What Is Drinking In Moderation

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What Is Drinking In Moderation

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KEY TAKEAWAYS

Drinking in moderation is defined in the UK as drinking less than 14 units per week, spread across 3 or more days [1].

What Is Moderate Drinking?

Professional Association	What Is Considered Moderate Drinking?
The Centres For Disease Control And Prevention	2 drinks or less per day for men and 1 drink or less per day for women [2]
World Health Organisation	Less than 1.5 litres of wine, 3.5 litres of beer, or 450 millilitres of spirits per week [3]
NHS	14 units of alcohol per week, consumed over 3 or more days [4]
National Institute on Alcohol Abuse and Alcoholism	3 drinks per day or 7 per week for women and 4 drinks per day or 14 per week for men [5]
UK Chief Medical Officers	Less than 14 drinks per week [6]
American Heart Association	1-2 drinks per day for men, 1 drink per day for women [6]

False Definitions Of Moderation

Not Feeling Drunk Means Moderation

Not feeling drunk whilst drinking does not equate to moderate drinking since:

Those with higher tolerance levels to alcohol may not feel drunk, but alcohol still impairs cognitive function
Men do not feel as drunk as women when consuming the same amount due to women having less dehydrogenase [7]
Those with liver disease or liver cirrhosis may not feel drunk due to decreased liver function

Binge Drinking Followed By Abstinence Means Moderation

Bingeing alcohol followed by abstinence does not equate to moderate drinking since:

Health effects of bingeing alcohol (e.g. gastritis, pancreas inflammation, hypertension, etc) are not changed by abstinence after drinking [8]
Triggers or addictive patterns of binge drinking can lead to addiction, even if followed by abstinence
If bingeing alcohol followed by abstinence becomes a pattern, the liver does not have time to recover after drinking, and the benefits of abstinence are limited

Alcohol Levels Just Below The Drink-Drive Limit At All Times Means Moderation

Maintaining alcohol levels just below the drink-drive limit at all times does not equate to moderate drinking since:

The drink-driving limit is the maximum amount a driver can drink and still be able to drive, not a safe amount of drinking in general
The drink-drive limit is changed by individual tolerance, weight, age, type of alcohol consumed, etc, meaning the drink-driving limit can be too high to mean moderation

Complications Of Defining Drinking In Moderation

Complications of defining drinking in moderation are:

No standardised definition of an alcoholic drink worldwide (e.g UK unit is 8g of alcohol, whereas Japan unit is 19.75g of alcohol)
Variability of alcohol percentages across different drinks (e.g wine ranges from 7% to 24% ) is ignored in research that defines drinking in moderation
Researchers report alcohol in grams, millilitres, or fluid ounces - refusal to standardise alcohol definitions leads to conflicting advice about safe alcohol consumption [9]

A standardised, worldwide definition of moderate drinking is needed to understand the associated risks and benefits to moderate drinkers.

Differing Definitions Of Drinking In Moderation In Practice

Drinking In Moderation Defined Differently By Professionals

Medical professionals defining drinking in moderation differently changes:

How a patient is diagnosed - if a patient presents with symptoms that are being caused by alcohol use, but due to the medical professional's definition of moderation, the patient is then misdiagnosed
Medication prescribed - if a doctor has a higher definition of moderation, patients may be prescribed medication that should not be mixed with alcohol (e.g disulfiram, chlorpropamide, or cefotetan) [10]

Patients Not Following Guidance

Patients are less likely to follow guidance from medical professionals:

When provided with conflicting government advice - Matt Hancock, Health Secretary, stated that "for 95% of people, the alcohol we drink is perfectly safe and normal" [11]
With a lack of knowledge of moderation guidelines - 18% of adults are aware that 14 units per week are the recommended moderation guidelines [12]
When those who have consistently consumed beyond guidelines are advised to cut down on drinking, but believe drinking habits have not caused any side effects previously and won't cause any side effects in the future, so continue drinking

Differing Public Health Guidance

Differing public health guidance that contributes to confusion about moderate drinking is:

Guidelines in the UK changed from 21 units for men and 14 units for women per week to 14 units per week for both genders in 2016, but only 18% of the public are aware of the change in guidelines [13] [12]
Differing advice between countries - Canada advises 2 drinks a week, The US advises 2 drinks a day for men and 1 drink a day for women and The Netherlands advises 1 drink per day [14]

How The Meaning Of Moderate Drinking Changes

Due To Setting

Outpatient Treatment Centres

Outpatient treatment centres change the meaning of moderate drinking as:

Moderation expectations are higher whilst beginning to implement harm reduction to provide realistic expectations of reduced drinking
Adjusting moderation expectations are necessary for long term drinkers who are resistant to cutting down drinking
Outpatient treatment centres are unable to recommend rapid reductions in drinking due to risk of death

GP

The definition of drinking moderately for a GP is 14 units per week, spread over 3 or more days [15].

