Hi Alice,

I am a healthy, fit, 18-year-old male. I have tried both ways: consuming small amounts of alcohol regularly (one standard drink a day) and consuming a lot of alcohol irregularly (10 to 20 standard drinks in one night, but only two days a month, or thereabouts).

I have tended towards drinking a lot irregularly because I have found that I can't notice any effects until I have had at least four or five drinks, 80 to 100 proof shots, usually mixed with soft drink.

I was wondering if either way was less healthy or more of a risk as the same amount of alcohol is ultimately consumed. Also, I noticed that I got a bit more of a 'beer gut' when I had one-a-day than 15 at once; is that likely or just my imagination?

Thanks,
Triple Shot

Dear Triple Shot,

To drink a little or to drink a lot (and how often), that is your question. Depending on how it's consumed, alcohol can be a pleasant, life-enhancing libation, but it can also be a misused substance. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), moderate drinking, which is lower risk, is considered no more than one drink per day and no more than seven drinks per week for folks assigned female at birth. For those assigned male at birth, it's no more than two drinks a day and no more than 14 drinks per week. For reference, a standard drink is one 12 ounce beer, one 5 ounce glass of wine, or one 1.5 ounce shot of 80 proof distilled spirits. Drinking a large amount of alcohol, even every once in a while, could be detrimental to your health (keep reading for more on this point). So, the short answer to your query is that if you do drink alcohol and given the choice between the two options you’ve outlined: it's lower risk to consume small amounts more frequently rather than large amounts infrequently. To answer the question about your weight, it can be helpful to note that alcohol can be a calorie-dense beverage, so it’s possible that consuming more calories in the form of alcohol may have contributed to weight gain. It’s worth exploring what’s behind the recommendation to drink fewer drinks in a given time rather than many drinks at a time (even infrequently) as well as the reasons why you might choose to drink as you determine what’s best for your own personal health.

Multiple drinks, even irregularly, poses health risks and can lead to riskier behavior. Higher-risk drinking is consuming more than the recommended daily limits. Drinking in this way puts a strain on the body because the liver can only process a limited amount of alcohol, averaging about one standard drink per hour. Even on a single occasion, higher-risk drinking can be detrimental to your health or even life-threatening. For example, alcohol intoxication can increase the risk of heart arrhythmias, particularly atrial fibrillation, which can lead to heart failure and sudden death, even in those who have healthy hearts. Drinking a lot at once may contribute to higher risk behaviors, such as injury or riskier sexual behaviors due to reduced decision capabilities, decreased coordination, and mood changes. Chronic or prolonged higher-risk drinking can lead to pancreatitis, various cancers, liver cirrhosis, high blood pressure, heart failure, and other disorders. 

It may also be wise to consider the psychological aspects of alcohol use. The amount of alcohol you choose to use may be influenced by the role it plays in your life as it does on physiological effects or definitions of higher- and lower-risk use. Have you thought about why you choose to drink alcohol? Do you use it to have a good time? To relax at the end of the day? Do you find it necessary to drink to be comfortable in certain situations? Do you find yourself not wanting to drink, but drinking anyway? Are you experiencing pressure to consume alcohol? How do you feel after you drink? You might consider asking yourself these questions and determining the role you want alcohol to play in your life. If you’re concerned, speaking with a substance abuse prevention specialist, mental health professional, or health care provider may help you explore your relationship with alcohol further.

Kudos to you for asking the question to help inform your choices about alcohol use in the future. Learning more about how it may impact your physical health is wise, but it's also worth considering your reasons for drinking (or not drinking) when deciding what’s best for you.

Cheers!

Alice!

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