HAMS: Harm Reduction for Alcohol

Heavy Drinking

The NIAAA defines heavy drinking as 5 or more standard drinks in a day for a man and 4 or more standard drinks in a day for a woman. SAMHSA defines heavy drinking as drinking five or more standard drinks on the same occasion on each of 5 or more days in the past 30 days. The CDC defines heavy drinking for a man as exceeding 2 standard drinks per day for a man and one per day for a woman.

The problem with these definitions is that they are purely black-and-white in nature and little better than the 19th century Temperance Movements attempt to classify everyone as either a teetotaler or a drunkard. The reality is that there is a world of difference between a person who drinks three beers on a Friday night and the person who is physically dependent on alcohol and drinks three fifths of whiskey per day. Let's face it--these definitions are even out of touch with everyday society--three beers on a Friday night is not the definition a heavy drinker--it is the definition of a lightweight.

There is also a world of difference between a person who never drives whether they drink or not and the person who loads up on a fifth of whiskey and decides to go cruising in his sports car. Both safety and quantity are essential factors to take into account when talking about whether drinking is problematic or not.

What is even worse is that the NIAAA will arbitrarily change the definition of what constitutes heavy drinking at will in order to scare you away from alcohol. In Alcohol Alert No. 42 Alcohol and the Liver the NIAAA defines heavy drinking as drinking five or more drinks every single day of the week 365 days a year, and they go on to say that 10 to 35 percent of heavy drinkers develop alcoholic liver disease. Yet in their Practitioner's Pocket Guide, the NIAAA tells doctors to classify people as heavy drinkers if they have had five or more drinks in a day even once in the past year. Is this some kind of double standard intended to force 12 step God-based alcoholism treatment on everyone against their wills?

The problem is that since their inception both the NIAAA and SAMHSA have been staffed by and run by graduates of God-based 12 step alcoholism treatment programs. And putting 12 steppers in charge of US alcohol policies is about on par with putting vegetarians in charge of the US Department of Agriculture. There is an obvious conflict of interest. DUH!

The failure of American government agencies and American chemical dependency treatment programs to recognize the fact that alcohol problems lie on a continuum results in a failure to target appropriate strategies to appropriate levels of alcohol misuse. This in turn leads to the horrendous failure rate of programs for the treatment or prevention of alcohol related programs in the United States.

HAMS recognizes that problems relating to alcohol lie on a continuum and that both the factors of quantity and safety must be taken into account--for more information about the continuum of alcohol misuse problems please visit our web pages The Harm Reduction Pyramid and HAMS Moderate Drinking Limits.

It is both unreasonable and impractical to expect every man, woman and child in the US to adopt a goal of total abstinence from alcohol. Recreational intoxication is a reality and it is here with us to stay. The realistic approach to alcohol problems is to teach people--especially young people--safe drinking strategies such as those embodied in the College Students Guide to Safe Drinking as well as teaching people strategies for Reduced Drinking, Safer Drinking and strategies to Prevent Alcohol Withdrawal Syndrome.


CDC - Alcohol and Public Health - FAQs
Accessed October 12, 2009

NIAAA - How To Screen For Heavy Drinking
Accessed October 12, 2009

National Institute on Alcohol Abuse and Alcoholism. (1998). Alcohol Alert No. 42: Alcohol and the Liver.
Accessed December 21, 2009

SAMHSA - Who's Drinking? More than Half Underage College Students
Accessed October 12, 2009

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