The Alcohol Use Spectrum – From Safe to Scary

Alcohol use is a spectrum that can be broken down into 5 levels, from safest to the most dangerous. Ever wonder how some people can drink on occasion with no repercussions and others seem to change into a different person with no self-control after just a few beers?  Do you think alcoholism means drinking out of a brown paper bag in a gutter and since you don’t do that, then you can’t possibly be an alcoholic?  Do you think you’re perfectly normal with nothing to worry about if you only get drunk a few times a month?  If you answered ‘yes’ to any of these questions, you should give this post a read!

I made this post into a video! Check it out on my YouTube channel here:

How Much Do You Drink?

If you’ve ever questioned your drinking habits and brought it up to your doctor there’s a good chance their first question was “how much do you drink?”.  While quantities sometimes matter it’s certainly not the only answer that matters in determining if you have a problem with drinking or not.  What determines problematic, risky, or disordered alcohol use is how much you drink yes, but also why you drink, and what happens in your life when you drink.  Your neighbour might only have a glass of wine a couple times a week but she might feel she needs that in order to feel happy or escape her thoughts, and guess what- that’s a problem. 

Many people have reached out to me over the years asking me about sober life and sometimes their motive for doing so is to compare their drinking with mine as a way to gauge if they should also quit.  This is not a good tactic and I highly recommend you never compare your drinking habits with someone else’s to attempt to determine your risk level or need to quit.  If you ask someone how much they drank before they quit and their number is higher than yours you might think “whew, thank goodness, I don’t need to quit then” and if their number is lower than yours you might feel like quitting is unachievable or like you’re “too far gone” which can lead to denial, lowered self-esteem, or depletion of motivation. 

What Is “A Drink”?

In Canada, for booze, “one drink” is any drink that contains 13.6 grams of pure alcohol.  What does that look like?

BEER/COOLER/CIDER
1 Drink = 12 oz. (351 mL) of 5% alcohol beer
Tallboy = 16 oz. (473 mL) which equals 1.3 drinks
Pint = 20 oz. (568 mL) which equals 1.7 drinks
Pitcher = 60 oz. (1.7 L) which equals 5 drinks

WINE
1 Drink = 5 oz. (142 mL) of 12% alcohol wine
Large Glass = 9 oz. (270 mL) which equals 2 drinks
Half Carafe = 12.5 oz. (375 mL) which equals 2.5 drinks
Bottle = 25 oz. (750 mL) which equals 5 drinks

LIQUOR/SPIRITS
1 Drink = 1.5 oz. (43 mL) of 40% liquor
Martini or Margarita (standard) = 3 oz. (86 mL) which equals 2 drinks
Mickey/Pint (depending on where you live this size has different names) = 13 oz. (375 mL) which equals 8.5 drinks
Bottle (or a “Quart” if you’re in Nova Scotia) = 26 oz. (750 mL) which equals 17 drinks

The Levels

If you’re curious about where you might fall on the alcohol use spectrum read through each level below and remember, a lot of people move up and down levels sometimes without even realizing it while other people stay in the low-risk drinking level their entire life.  So many factors determine where you fall on the alcohol use spectrum and where you might be headed.  Alcohol amounts also affect people differently based on many things like weight, age, medical conditions, medications, etc.

This is the best and safest stage on the alcohol use spectrum and technically isn’t even “use” because it’s abstinence- AKA not drinking.  That can mean either you never drank in your life or you don’t drink anymore.  Whether you’re newly sober or someone who has never let alcohol pass their lips, your body and mind thank you.

What This Stage Can Sound Like:
“No thanks, I don’t drink”
“I don’t drink for religious purposes”
“I quit drinking a while ago”

To be considered low risk, you’d have to stay below the drink guidelines set by CCSA (Canadian Centre on Substance Use and Addiction).  Which are, for men, 15 drinks per week, with no more than 3 drinks per day most days.  And for women, 10 drinks per week, with no more than 2 drinks per day most days. And as mentioned above, quantities aren’t everything, so you’d be considered low risk if you also exhibit no negative consequences to your drinking.

I think most people fall in this level of drinking where they can go to a patio with some friends for afternoon beers with no issues at all.  They don’t feel the need to control their drinking and they never question their alcohol use because it never presented as a problem.

What This Stage Can Sound Like:
“I’d like to raise a toast to the bride and groom!”
“I bought a few kinds of craft beer I’d like to try”
“Having my Sunday afternoon Bailey’s in my coffee is my little treat”

Risky drinking would be drinking more than the quantities outlined above but without the physical, social, mental, or legal consequences.  So basically, a “heavy drinker” whose life is still totally fine despite the increased alcohol consumption.  No DWIs, no hangover-induced anxiety, no strained relationships due to drinking, just smooth sailing.  The risk increases with quantities, the ‘whys’, and the frequency of drinking sessions.  Binge drinking first shows up in this level, and it is defined as drinking a large quantity of alcohol- five or more drinks in two hours for men and four or more drinks for women- with the intent of getting drunk.

