Women on the Verge of a Drinking Problem
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Women on the Verge of a Drinking Problem

You look forward to that glass of wine after a tough day, but what happens when you pour that second glass -- and then a third? The sobering truth about what moderation really means.

We're at my mom's for dinner and she shoots me a look as my brother refills my wineglass. I'm busy stirring the gravy and haven't noticed how much he's been pouring. "I figure you've had about three drinks," Mom says before dinner. "You know, Sarah, it's not cool to be a three-drink girl. You don't want to cross that line." I roll my eyes. I remind her that drinking in moderation is actually good for my health. I love reading reports about the ever-expanding list of benefits: fewer heart attacks and strokes and reduced risk of type 2 diabetes, dementia, and some cancers. Experts say alcohol of any type (not just that media darling red wine) can prevent blood clots and also raise my HDL -- the good cholesterol that protects us from heart trouble. In fact, alcohol is thought to be so effective in helping people live longer and stay mentally sharp that some experts have suggested that aging teetotalers start a daily habit. Hey, maybe I should drink more. But sometimes I wonder if I'm taking a good thing too far, considering I usually have a couple of glasses a night and often a third on weekends. I never drink enough to throw up or have a terrible hangover, but I can't say I feel that great after drinking, either. While alcohol helps me fall asleep almost too easily, I often wake up at 3 a.m. and then toss and turn until my alarm screeches. I spend mornings with a fuzzy head; my skin feels dry and sometimes my stomach churns. And I suspect that my beloved pinot grigio also helps sabotage my efforts to lose the five pounds required to zip up my favorite skinny jeans. So, should I worry?

I mean, most of the national attention on women's drinking habits focuses on the alarming rise of binge drinking (defined by the CDC as four or more drinks in about a two-hour period). Nearly 30 percent of women who drink admitted to consuming that much at least once in the past year, and about 15 percent did so at least a dozen times, says the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Except for the occasional open bar at a wedding or bar mitzvah, I rarely qualify for the blotto-binge category.

But it turns out there may be reason for me to be concerned. According to experts, many women who think they're drinking in moderation may be unknowingly going well beyond what's recommended. There's a fine line between alcohol's healthful and harmful effects, says David J. Hanson, PhD, an alcohol researcher and professor emeritus at the State University of New York at Potsdam, and women cross it way before they reach binge-level consumption. "People who drink in moderation are 40 percent less likely to die of cardiovascular disease than those who don't drink at all," he says. "But when they increase their consumption, the harm goes up. For people who drink more, their life expectancy drops quite a bit." Their quality of life may drop, too. One study found that downing three or more drinks in one night disrupts your sleep. That amount can also lead to alcohol-related weight gain in women, says Eric Rimm, ScD., associate professor of epidemiology and nutrition at the Harvard School of Public Health.

And then, of course, there's the risk of becoming addicted. I've always told myself that I drink because I enjoy it, not because I need it. But I'm a little worried about whether I can cut back. I rarely skip a glass of wine two nights in a row and once questioned my doctor's instructions to give up booze for five days while taking a course of antibiotics. On more than one occasion I've suggested to my boyfriend that we grab a drink on the way to meet his business colleagues for dinner because I worry they'll want to share a bottle among the four of us and it won't be enough. Am I on the verge of a drinking problem? If so, will I fall into the category of alcoholics who have to give up drinking completely?

One and Done

Here's the bottom line: The USDA defines moderate alcohol consumption for women as being no more than one daily serving of 5 ounces of wine, 12 ounces of beer, or a one-and-a-half ounce shot of hard liquor. (It's not fair, but men are allowed two drinks a day because they metabolize alcohol more easily than women do.) Plain and simple, "Women who drink just one drink a day live the longest," Dr. Rimm says. "That's it?" I ask, realizing that I regularly drink twice that amount. I quickly dismiss the government recommendations as overly conservative, in much the same way that I convince myself that a half cup of ice cream isn't a "real" serving. I call Deidra Roach, MD, a program officer in the Division of Treatment and Recovery Research of the NIAAA, to parse the disclaimers. Surely this limit is intentionally low to include women who weigh less than 100 pounds or who get buzzed off two sips of wine. But while she acknowledges that individual women process alcohol differently according to body weight and genetic background, the recommendation is based on huge scientific studies and pretty much applies to all of us. "When you drink more than that, your risk for alcohol-use disorders and health problems increases," she says.

