Breaking Bad: Problematic Alcohol Consumption

The earliest evidence of residue of an alcoholic beverage—made from rice, honey, and grapes and dating between 7000-6600 BCE—has been traced to a Neolithic village in China’s Yellow River Valley. So we can say with certainty that people have been using alcohol to celebrate successes, mark life’s milestones, and drown their sorrows for millennia.

But just because it’s been a tradition since time immemorial doesn’t mean it’s good for us.

Current U.S. guidelines recommend no more than two drinks a day for men, and one drink or less a day for women, to minimize the inherent risks of alcohol consumption. These same guidelines identify heavy drinking as four or more drinks a day, or eight or more per week for women; and five or more drinks a day, or 15 or more per week for men. Alcohol Use Disorder (AUD), according to the DSM-5, combines “alcohol abuse and alcohol dependence into a single disorder … with mild, moderate, and severe sub-classifications.”

What’s the problem?

In 2023, The World Health Organization issued a statement that no amount of alcohol should be considered safe, and the results of a study by the Canadian Centre on Substance Use and Addiction cautioning people to curb their alcohol usage as much as possible made headlines around the world.

The inherent risks of alcohol these warnings aim to address include heart disease, stroke, gastro-intestinal problems, a number of cancers, and mental health issues including mood disorders and addiction. Family and job performance issues, workplace accidents, severe injury or death, and life-changing legal consequences can result from impaired driving. These consequences result from all kinds of alcohol, including beer, hard liquor, clear liquors, the finest Champagnes, and even red wine, which has long celebrated for its purported health effects. And while it's true that some drinks may not be as "bad" as others, the reality is that there is no "healthy" alcohol.

Alcohol consumption in the media

Films, TV series, and social media posts often depict alcohol consumption as common, exciting, or of little consequence. Over-the-top levels of consumption may be depicted as normal. Teenagers who follow the lead of social-media influencers challenging them to consume high levels of alcohol may consume more in a sitting than even long-term drinkers would not attempt. Aside from their tenuous links to the real-world effects of excessive consumption, these depictions promote excessive alcohol usage as socially acceptable and an essential element of good times.

How alcohol usage becomes problematic

That said, even cautionary studies rank the risk of light, occasional alcohol consumption as low. But when alcohol is used to help manage social anxiety or fit in with peers on a night out, to numb uncomfortable or unpleasant feelings, or to "take the edge off" at the end of a tough day, usage—and risk—can creep up and become problematic.

Retooling our schemas

Schemas are our maps of the world. They are how we make sense of the world and make our lives manageable. Our schemas also include habits that help us cope with challenges and stressors. For many of us, especially in trying times, having a couple of glasses of wine, or a cocktail or two, with dinner seems like a great idea at the end of a tough day, in a stressful social setting, or at an intimate dinner, while not drinking may make the people we are with feel uncomfortable or awkward in our presence.

Here’s the thing about habits: When we know better, we can choose to do better. There’s no time like the present to change unhealthy routines.

7 Steps to Address Problematic Alcohol Consumption

• Take stock. Keep track of the number of alcoholic drinks you consume in the coming week. This will provide you with a clear picture of your current habits.
• Consider set and setting. Make note of the times you use alcohol to lower anxiety. Think of where and when you are most likely to consume alcohol with other people. Being aware of people who pressure you to drink more (directly or indirectly), and of the situations and settings in which you are most likely to over-indulge to go along with the crowd, will help you be ready to face detractors.
• Set new rules. Create goals and limits around how much — or how little — you wish to consume.
• Find enjoyable alternatives. Many restaurants offer mocktail versions of their most popular cocktails and other enjoyable alternatives to alcoholic beverages. Find something you enjoy, and make that your go-to.
• Get comfortable with saying no. Don’t hesitate to say no, and stick to your healthy new habits.
• Create new ways to wind down. A walk in nature, a conversation with a friend, or other enjoyable plans can be part of a new way to calm down after a tough day.
• Talk to a mental health professional. If you’re struggling to get problematic alcohol use under control, seek professional help. To find a therapist, visit the Psychology Today Therapy Directory.