Hospital

Those suffering from chronic liver disease, liver cirrhosis, chronic obstructive pulmonary disease, or liver cancer are advised during hospital intervention to lower moderate levels of drinking to 0 units [16].

Mental Health Facilities

Those receiving treatment in a mental health facility are advised to lower drinking in moderation to 0 units, due to alcohol interacting with antipsychotic medications [17].

Due To Medication Usage

Medication	Can Medication Be Combined With Moderate Alcohol Use?	Why?
Paracetamol	Yes (under medical professional advice)	Safe in absence of underlying liver concerns [18]
Statins	Yes (under medical professional advice)	Considered safe, but medical professionals may request abstinence [19]
Diazepam	No	Considered unsafe by medical professionals when combined with Diazepam [20]
Doxycycline	No	Moderate drinking reduces the absorption rate of doxycycline by 35.3% [21]

Psychosocial Factors Affecting Moderation Perceptions

Cultural Norms Towards Alcohol

Cultural norms towards alcohol that change how moderation is perceived are:

Japanese Nomikai culture - compulsory drinking sessions with co-workers and bosses where there is an expectation to drink excessively [22]
India has no guidelines for drinking in moderation, instead causing restrictions on alcohol sales and taxes [23]

Laws And Regulations

Country	Drinking Laws And Regulations	How This Affects Moderation Attitudes
Eritrea	Legal drinking age is 25 -no official guidelines on moderation	1.3% have alcohol use disorder [24]
Burkina Faso	Legal drinking age is 13 -no official guidelines on moderation	2.7% have alcohol use disorder, with others citing religion as reason for abstinence [25]
Iran	Drinking is illegal - punishment includes 80 lashes and up to 6 months imprisonment - no official guidelines on moderation	National programme to cut alcohol use by 10% by 2025 and implement more screening for alcoholism/ alcohol-related health disorders - impeded by illegality of alcohol [26]
Germany	Legal drinking age is 16- 14 year olds can drink with parent’s permission	Moderation guidelines are 24g per day for men and 12g per day for women [27]