Here's my gripe with this one-drink-a-day rule: The women I know don't imbibe in perfectly spaced one glass increments. They share a bottle of wine with their husband or drink several servings throughout an evening -- but not every evening. A 2011 survey of American drinking habits by Yahoo! Shine reported that 15 percent of adult women fess up to downing three to five drinks over a typical weekend, while 7 percent admit they have six or more. They're more moderate on weekdays, as 21 percent say they drink one to two over the course of the week and 7 percent have three or more. That's the real world.

So here's some good news: In an effort to make the guidelines easier to follow, the NIAAA, which is an arm of the National Institutes of Health, has developed a more realistic approach that allows you to divvy up your seven-drink total weekly allotment -- as long as you don't have more than three drinks in one day. For example, you could go crazy with three margaritas on Saturday night, enjoy a beer during the game on Sunday, and sprinkle your remaining three servings of wine during the weekdays.

Really, that's okay? Well, sort of. To be your healthiest, one drink a day is best -- period. Dr. Roach recommends spacing your drinks evenly throughout the week whenever possible. But when you do have a three-drink-splurge once in a while (and you know you will), don't guzzle them but space them out throughout the evening, maybe with a nonalcoholic drink between each one.

Still, I'm discouraged. For me alcohol isn't medicine to be taken in measured doses. It's more about my psyche. That first sweet sip of wine smooths out the edges of a rough day. It's a ritual -- I love having a glass of chardonnay while cooking dinner and chatting with my boyfriend. Then there's the importance of alcohol to my social life. Nearly every professional and alumni event I go to is at one of the new wine bars popping up everywhere, and at book club meetings my friends and I often bring bottles of wine with funny labels, such as Mommy's Time Out and Mad Housewife.

Rebellion Against Rules

For moral support I call my old college roommate, a mother of four who lives in San Francisco, to talk about how our drinking habits have changed since college. (Even though we no longer drink that dangerous 190-proof Everclear-spiked punch, we do drink more often.) My friend confesses that she counts down the hours until dinnertime, when she can open up a bottle of pinot noir, and often ends up having two glasses by the end of the evening. She says it helps her get through the tedious tasks of giving her two youngest daughters baths and reading Bobby Bear's ABC book for the hundredth time. But she worries she may be developing an alcohol dependency and thinks she should drink less.

After learning about the government guidelines, she says she realizes that she has been looking forward to drinking every day more than she should. "I say to myself, 'It's better for the kids since I'm more relaxed,' or 'They say it helps you live longer.' It's easy to latch onto those claims." Funnily enough, though, she has already decided she should limit her consumption to the recommended seven drinks a week. So now she tracks her intake on the dry-erase calendar she uses to manage the family's activities. "In the corner of each box, I write zero, one or two. When the weekend rolls around, I know what I have left."

While I'm impressed by my friend's discipline and planning, I don't like the idea of adopting such a structured approach to drinking. Isn't it supposed to be an escape from my hyper-scheduled days in the first place? I also think such limits might be counterproductive, psychologically speaking. Surely the sentence "you can only have one drink" will make me crave more.

I wish I could report that I forced myself to drink less because I'm concerned about being around longer for my future children. However, it's really vanity -- and the desire to fit into a certain turquoise silk dress that has been taunting me from my closet -- that finally prompts me to shorten my happy hours. Despite weeks of giving up sugar and eating whole-grain everything, I'm still struggling with the zipper.

I know that alcohol is a no-no on most diets. But I've been collecting evidence to bolster my case that a little bit is okay. A study that surveyed the drinking habits and weight history of more than 19,000 middle-aged women found that women who consumed light to moderate amounts of alcohol gained less weight over 13 years than their peers who abstained or drank heavily. Besides, wine and vodka are low carb. And isn't it true that French women drink and don't get fat?

