What is moderate drinking, and who can afford it

“I drink in moderation.”

I hear that sentence often and it almost always means something other than I would assume. For one person it means drinking less than his father did. For another, never drinking in the morning. For a third, not during the week, while weekends do not count. For a fourth, never having had trouble at work. Moderation is a word each of us measures with the ruler we keep at home.

The question in the title is therefore more complicated than it looks. Not because the science of alcohol is impenetrable, but because it has shifted considerably over the past two decades — and because an answer that would hold for everyone does not exist. This piece is not an instruction. It is a reflection on the relationship you have with drinking, and on what would be honest to know before you tell yourself that everything is fine.

Why you will not find numbers in this piece

I will deliberately give no measures. Three reasons.

The first is professional: any figure I gave would apply to the average of some population, not to you. National recommendations differ more than one would expect, and in recent years many have been lowered. If I wrote one down, it would in truth be out of date before you read it.

The second is practical: from my room I know what happens to a figure. It becomes a target. Someone worried before reading is no longer worried afterwards, because they have placed themselves below the line — and that reassurance is often more harmful than the worry it replaced.

The third is simple: nobody in my room has ever changed anything because someone told them a number. People move when they see what drinking is doing for them.

What became of the belief that alcohol protects the heart

For thirty years it was held that people who drink moderately have less heart disease than people who do not drink. That finding was true as an observation and wrong as a conclusion.

The problem lay in who made up the non-drinking group. It included people who had stopped because they became ill, because they were on medication, or because they had a period of heavy drinking behind them. The “healthy moderate” group was thus being compared with a group containing many sick people. Once researchers began subtracting that effect, the protective benefit began to shrink.

The decisive shift came from studies that use genetics instead of questionnaires. Some people carry a gene variant that makes alcohol produce an unpleasant reaction, so they drink less all their lives — entirely independently of whether they are healthy. Because a genetic variant is allocated at conception rather than by lifestyle, such a comparison is much closer to a real experiment. In those studies no protective effect on the heart was visible.

I want to be precise here, because this story is often told too triumphantly. It is not that scientists were previously lying, or that they have changed their minds out of fashion. It is that the methods improved, and an error that could not previously be seen could be subtracted. That is a normal course of events and no reason for distrust — it is a reason for caution towards any simple health message that sounds good.

Why no safe limit can be set for everyone

Even if a single figure existed, it would mean two different things in two people. Metabolism differs by sex, body composition, age and genetics. Medication changes the picture. Pregnancy changes it entirely. Insomnia, liver disease, epilepsy, certain mental health conditions and a family history of addiction move the line elsewhere or remove it.

This is not evasion. It is the answer. Anyone looking for one measure that will hold for the rest of their life is looking for something the field does not have — and it would not be honest to pretend otherwise.

Function says more than quantity

In therapy what interests me is mainly the third column of that picture. Not how much, but what for.

The question “what for” is not an accusation. Plenty of people drink because company is nicer that way, and that is a legitimate answer that need not be twisted. What interests me is something else: whether there is a job alcohol is doing in place of something, or someone, that ought to be doing it.

Alcohol is a reliable short-term sedative. It works fast, it works predictably and it is available everywhere. So people often use it for what would otherwise require something slower: to stop after work, to endure a family lunch, to fall asleep, to say in company what they otherwise would not.

Once drinking is given a task, its position changes. It is no longer something you treat yourself to but something you need in order to get through the day. That shift — not the amount — is what turns a habit into a problem. With sleep this is especially clear: alcohol helps you fall asleep and at the same time dismantles the second half of the night, so you wake at three and cannot get back. I have written about why that happens, and what the nervous system is doing then, in a piece on insomnia and the nervous system.

How the science moved

How you read this matters. It does not follow that every sip is dangerous and that you must reproach yourself over every celebration. What follows is something more awkward: there is no line below which you are entirely safe, and no line above which all is lost. Risk changes gradually.

When your surroundings define what is normal

We judge our own drinking comparatively. The yardstick is not a study, it is the table you are sitting at. If everyone around you drinks similarly, your drinking looks moderate by definition.

So the question I sometimes ask is not the expected one: not “how much do you drink” but “who is the person in your head that you compare yourself to”. The answer is often a father, an older brother or a colleague who drinks noticeably more. As long as he is the yardstick, the verdict will always be lenient.

In Slovenia that yardstick is especially generous. Alcohol here is woven into rituals from birth to funeral and consumption is high by European standards. This means that the average you compare yourself with is not a neutral reference. A person can feel moderate all their life while sitting above the continental average.

An experiment tells you more than an estimate

The most useful thing you can do is not to count. It is to try something and observe.

Take a period long enough to include your usual occasions — not just a week when you are at home anyway. Then watch four things: how easy or hard it was, what you did instead, when you missed it most, and what other people said. The last is often the most instructive; how those around you react to your not drinking says a great deal about the circle you move in.

If the experiment was easy, you have gained useful information. If it was harder than expected, you have gained more useful information still — and neither is grounds for shame. Shame is a poor adviser in decisions and an excellent one in postponing them; I have written about its role in a piece on healthy and toxic guilt.

An important warning: if you have been drinking heavily for a long time, stopping abruptly on your own is not safe. Withdrawal from alcohol and sedatives can run into life-threatening complications and needs medical supervision. In that case the experiment is not a home exercise but a conversation with a doctor. I have set out when a doctor is the first address in a separate piece.

Sober breaks and harm reduction

For some people the word abstinence closes the conversation before it opens. So it is worth having intermediate options. Sober months, days in the week without, an agreement to keep no supply at home, a decision to drink only in company and never alone — all of these are forms of harm reduction.

Harm reduction is a well-established approach, not a consolation prize for those who cannot stop. For many it is the only path they can actually begin, and it is often the beginning of something larger. For some people — above all those with established addiction — moderate drinking is realistically not a goal that can be sustained, and it is honest to say so.

What these intermediate steps reveal quickly is something other than expected. People rarely discover that they are addicted. Far more often they discover how much room alcohol occupied in their planning: where they went, with whom, at which hours, and what they did not do because it would have got in the way of the evening. That discovery is often more striking than any number, and more useful too, because it can be addressed.

Where my argument breaks

First: giving no numbers has a cost. For some people a concrete limit would genuinely help — someone with no feel at all for what counts as a lot, who needs support from outside. My approach does not give that person enough. For them the right address is a GP or a specialist clinic, where measures will be given and placed within their own health picture.

Second: the danger in my emphasis on function is that everything becomes psychological. It is not. Part of alcohol’s harm is purely physical and arises in someone who drinks out of enjoyment and carries no distress at all. Pleasure is not protection.

Third: there is a real risk that a piece like this pushes someone into unnecessary anxiety. If you tend towards constant checking and turning things over, you can make this text into a fresh worry to run around your head. That is not the intention and it is not an improvement. I have written about how rumination feeds on precisely such subjects in a piece on rumination.

What to remember

Moderation is not an objective measure. Everyone gauges it by comparison with the people around them, and here that comparison is generous.

The belief that moderate drinking protects the heart was largely a methodological error. Newer and better-designed studies do not confirm it.

A safe limit that would hold for everyone cannot be set. Less always means less risk, but there is no threshold.

For some circumstances — pregnancy, certain medicines and conditions, recovery from addiction — the question of moderation is not open at all.

What you drink for says more than how much. Once alcohol has a task, the picture has already shifted.

An experiment without drinking tells you more than any counting — but if you have been drinking heavily for a long time, talk to a doctor first.

And last: if this piece has made you think about your own drinking at all, you have done more than ninety per cent of the people who know the right number.