How Much Alcohol Is Okay?

Updated on October 19, 2020

Approximately 11 million people in the United States and Canada use some form of sleep aid on a regular basis, with alcohol and antihistamines being two popular choices.

Contrary to popular belief, having a nightcap - 5 ounces of wine, 1-2 ounces of a distilled spirit like tequila, vodka, or whiskey, or 8-12 ounces of beer - does not improve sleep quality. In fact, having a nightcap actually takes away from the amount of restful sleep we experience.

Alcohol acts as a sedative on the central nervous system - it interacts with the same receptors that sleeping pills work on. In sedating the brain with alcohol, it's accurate to say that we knock ourselves unconscious - entering a state of deep restful sleep is quite different from knocking ourselves out with a sedative.

Sleep expert and neuroscience professor Matthew Walker of the University of California at Berkeley explains that consuming alcohol before bed fragments our sleep, which is to say that it causes us to wake up more frequently at night - these moments of light sleep or awakeness are often so brief that we may not be fully aware of them, but studies clearly show that ingesting alcohol has a large negative impact on the overall amount of rest that our cells experience.

Alcohol also blocks rapid eye movement sleep, the deep state of rest that allows us to experience dreams. The net result is less restful sleep and feeling less refreshed in the morning.

In considering alcohol from a purely biochemical perspective, it's accurate to say that having no alcohol is better for our health than having any amount. As concluded in a comprehensive study of global consumption patterns and mortality, published in The Lancet in 2018:

Alcohol use is a leading risk factor for global disease burden and causes substantial health loss. We found that the risk of all-cause mortality, and of cancers specifically, rises with increasing levels of consumption, and the level of consumption that minimises health loss is zero. These results suggest that alcohol control policies might need to be revised worldwide, refocusing on efforts to lower overall population-level consumption.

With all of the above stated, I feel it's worth considering potential positives that can come from conservative consumption of alcohol. In discussing this topic during initial evaluations with most of my patients over 20 years of outpatient practice, it became exceedingly clear to me that the primary objective behind modest consumption of alcohol is to decrease tension.

For some people, there is fear that it would be far more destructive to their lives if they were to quit a job, leave a marriage, or become estranged from family members that they just don't get along with - in these and other stressful circumstances, having a modest amount of alcohol a few times a week may allow for enough dissipation of tension or perhaps enough numbing of underlying emotional pain to continue on with life without blowing everything up. In some cases, people may feel that having a glass of wine to temporarily forget financial stress, resentment in an important relationship, or some underlying sadness is a good alternative to being chronically worried, miffed, or melancholic.

Some argue that from a holistic perspective or just as a matter of principle, it's more important to be true to oneself and get to the root issue in every instance of conflict or angst regardless of how much destruction may occur - in theory, perhaps this is the journey that all of us should aspire to take. But life can be exceedingly complicated - sometimes, an employer, a co-worker, a life partner, or a family member may not have the capacity to work through conflict in an emotionally intelligent and productive way. Sometimes, insisting that a chronic source of tension be resolved can lead to serious combustion; what if this leads to more financial and emotional stress? What if there are children or grandchildren involved who would surely be gutted for years if the family was broken apart?

My feeling is that the question of whether to have some alcohol or not is one that only each individual can answer. Blood testing is a good idea, as individual tolerances can vary widely - the primary organ to assess is the liver, as over time, metabolism of alcohol in the liver can lead to degenerative changes, marked primarily by an enzyme called ALT. Ultrasound can also be used to assess general liver health.

If liver function remains fine by healthy standards and if sleep is not compromised in a significant way, then perhaps modest consumption of alcohol can be an acceptable choice insofar as it leads to less tension and the maintenance of long term relationships that are more healthy than they are debilitating.

The reality is that life can be complicated. Long and winding roads can present experiences that cause us to feel sad, resentful, and even broken. Few issues have only black and white sides. As the Chinese proverb says: deep doubts, deep wisdom; small doubts, little wisdom. Often, we travel through grey areas, and we are usually well served by following our instincts, observing how things go, and making needed adjustments along the way.

On a personal note, I strive to keep alcohol intake to a minimum as I find that my sleep quality is much better without it.  With that said, I appreciate the role that a modest amount can have in facilitating fun and meaningful conversation with those we break bread with.  So my general perspective is that most people can enjoy modest intake when they are with people they enjoy.  Also, it's probably best not to get into the habit of drinking alone.