthy blood vessels. And there are healthier foods, such as berries, that contain antioxidants.


Interestingly, research suggests that if you are already engaging in healthy behaviors — like exercising, eating nutritiously, and maintaining a healthy weight — adding alcohol may have no additional benefit for the heart. A study published in the American Journal of Preventive Medicine indicates that studies about the potential health benefits of moderate drinking “should be interpreted with caution” because of the deleterious toll that alcohol can have on the body in excessive amounts.


When it comes to whether a glass of wine a day can be part of a healthy lifestyle, the AHA’s stance is clear: “The American Heart Association does not recommend drinking wine or any form of alcohol to gain potential health benefits.”


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ABOUT THE AUTHOR

We wish to thank Allison Young, for this highly insightful and well-written article.


Allison Young, MD Allison Young, MD, is a board-certified psychiatrist specializing in evidence-based lifestyle interventions for the management of mental distress. She graduated magna cum laude from Georgetown University with a bachelor of science degree in neurobiology and theology. She then obtained her doctor of medicine degree with honors in neuroscience and physiology from the NYU Grossman School of Medicine. She continued her training at NYU during her psychiatry residency, where she was among a small group selected to be part of the residency researcher program and studied novel ways to assess and treat mental distress, with a special interest in trauma. Dr. Young currently runs a private practice and serves as an adjunct professor of psychiatry at the NYU Grossman School of Medicine. She is an active member of the American College of Lifestyle Medicine, where she is engaged in creating educational materials on and advocating for the use of lifestyle interventions to improve overall health and mental wellness.


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