Alice —

A friend says cocaine is stupid, expensive and boring. He prefers alcohol. Is this valid reasoning for getting drunk on tequila and falling asleep on the bus to Hoboken?

— I'm Worried

Dear I'm Worried,

It sounds as if your friend wants nothing to do with cocaine, yet you've hinted that he has much more than the occasional drink. You realize that drinking to excess and passing out on a bus is unsafe behavior, but does he? As his friend, learning a bit more about moderate versus high-risk drinking and how to share your concern in a constructive way will provide you with a few options to help him realize that his behavior could potentially be dangerous.

To begin, moderate drinking is defined as:

  • Men — no more than two alcoholic drinks per day
  • Women — no more than one alcoholic drink per day

The more a person drinks, the greater her/his chances for negative health and behavioral consequences (e.g., problems at work or school, trouble with campus or local law enforcement, physical injury). Higher-risk consumption, when these issues are more likely to occur, is defined as:

  • Men — greater than four drinks per occasion or greater than 14 drinks per week
  • Women — greater than three drinks per occasion or greater than seven drinks per week

While drinking moderately does tout some benefits (including lower risk for heart disease, stroke, and diabetes), excessive alcohol consumption can lead to serious consequences both in the short- and long-term. More immediate health risks can include injuries (including motor vehicle crashes, falls, and burns), alcohol poisoning, and unintended pregnancy and sexually transmitted infections (STIs) due to unprotected sex. In the long run, health consequences, such as increased blood pressure, heart and liver damage, greater risk of cancers of the mouth, throat, esophagus, colon, and breast, trouble with learning and memory, interpersonal problems with family and friends, and alcohol dependence can result.

If your friend continues to drink in the way you’ve described, there may be cause for intervention. For suggestions on how to approach the subject and share your concern, read Friend of an alcohol abuser. If you don’t feel comfortable approaching your friend alone, perhaps you can ask another friend to join in the discussion. Make sure that you are clear about your concern(s), use "I" statements, and emphasize that you are not saying this to judge or gang up on him. Let him know that you care about him and his health; this may ease some tension and feelings of defensiveness.

Your friend's comparison between cocaine and alcohol seems to hint that he may be rationalizing his choice to use alcohol. Dependency on mind-altering substances, such as alcohol and other drugs, often hint at additional problems that are masked beneath the addictive behavior. After you’ve had a chance to voice your concern, let your friend know that you are available to talk. Your friendship and support can help him through tough times, while he sorts out his reasoning for using these substances in a higher-risk manner. Whether he is taking the subway or the bus, walking, or getting into a car, your friend is not ensuring that he will arrive home safely by making the trip completely intoxicated. Reminding him that you care about him enough to be worried may help him realize that he is putting his health and well-being at risk, and that seeking a more productive way to work out issues, possibly with a health professional or a support group, might be beneficial.


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