What, Exactly, is an Alcoholic Drink-equivalent?
The shapes, sizes, and content of a US alcoholic drink-equivalent vary widely. Get a quick educational summary of the variety and more data that may help in your daily clinical practice.
What, exactly, is an alcoholic drink-equivalent? Also known as the US standard drink, the National Institute on Alcohol Abuse and Addiction (NIAAA) definition of an alcoholic drink-equivalent is "any beverage that contains ~0.6 fluid oz (14g) of pure alcohol."
How much of any alcoholic beverage, exactly, comprises a US standard drink? How many US standard drinks are in a can, bottle, a half pint, or "a fifth?"
The NIAAA website "Rethinking Drinking" has answers to these questions and many more that might help you talk to your patients who are curious or who you feel may need information and support for a "drinking problem." Click through the slides below for an overview, then please visit the site.
The US Standard Drink. A “standard” drink – any beverage that contains ~0.6 fluid oz (14g) of pure alcohol (aka, an alcoholic drink-equivalent. Although the drinks that follow on the next 2 slides are different sizes, each contains approximately the same amount of alcohol and counts as 1 US standard drink or 1 alcoholic drink-equivalent.
Standard Drinks. Regular beer, malt liquor, table wine, fortified wine, ie, sherry port.
Images from stock.adobe.com: beer ©Scanrail; malt liquor © wine ©somchaji; sherry ©janvier;
Standard Drinks. 11.5 oz shot 80-proof distilled spirits, 1.5 oz brandy or cognac, 2-3 oz cordial, liqueur, apertif
Images from stock.adobe.com: shot ©pairoj; brandy ©alter photo; cordial ©orinocoArt
Read the label, if there is one. Alcohol content can vary greatly for different types of beer, wine, or malt liquor—but differences can be small. The label may not always display alcohol content as not all beverages (eg, malt beverages) are required to list it. The US Alcohol and Tobacco Tax and Trade Bureau offers fact sheets on how to read labels for wine, beer, and malt liquor. The bottler’s web site also has details.
How many drinks are there in common "containers?" A US standard drink is any beverage that contains 0.6 fl oz (14g) of pure alcohol. Following are the approximate number of standard drinks in cans and bottles of alcohol in common volumes.
How many drinks in this container? Regular beer, malt liquor.
And, how many drinks in these containers? 80-proof distilled spirits.
The drinking definitions. The 2015-2020 Dietary Guidelines for Americans defines drinking in moderation as up to 1 drink per day for women of legal drinking age and up to 2 drinks per day for men of legal drinking age. NIAAA and the Substance Abuse and Mental Health Services Administration (SAMHSA) define the following drinking patterns: Binge drinking, heavy drinking, high-intensity drinking.
Binge drinking. NIAAA: a pattern of drinking that brings BAC levels to 0.08 g/dL or higher. This typically occurs after a woman consumes 4 drinks or a man consumes 5 drinks—in about 2 hours. SAMHSA: consuming ≥5 alcoholic drinks for men or ≥4 alcoholic drinks for women on the same occasion (ie, at the same time or within a couple of hours of each other) on at least 1 day in the past month.
Heavy drinking. NIAAA Men: consuming >4 drinks on any day or >14 drinks/wk. Women: consuming >3 drinks on any day or >7 drinks/wk. SAMHSA: binge drinking on ≥5 days in the past month.
High-intensity drinking. An emerging drinking pattern of great concern: Consumption of ≥2x the gender-specific thresholds for binge drinking, ie, ≥10 standard drinks for men and ≥8 for women. High-intensity drinking is consistent with drinking at binge levels II and III. Binge drinking levels are defined as: 1-2x (I), 2-3x (II), and ≥3x (III) the standard gender-specific binge thresholds.
Severe outcomes of high-intensity drinking. Compared with people who did not binge drink, people who drank alcohol at twice the gender-specific binge drinking thresholds were 70x more likely to have an alcohol-related ED visit, and those who consumed alcohol at 3x the gender-specific binge thresholds were 93x more likely to have an alcohol-related ED visit. High-intensity drinking appears to peak in the early 20s but does not disappear. A recent study found that 12.4% of young adults ages 25/26 reported drinking ≥10 drinks in a row at least once in the previous 2 wks.
Alcohol use, misuse, abuse, dependence. Alcohol misuse: Drinking in a manner, situation, amount, or frequency that could cause harm to users or to those around them. For individuals younger than the legal drinking age of 21, or for pregnant females, any alcohol use constitutes alcohol misuse. Alcohol use disorder*: A chronic brain disorder marked by compulsive drinking, loss of control over alcohol use, and negative emotions when not drinking. AUD can be mild, moderate, or severe. Recovery is possible regardless of severity; the definition integrates 2 previously distinct disorders—alcohol abuse and alcohol dependence.
Cautionary data from NIAAA. ~ 95 000 people (~68 000 men, ~27 000 women) die from alcohol-related causes annually, making alcohol in the US the 3rd-leading preventable cause of death, behind #1, tobacco and #2, poor diet and physical inactivity.
