Society Underestimates Excessive Drinking and Its Major Health Risks

Man passed out with alcohol in his hand
Man passed out with alcohol in his hand
Identifying a person as having a drinking problem only if they are dependent on alcohol is wrong and dangerous.

It’s no secret that excessive alcohol consumption can lead to poor decision-making and health risks. Yet, many people don’t consider the choice to down one — or five — drinks too many to be especially reckless. On the contrary, binge drinking is popular and even celebrated in the United States, with about one in six adults reportedly indulging in the habit four times a month, according to the Centers for Disease Control and Prevention (CDC).1

A CDC study2 released in January suggests that this trend could be much more dangerous than previously thought. Many people assume that excessive alcohol consumption can only really pose a serious threat to someone if they are alcohol dependent. But the CDC report shows that 90% of excessive drinkers — about one in 12 Americans — are not actually considered alcohol dependent by current medical standards.3

It turns out that even though we place so much emphasis on identifying and treating alcoholism, we may be missing the bigger picture. It’s time we completely changed the way we think about how many people may need help reducing their alcohol intake, and how to address this significant public health challenge.

Alcohol dependence is treated seriously in the U.S. People who are physically or mentally dependent are often referred or self-enrolled into comprehensive programs at treatment centers designed specifically to combat that addiction. Yet, the vast majority of heavy drinkers do not show dependence, and so they are rarely encouraged to seek any kind of treatment.

We must stop thinking of dependence as the single indication of a real drinking problem. Instead, we need to recognize the serious risks associated with all kinds of excessive alcohol consumption habits and patterns. By changing our attitudes, we can use better education, public policies and other means to reduce the negative impacts of too much drinking.

Do you believe alcohol-related disorders are being adequately treated?

Our misperceptions about alcohol abuse are deeply rooted in a lack of understanding about what actually qualifies as excessive drinking. For women, “binge drinking” means having four drinks or more in the span of two hours, and for men, five drinks.3 But many binge drinkers don’t limit themselves to those quotas, and others may indulge in the habit many times each month — or even each week — without being considered dependent on alcohol. In fact, the CDC study from earlier this year showed that even among those who reported binge drinking ten or more times in the past month, more than two-thirds did not meet the criteria for alcohol dependence.3

Millions of people whose drinking habits may have serious psychological and health repercussions see little cause for alarm simply because they are not dependent. But this kind of habit should raise a serious red flag. Excessive alcohol consumption is responsible for 88,000 deaths annually in the U.S., though many of those deaths are the result of drunk driving, which remains a serious threat to public safety.3

In general, our perceptions about excessive drinking have become far too complacent. Even when excessive drinking is identified, we don’t address this issue with nearly the level of seriousness that we apply to alcohol dependence or other bad health habits. New gadgets and national campaigns have helped to make some healthy habits — like counting calories or the number of steps we take every day — easier and trendy. But too often, our approach to the significant health risks linked with alcohol abuse is to brush them off.

Instead, binge drinking actually seems to be encouraged. Purchasing alcohol is convenient, cheap and widely available, and happy hours, group deals and drinking games encourage excessive consumption. Our local, state and federal policies have also lagged behind, despite a number of studies showing that higher alcohol taxes, earlier bar closing times and reduced availability can all lead to lesser consumption.4

It’s long past time we abandoned the old way of identifying and addressing alcohol issues, where we see drinking as “excessive” only when a person is dependent. Instead, we must understand that most excessive drinkers, while not technically dependent, may still have a serious drinking problem — and that may apply to a whole lot more of us than we’d like to admit.

Jonathan E. Shaywitz, MD, is a psychiatrist and the medical director of the behavioral health program at Mission Hospital in Laguna Beach,  Calif.


  1. Centers for Disease Control and Prevention. Binge Drinking. Fact Sheet. Last updated January 16, 2014.
  2. Centers for Disease Control and Prevention. Alcohol poisoning kills six people in the US each day. News Release. Issued January 6, 2015.
  3. Esser MB, et al. Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009–2011. Prev Chronic Dis. 2014; 11:140329.
  4. Xuan Z, et al. The Alcohol Policy Environment and Policy Subgroups as Predictors of Binge Drinking Measures Among US Adults. Am J Public Health. 2015; 105(4):816-822.