Does A ‘Healthy Relationship’ With Alcohol Even Exist?

More and more people are swapping their boozy cocktails and full-bodied wines for non-alcoholic options, as proved by the rise in alcohol-free beverages and sober bars throughout the world. In fact, according to a 2023 Gallup poll, 62% of adults younger than 35 drink, compared with 72% in 2003. But that same poll found that adults 55 and older are actually drinking more now than 20 years ago, making it clear that everyone is not on the same page when it comes to alcohol.
It’s easy to be confused about the dangers and benefits of alcohol. For years, headlines claimed red wine was good for heart health (it’s not — the data that “proved” this was flawed), while societal norms make it seemingly OK to ask someone why they’re not drinking (once again, it’s not). More, grabbing a drink with a friend is a way many people connect with loved ones, and research shows that community is important. More recently, though, it’s come out that alcohol is actually really harmful to our health. It’s categorized as a Group 1 carcinogen by the International Agency for Research on Cancer, meaning it’s known to cause cancer.
Suffice it to say, because of societal norms and evolving research, our relationship with alcohol is understandably complicated. With more awareness of this, it’s only natural to consider your relationship with it. Is it OK to drink? Are you drinking too much?
Those considerations are highly personal, and there isn’t one flat-out answer for everyone. But addiction therapists and recovery experts say there are some facts and guidelines you can keep in mind when considering your relationship with alcohol. Here’s what they are:
The idea of a “healthy relationship” with alcohol is interesting, said Dr. John Kelly, director of the Massachusetts General Hospital Recovery Research Institute. “You could call it a ‘healthier’ relationship with alcohol, but alcohol has risks at even very low levels, so it’s just a matter of how much risk you want to take on.”
“Alcohol causes harm through three different pathways,” Kelly said. “One is through what we normally think of culturally as addiction … but you’ve got two other pathways: One is intoxication, of course, which is independent of addiction — people become intoxicated, have psychological impairment at low levels [of alcohol consumption]. The third pathway is toxicity, which is the thing we don’t often think about, and that’s the cancer risk, liver disease, other kinds of risk.”
And those aren’t the only known issues, said Dr. Emily Hartwell, an assistant professor of psychiatry at the University of Pennsylvania Perelman School of Medicine. It can cause cardiovascular problems, increase your stroke risk and affect your immune system. Drinking also alters your mental health.
“Alcohol hits on a bunch of different neurotransmitter systems in your brain —GABA and glutamate and serotonin and dopamine and a whole bunch of other ones,” Hartwell said.
Unlike many other drugs, alcohol affects many different areas that control how our body and brain function, she said. So if someone who is prone to depression is drinking heavily, that’ll exacerbate a bunch of systems in their body, Hartwell explained.
Even if you don’t struggle with depression or another mental health condition, alcohol still affects how you feel and can actually amplify whatever feeling you’re trying to quell, whether it’s stress, anxiety or sadness.
“If someone’s drinking alcohol because it relaxes them … when you’re then withdrawing from it later, when alcohol is no longer in your system, basically the opposite is going to be happening,” Hartwell said. You may feel anxiety, panic, sadness or other emotional symptoms.
There is no such thing as no-risk drinking, Kelly said, but the National Institute on Alcohol Abuse and Alcoholism defines low-risk drinking as no more than seven drinks per week or three drinks on any one day for women and no more than 14 drinks per week or four drinks on any one day for men. For all people 65 and older, the guidelines say no more than seven drinks per week and three per day.
These guidelines “lower your risk, but it doesn’t get rid of the risk completely because … you are exposing yourself to a level-one carcinogen,” Kelly said.
This doesn’t mean you can’t choose to drink, Kelly said, “but be properly informed about your risk, just like with any other thing that we do.”
“We drive fast, we eat bad food, we do things that are bad for us, but we know we’re doing it,” Kelly said. “We know that certain foods increase cancer risk … but we’re not duped about it. The alcohol industry has duped the public. It’s allowed misperception or amplified misinformation to the benefit of their profits, but it’s not in the interest of public health.”
“It’s informed consent, right? That’s my goal here,” Hartwell said. “People, I think, are still going to drink. We can tell people all the scary information, all those statistics until we’re blue in the face. People are still going to be drinking.”
If you weigh the pros and cons, and decide you still want to drink that cold beer or cozy up with a glass of wine at the fireplace, that’s your decision ― as long as your eyes are open to all of the effects alcohol can have on your body.
The first sign is if you use alcohol to cope with situations in your life. Alcohol “can easily become a problem if it becomes a primary way of dealing with anxiety, of dealing with conflict, because alcohol is essentially a depressant,” said Johanna Jones, a licensed professor counselor with Thriveworks in Blacksburg, Virginia.
“When it becomes something that we’re using for a specific emotional purpose — to overcome anxiety, to release the cares of the day, to make us feel more comfortable with other people — I think it invites potential problems,” Jones added. “It is a lot easier to have a drink and forget all these things and get more comfortable in your own skin and in your own brain … than it is to learn the ways of managing anxiety, to learn the ways of looking at life in a more balanced way.”
If you use drinking as a tool to manage your emotions, it’s creating a whole different problem — mental dependence on alcohol, too, Jones added. Ask yourself how you deal with pressure or stress. Pouring a glass of wine might be a sign that your relationship with it is unhealthy.
Additionally, if your tolerance has increased, you should take note. This is a misunderstood concept, as having a high alcohol tolerance is often looked at socially as a good thing — but that’s wrong. Maybe when you first started drinking, it would take one drink for you to get a buzz, but now it takes three or four drinks to get that same buzz.
That right there is the development of tolerance, “and that is, to me, a big warning sign that it is time to reassess what is going on and if you are drinking within healthy limits for yourself,” Hartwell added. “Your brain might be feeling like, ‘I’m good, I’m finally getting that buzz,’ but your body is still feeling the effects of three glasses of wine. That hasn’t changed.”
If alcohol is costing you more than money, you should also be concerned. Is it costing you relationships? Or a job? Is it taking an emotional toll? Are you jeopardizing your safety? Is it costing you sleep? These are all questions to ask yourself, experts say.
“There are lots of online screening forms that you can do to self-assess in the privacy of your own home. You can go online and fill out as honestly as you can … one of these online screeners and get some personalized feedback,” Kelly said. Both CheckUp & Choices and the CDC have online alcohol screening tools available.
“If it’s become more of a problem where alcohol is costing you more than money and you’re finding it difficult to cut down or stop, then there’s more information available on the NIAAA website about what to do, where to go,” Kelly said.
A healthy relationship with alcohol is not a reality for everyone.
“There certainly is that subset … who really should not be drinking, whether that’s due to medical complications or an alcohol use disorder in the past, or people who just know that they have a really high risk for it due to family history or seeing it in their lives,” Hartwell said.
How much you can drink, if you want to drink and if you can drink is personal. You shouldn’t allow pressure from others to dictate what you do — only you know what is right for you.
“There’s no number I can point to to give you that’s saying, “OK, if you only drink this much, you’re healthy, you’re good to go,” and that number is going to be different for each and every individual,” Hartwell said. “I can’t give you a carte blanche blanket answer … this is the path, unfortunately. I wish there was.”
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.