References

[1] NHS. Drink Less - Better Health. 6 July 2021. "It’s recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more. That’s around 6 medium (175ml) glasses of wine, or 6 pints of 4% beer. There’s no completely safe level of drinking, but sticking within these guidelines lowers your risk of harming your health. Try using Alcohol Change UK’s unit calculator to work out how many units you drink and watch our video guide to alcohol units.”
[2] CDC. “About Moderate Alcohol Use.” Alcohol Use, 23 May 2024. “Moderate alcohol use is: For men—two drinks or less in a day. For women—one drink or less in a day.”
[3] World Health Organization. “No Level of Alcohol Consumption Is Safe for Our Health.” World Health Organisation, 4 Jan. 2023. “‘Moderate’ alcohol consumption – less than 1.5 litres of wine or less than 3.5 litres of beer or less than 450 millilitres of spirits per week.”
[4] NHS. Drink Less - Better Health. 6 July 2021. “It’s recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more.”
[5] Alcohol Research Current Reviews. Drinking Patterns and Their Definitions | Alcohol Research: Current Reviews. “As defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), for women, low-risk drinking is no more than 3 drinks on any single day and no more than 7 drinks per week. For men, it is defined as no more than 4 drinks on any single day and no more than 14 drinks per week.”
[6] UK Department of Health. "UK Chief Medical Officers' Alcohol Guidelines Review: Summary of the proposed new guidelines." Jan. 2016. "You are safest not to drink regularly more than 14 units per week, to keep health risks from drinking alcohol to a low level."
[7] Marketing Communications: University of Notre Dame. “Absorption Rate Factors // Rev. James E. McDonald, C.S.C., Center for Student Well-Being // University of Notre Dame.” Center for Student Well-Being, Rev. James E. McDonald, C.S.C., Center for Student Well-Being, 2019. “Women have less dehydrogenase, the enzyme that breaks down alcohol in the stomach, which contributes to higher BACs than men drinking the same amount of alcohol. Hormone levels also affect the body’s ability to process alcohol, and women will experience higher BACs drinking their regular amount of alcohol right before menstruation. Women tend to have a higher percentage of body fat and a lower percentage of water. Additionally, the less you weigh, the more you will be affected by a given amount of alcohol.”
[8] Molina, Patricia E., and Steve Nelson. “Binge Drinking’s Effects on the Body.” Alcohol Research : Current Reviews, vol. 39, no. 1, 2018, p. 99. “Figure 3.”
[9] Dufour, Mary C. “What Is Moderate Drinking? Defining ‘Drinks’ and Drinking Levels.” Alcohol Research & Health, vol. 23, no. 1, 2024, p. 5. “In the United States, however, each bar, restaurant, or other establishment that serves alcoholic beverages can set its own standards, although establishments generally are consistent in the sizes of the drinks they serve. In private homes, drink sizes may vary even further. For beer, wine coolers, and similar alcoholic beverages, the serving size is most likely to be consistent across different households because a ‘serving’ or drink often corresponds to one (standard size) can or bottle. For wine and distilled spirits (e.g., vodka and whiskey), however, the size of one drink is entirely up to the person pouring it and may vary from occasion to occasion.”
[10] Weathermon, Ron, and David W. Crabb. “Alcohol and Medication Interactions.” Alcohol Research & Health, vol. 23, no. 1, 2024, p. 40. “Moderate drinkers are not likely to be treated with disulfiram; however, many other medications (and certain toxic substances) also can induce disulfiram-like reactions when combined with alcohol (see table 2). For example, the commonly prescribed diabetes medication chlorpropamide and the antibiotics cefotetan and metronidazole can induce disulfiram-like reactions, even after ingestion of only small alcohol amounts. These reactions not only are unpleasant but also can result in serious medical consequences. For example, flushing is associated with a widening (i.e., dilation) of the blood vessels, low blood pressure, and rapid heartbeat, all of which can be dangerous in patients with coronary artery disease. Patients taking medications that can induce disulfiram-like reactions therefore should be advised not to drink alcohol.”
[11] Chiles, Adrian. “Why a THIRD of Drinkers Reading This Have an Alcohol Problem.” Mail Online, 1 Feb. 2019. “On the page was part of a speech made a few weeks ago by the Secretary of State for Health, Matt Hancock. It read: ‘For 95 per cent of people, the alcohol we drink is perfectly safe and normal. I like a pint or the odd glass of wine, and I know I speak for most of my audience and certainly the vast majority of my colleagues, too.’”
[12] Drinkaware. “80 per Cent of Adults in the UK Don’t Know the Low Risk Drinking Guidelines.” Drinkaware UK. “87% of UK adults have heard of the low risk drinking guidelines but, only 18% know that they are 14 units a week.”
[13] Department of Health and Social Care. “New Alcohol Guidelines Show Increased Risk of Cancer.” GOV UK, 8 Jan. 2016. “Men should not drink more than 14 units of alcohol each week, the same level as for women. This equals 6 pints of average strength beer a week, which would mean a low risk of illnesses such as liver disease or cancer. The previous guidelines were 21 units for men and 14 units for women per week.”
[14] Honderich, Holly. “What’s behind Canada’s Drastic New Alcohol Guidance.” BBC News, 18 Jan. 2023. “In Canada, it should be Dry January all year round, according to new national recommendations that say zero alcohol is the only risk-free approach. If you must drink at all, two drinks maximum each week is deemed low-risk by the government-backed guidance.”