What This Stage Can Sound Like:
“I’ve been pretty bored and a little sad so I’ve been drinking more to spice things up”
“Let’s pre-drink before we head to the bar because I need to get drunk af tonight”
“Having a drink after a hard day at work makes me forget about my problems and is the only way I can relax”

This is the level on the alcohol use spectrum where one’s drinking now has mental, social, physical, and sometimes legal consequences.  This could be getting a DWI, job loss due to drinking or hangovers, relationship issues, drinking to escape depression, etc.  This stage is scary yet rife with denial for most people.  It’s so easy to think there’s nothing “actually” wrong with you because “everyone” drinks like this.  “Everyone” has negative effects because of their drinking and “everyone” drinks to get drunk.  I told myself those things for years which made me feel better but kept me in denial of my increasingly problematic drinking until it turned into an even bigger problem that was impossible to ignore.

What This Stage Can Sound Like:
“We broke up because she said I drank too much”
“I feel like a loser if I don’t party and get drunk every weekend”
“The only time I feel like myself is when I’m drunk”
“I always make sure the floor around my toilet is super clean for when I pass out after puking” (literally said by me)
“Sorry I missed your baby shower- I was so hungover”

This is the highest stage on the spectrum and once here, you’re considered living with an Alcohol Use Disorder (AUD). This term came to be in 2013 with the updated DSM-V (American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) and it combines the two former categories of alcohol abuse and alcohol dependence. AUD is a medical diagnosis and ‘alcoholism’ is the non-medical term usually used to describe this stage. The term ‘alcoholic’ can be used to describe people in this stage or the problematic stage.

To be diagnosed as living with AUD by a medical professional, they would determine if you show any of the below 11 symptoms over a 12-month period. If you exhibit 2-3 symptoms they’d consider your case to be ‘mild’. If you show 4-5 symptoms that would be ‘moderate’ and ‘severe’ Alcohol Use Disorder would be showing 6 or more symptoms.  Here are those symptoms:

• Drinking more or for longer than what you intended
• You want to cut down or control your drinking but you’ve been unsuccessful (e.g., you tell yourself you’ll only drink on Saturdays but after a few weeks you’re back to drinking more often and feel like you can’t control it)
• A lot of time is spent acquiring booze, drinking, or recovering from the effects of drinking
• Cravings/strong desires to drink
• You keep drinking even though you’re unable to fulfill major role obligations at work, home, or school
• You keep drinking even though drinking clearly makes interpersonal and social problems worse
• You either slack on or give up on important social events, work responsibilities, or recreational activities
• Finding yourself in dangerous or harmful situations because of your drinking
• Continuing to drink even though you know it causes (or makes worse) physical or psychological problems
• Your tolerance has gone way up- you keep needing more booze in order to get the same level of drunk
• You experience withdrawal symptoms when you stop drinking. Withdrawal symptoms can range from tremors, insomnia, sensory hallucinations, anxiety, psychomotor agitation, nausea, sweating, palpitations, dry mouth, lightheadedness, and/or seizures. You might also drink (or take benzodiazepines) to avoid withdrawal symptoms

Surprised by these?  I know I was back when I was trying to determine if I needed to quit or not.  I thought full-blown alcohol use disorder meant seizures without booze and falling down drunk 24/7.  But there’s so much more to it.

What This Stage Can Sound Like:
“I only made it half-way through Sober October because it was just too hard”
“I keep a beer next to my bed so I can chug it as soon as I wake up”
“After just 1 or 2 drinks it’s like I have no control and I can’t stop myself from ordering another one”

Final Thoughts

Remember that even though you might be in level 1 or 2 now on the alcohol use spectrum, that doesn’t mean you’ll necessarily stay there.  The potential to move up to higher levels is there for a lot of people.  For myself, I started in level 0, moved up to level 1 around the age of 13, entered level 2 by age 17, graduated into level 3 around age 20, and landed in level 4 around age 25.  Thankfully, at 30 I went back down to level 0, where I still reside today.

If you feel you need help today, or that you’re in risky territory and don’t want to get any worse, please reach out to any of these local resources.  You can also read books or watch YouTube videos on quitting drinking and recovery.  Before I started Sober City, I made alcohol recovery YouTube videos on my channel Addicted to Happy, (which I still create for!) so you can start there to get in the mindset of life without alcohol.