Drinking Definitions Hazardous drinking is another term for heavy drinking. Heavy drinking is defined in terms of number of drinks per week and is in contrast to moderate or controlled drinking. While specific drinking amounts have varied from country to country, and research study to research study, in recent years (due largely to excellent work by Martha Sanchez-Craig and her colleagues at the Addiction Research Foundation in Toronto, Canada) a consensus appears to have formed that consumption of more than 14 drinks per week, or more than 4 drinks at a sitting, for men and more than 9 drinks per week, or more than 3 drinks at a sitting, for women constitutes hazardous drinking. It is important to realize that these are “average” or “aggregate” figures that are based on a mythical “average” person. Individuals of different heights and weights, experience with alcohol, with or without medical or other psychological problems will be affected differently by consuming these amounts. Nonetheless, on the average, drinking more than these amounts greatly increases the risk that a person will be harmed. Figure 1.1: Continuum of alcohol problems. Source: Adapted from the Institute of Medicine (1990). Harmful drinking is drinking that has actually caused harm, where the harm can clearly be attributed to the alcohol. However, there are some qualifications to this definition. One is that alcohol consumption has been persistent over at least a month or has occurred repeatedly over the course of a year. The other is that the person is not alcohol dependent (see definition, on p.12). This means that a person who is experiencing harmful drinking probably lies somewhere between the person who is alcohol dependent, or alcoholic, and the person who is a moderate drinker. Moderate (or controlled) drinking is drinking that falls below the quantities and frequencies that define hazardous drinking. Thus, a moderate drinker consumes (if a man) no more than 14 drinks per week, and no more than 4 drinks at a sitting, or (if a woman) no more than 9 drinks per week and no more than 3 drinks at a sitting. Often the term “controlled” drinking is used to refer to a person who has suffered from alcohol dependence or alcoholism who has reduced their drinking to moderate levels. This definition, as well as the two previous ones, raises the question of what is a “drink”? As with other definitions, this one also varies from country to country. For example, in Japan a “standard” drink contains 28 grams of alcohol, while in the United Kingdom a “standard” drink contains 8 grams.
In the United States, however, there is a more or less generally accepted definition of what is called a “standard” drink that states that a 12-ounce can of beer, a 5-ounce glass of table wine, or 1.5-ounces of 80 proof liquor are all “standard” drinks. That is, they all contain about the same amount of alcohol. When using the term “drink” throughout the rest of this book, I will adopt this definition. So when I speak of a person as being a “moderate” beer drinker, that means a man consumes no more than 14 12-ounce beers per week and a woman consumes no more than 9 12-ounce beers per week. Our final Drinking Definition is binge drinking. As with the previous definitions, this one has numerous forms and is quite controversial. The definition of binge drinking often depends on who is using the definition and in reference to whom. Thus, a widely used definition of binge drinking has grown out of studies of college students and other drinkers who are not alcoholics or alcohol dependent, but whose drinking appears to correspond to the definition of hazardous drinking outlined above. This definition defines a “binge” as consumption of 5 or more drinks on one occasion by a man or 4 or more drinks on one occasion by a woman. Again, the significance of these quantities varies from individual to individual. Thus, consumption of 5 standard drinks by a massive offensive lineman for a professional football team has a different implication for harm than does the consumption of the same 5 drinks by a professional jockey! Clinically, when speaking about people who have a diagnosable alcohol problem, the term “binge” takes on another meaning. In this context, binge drinking is used to refer to a pattern of drinking in which a person drinks heavily for days or weeks at a time, but then stops drinking, again often for days or weeks at a time. This alternating pattern of drinking and abstinence is often called a binge-drinking pattern. Here, the quantities consumed usually exceed the 5 and 4 drinks referred to in the aforementioned definition of binge, and the person often remains almost continuously intoxicated during the binge-drinking period. Notably, with the exception of harmful drinking, none of these definitions implies that drinking is or is not harmful to a particular person. The dividing line between harmful and hazardous drinking, between moderate and immoderate drinking, is a fine one—actually one drink more than the levels considered moderate. Consequently, a great deal of confusion exists when applying these definitions to individuals because the definitions fail to take individual differences into account. As we shall see, similar problems plague the Diagnosis Definitions.
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