[15] NHS. “Drink Less - Better Health.” NHS UK, 6 July 2021. “It’s recommended to drink no more than 14 units of alcohol a week, spread across 3 days or more. That’s around 6 medium (175ml) glasses of wine, or 6 pints of 4% beer.”
[16] NHS Choices. “Treatment - Alcohol-Related Liver Disease.” NHS, 2019. “Treatment for ARLD involves stopping drinking alcohol. This is known as abstinence, which can be vital depending on what stage the condition is at. If you have fatty liver disease, the damage may be reversed if you abstain from alcohol for a period of time (this could be months or years).”
[17] Cheng, Cynthia, et al. “Interaction between Psychotropic Medications and Alcohol: Perceptions among Patients Attending an Adult Mental Health Day Hospital Program.” The Canadian Journal of Hospital Pharmacy, vol. 71, no. 1, Mar. 2018, p. 7. “A total of 131 participants answered the questionnaire between July 2014 and February 2015; 31 of the questionnaires were incomplete and were excluded from analysis. Of the 100 participants included in the analyses, 75 reported having received counselling from a health care provider about alcohol–drug interactions, and 49 of these reported following the advice provided. The most common advice reported by participants was to avoid alcohol consumption while taking medications. Serious adverse effects, such as worsening of a psychiatric condition, admission to hospital, and increased drowsiness, were reported by 23 participants.”
[18] NHS. “Common Questions about Paracetamol for Adults.” NHS UK, 21 Oct. 2022. “Drinking a small amount of alcohol while taking paracetamol is usually safe. Try to keep to the recommended guidelines of no more than 14 units of alcohol a week. A standard glass of wine (175ml) is 2 units. A pint of lager or beer is usually 2 to 3 units of alcohol. It may not be safe for you to drink alcohol with paracetamol if you have certain health conditions, such as liver problems.”
[19] NHS Choices. “Considerations - Statins.” NHS, 2019. “The doctor will also ask you how much alcohol you drink before prescribing statins. People who regularly drink large amounts of alcohol are at increased risk of getting more serious side effects. If you’re prescribed a statin, you may be able to continue drinking alcohol. However, you should not drink more than 14 units of alcohol a week.”
[20] National Health Service. “Common Questions about Diazepam.” NHS UK, 7 Feb. 2022. “Do not drink alcohol while you’re taking diazepam. Alcohol can increase the effects of diazepam. It can make you go into a very deep sleep. There’s a risk you will not be able to breathe properly, and you may have difficulty waking up.”
[21] Mergenhagen, Kari A., et al. “Fact versus Fiction: A Review of the Evidence behind Alcohol and Antibiotic Interactions.” Antimicrobial Agents and Chemotherapy, vol. 64, no. 3, Dec. 2019. “Alcohol intake has been reported to diminish the antimicrobial effect of doxycycline. In a rat model, long-term alcohol ingestion (a 15-day liquid diet with alcohol accounting for ≥ 42.2% total calories).”
[22] Japan Medical Resource Network. “Nomikai Culture in Japan: The Liquid Approach to Building Bonds and Social Capital.” CarterJMRN, 23 July 2019. “Since many firms in Japan lack formal evaluation systems for employees, managers also use nomikai sessions to assess their minions from a variety of perspectives. How do they interact with other employees? Are they team players? What talents, personality traits and flaws do they reveal? And most crucially, how well do they relate to their superiors? The pressure is on: You can’t get out easily of the nomikai. Bonenkai and shinnenkai—year-end and New Year’s parties, respectively—are compulsory affairs. All of the other times you could go drinking with your office mates and bosses add up.”
[23] Schess, Jaclyn, et al. “Alcohol Policies in India: A Scoping Review.” PLOS ONE, vol. 18, no. 11, Public Library of Science, Nov. 2023, pp. e0294392–92. “At the Federal level, India still lacks a comprehensive national policy on alcohol, but instead has focused on promoting prohibition-centered supply reduction and tertiary prevention, both implemented inconsistently and inefficiently [15]. States are responsible for drafting and implementing their own alcohol policies including setting a legal drinking age, place of sale restrictions, and excise taxes on alcohol products.”
[24] WHO. "Eritrea: Alcohol Consumption: Levels And Patterns." Cdn Who Intl Media. 2018.
[25] Bonnechère, Bruno, et al. “Alcohol Consumption and Associated Risk Factors in Burkina Faso: Results of a Population-Based Cross-Sectional Survey.” BMJ Open, vol. 12, no. 2, Feb. 2022, p. e058005. Accessed 19 Mar. 2022. “The overall prevalence of people with abusive alcohol consumption is 2.7% (2.0%–3.7%). This consumption is lower compared with other African countries12 and the rest of the world.”
[26] The Lancet. "A public health approach to alcohol use and its related harms in Iran." The Lancet Public Health, vol. 4. April 2019.
[27] European Commission Knowledge for Policy. “National Low-Risk Drinking Recommendations (or Drinking Guidelines) and Standard Units | Knowledge for Policy.” European Commission Knowledge for Policy, 31 May 2022. “Men: maximum 2 standard units per day. Women: maximum 1 standard unit per day. At least 2 alcohol-free days per week.”

About the author

Harriet Garfoot

Harriet Garfoot BA, MA has an Undergraduate degree in Education Studies and English, and a Master's degree in English Literature, from Bishop Grosseteste University. Harriet writes on stress & mental health, and is a member of the Burney Society. Content reviewed by Laura Morris (Clinical Lead).

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Last Updated: January 3, 2025