A Weighty Issue

I contact nutritionist Andrea Giancoli, a spokesperson for the American Dietetic Association, to find out whether I can still drink and diet. "If you're drinking alcohol, you're consuming calories," she says, pointing out that a regular 12-ounce beer packs 150 calories, and a 5-ounce glass of wine or an ounce-and-a-half shot of 100-proof liquor adds about 125 -- and that doesn't include sugary mixers. For example, a frozen strawberry margarita has 350 calories. "We don't tend to count liquid calories, but they have to be factored into your calorie count during the day. A couple of drinks a night could put you over your limit, and that leads to weight gain."

Even worse, because your body tends to break down alcohol calories first, it may not have time to metabolize a high-fat meal efficiently. "Your body is trying to detox the alcohol. So when you overindulge in alcohol and a heavy meal, the fat you eat is more likely to get stored or accumulate in your liver," says Giancoli. One strategy is to include alcohol only with low-fat meals, she says. Or have your glass of wine before dinner -- although she cautions that drinking on an empty stomach can make you quickly intoxicated, which can lead to diving head-first into the bowl of chips.

It's clear that I need to cut way back on the vino. In the first week I learn that it's easier to abstain on Monday through Wednesday, especially when I eat dinner early and schedule an evening workout. After achieving an adrenaline high or yoga bliss-out, I don't even feel like having a drink. But by Friday I want to give in to my cravings. I'm tempted to have a second glass, too, but I don't want to sabotage a day of good food choices so I manage to resist. And over the next couple of weeks I limit my consumption to a glass every few days, and as a result my clothes are looser. I may want more, but my weight loss keeps me motivated. I actually order a diet soda instead of a beer at the softball game on Saturday. At a party I drink one white wine, then switch to club soda. I don't know if it's because I'm eating less, but I even feel a mild buzz after just one glass. Perhaps I'm resetting my tolerance.

The true test comes when I forget my resolve and guzzle three glasses in a row at a birthday party. By the time I stumble into a taxi I'm smashed. When I wake up dehydrated and nauseous, with my contacts feeling like potato chips in my eyes, I want my moderate ways back. A few days later my dinner partner orders me a glass of expensive cabernet. I sip it, savoring the cherry notes and rich, velvety texture. I feel satisfied and don't want another. I revel in the fact that this amount of wine is good for me -- yet still a treat. I raise a toast to myself. I'm no longer a "three-drink girl."

The Moderation Exception

While we wish the moderation rule applied to everyone equally, it doesn't. Women at high risk for breast cancer need to be extra cautious because even those who keep to the one-drink-a-day guideline face a 10 percent greater risk of breast cancer, according to a huge British study. In addition, research shows that the risk of breast cancer continues to increase for each additional drink a day. "If you have a family history, the risk is even greater," explains Deidra Roach, MD, a program officer in the Division of Treatment and Recovery Research at the NIAAA. "Those women should drink less."

How Do You Find Moderation?
I have a rule that I don't drink Sunday through Wednesday. I usually stick to two glasses if I can because if I have three, I lose my good judgment.
Melissa, 34, Brooklyn, New York

I love refreshing cocktails, so I look for ways to make nonalcoholic drinks fun. I buy fancy bubbly water and pour it into pretty vintage French tumblers with crushed strawberry and lime.
Megan, 43, Jackson, Wyoming

I can't keep up drinking with the boys at work. I don't want them to think I'm pregnant or a prude, so after I reach my two-drink maximum, I order club soda and ask the bartender to make it look like a drink by putting it in a short glass and adding a lime.
Anna-Marie, 32, Long Island, New York

About twice a year I take a break from drinking for a couple of months. I like to show myself I can stop at any time. It feels like a cleanse for my kidneys and liver.
Beth, 54, Frenchtown, New Jersey

I pace myself by having water in between drinks. I also give myself a curfew of 10 on a work night and midnight on a weekend so I'm not hung over the next day.
Monica, 46, New York City

I used to drink to get a buzz. I tried to cut back by drinking only beer. But I craved alcohol more and more. I shocked myself into quitting when I drove home from a playdate drunk. I intend never to drink alcohol again.
Molly, 45, Santa Rosa, California

Drinking a Bit Too Much?
Find helpful resources, including frequently asked questions about drinking, strategies for cutting back, signs you might have an alcohol abuse problem, and more at rethinkingdrinking.niaaa.nih.gov.