Basics
It is Friday, the week was long, and the first glass of wine is poured before you have decided anything. A second follows at dinner and a third on the sofa. None of it felt like a choice, and that is how most drinking adds up. Alcohol plays a causal role in more than 200 diseases, injuries and other health conditions, and the harm depends mostly on the total amount you drink [1]. Each year it causes 2.6 million deaths, 4.7% of all deaths worldwide [2].
Each year it causes 2.6 million deaths, 4.7% of all deaths worldwide [[2]].
Five steps help you cut back on your own terms, wherever you live.
Step 1: Score the AUDIT-C and Count Your Real Pours
WHY THIS MATTERS
The US Preventive Services Task Force recommends screening every adult with short tools like the AUDIT-C: 3 questions that take 1 to 2 minutes [3]. A score of 4 or more for men, or 3 or more for women, flags drinking worth cutting back [3]. The 3 questions are the first part of WHO's 10-question AUDIT [4].
- Answer the 3 questions about the past year and add up your points (0 to 12) [4]:
- How often do you have a drink with alcohol? Never (0), monthly or less (1), 2 to 4 times a month (2), 2 to 3 times a week (3), 4 or more times a week (4).
- How many drinks do you have on a typical day when you drink? 1 or 2 (0), 3 or 4 (1), 5 or 6 (2), 7 to 9 (3), 10 or more (4).
- How often do you have 6 or more drinks on one occasion? Never (0), less than monthly (1), monthly (2), weekly (3), daily or almost daily (4).
- Learn your country's standard drink. It is 8 g in the UK, 10 g in Australia and New Zealand, about 13.6 g in Canada, 14 g in the US and 19.75 g in Japan [4]. Check your health ministry's figure if your country is not listed.
- Fill your usual glass with water, pour it into a measuring cup and write down the ml.
- Work out the grams in any drink: ml x (% alcohol / 100) x 0.79 [4]. Worked examples with that formula:
- 150 ml of 13% wine: 15.4 g. That is about 1.1 drinks in the US or Canada, 1.5 in Australia and almost 2 UK units.
- 500 ml of 5% beer: about 20 g, 1 drink in Japan and 2 in Australia.
- Add up last week drink by drink, in grams. Keep the total for Step 2.
In 10 minutes you know your AUDIT-C score, the size of your usual pour and your weekly total in grams and in your country's drinks.
Step 2: Set a Weekly Limit and Keep It
WHY THIS MATTERS
"Drink less" is too vague to keep. Researchers use WHO's risk drinking levels as a ladder: find your level and aim at least one rung lower [5]. Their review of 34 papers linked these drops to fewer alcohol problems, less craving and better quality of life. Even a one-level drop helped, and the US drug regulator now accepts a two-level drop as a main goal in alcohol trials [5].
- Divide your weekly grams by 7 to get your daily average, then find your level [5]:
- Men: low risk 1 to 40 g a day, medium 41 to 60 g, high 61 to 100 g, very high 101 g or more.
- Women: low risk 1 to 20 g a day, medium 21 to 40 g, high 41 to 60 g, very high 61 g or more.
- Set your weekly number at the top of the level below yours. A man averaging 50 g a day (medium) aims for 40 g a day or less, which is 280 g a week. A woman averaging 30 g a day aims for 20 g a day or less, 140 g a week.
- Already low risk? Work toward WHO's brief-advice level: no more than 20 g a day, on no more than 5 days a week [4]. That is 100 g a week at most: about 7 US drinks, 10 Australian drinks or 12 UK units.
- Mark alcohol-free days on the calendar. WHO's level means at least 2 a week [4]; aim for 3, ideally 2 in a row.
- Log every drink for 2 weeks in a phone note: date, drink, ml, % alcohol, grams, where and with whom. On day 14, circle the moments that led to extra drinks.
- Keep no extra bottles at home. Buy only the week's number.
In 2 weeks you have a written weekly number, a calendar with alcohol-free days and a short list of your triggers.
Step 3: Pace a Night Out to Your Planned Number
WHY THIS MATTERS
Extra drinks often happen in the moment, when someone tops up your glass. An if-then plan moves that choice to a calm moment before you go. A review of 16 studies found that if-then plans cut weekly drinking by a small amount, with bigger effects in adults in the community and when the plan was written on paper rather than online [6].
- Before you go out, write your number for the night and 2 if-then plans on paper [6]:
- "If someone offers a top-up, then I put my hand over my glass and say I'm fine."
- "If I finish drink number 2, then I order sparkling water."
- Eat a full meal before your first drink, start with a large glass of water, and have water or a soft drink between alcoholic drinks.
- Shrink each drink. Using the Step 1 formula [4], 125 ml of 13% wine holds 12.8 g against 18 g in a 175 ml glass. A spritzer of 100 ml of wine topped with soda holds about 10 g. A 500 ml bottle of 0.5% beer holds about 2 g, a tenth of a 5% beer.
- Tell one person your number, and bring only enough money for it.
Within 2 weeks most of your evenings end at or under the number you wrote down.
Step 4: Know When Drinking Needs Help
WHY THIS MATTERS
Three moments change the plan from "cut back" to "get help": getting home, someone who may have alcohol poisoning, and withdrawal when you stop.
- Plan the ride before the first drink. Your liver clears alcohol at a roughly steady rate, on average about 15 mg per 100 ml of blood an hour [7], so after a heavy night you may still have alcohol in your blood the next morning. Book a sober friend, a taxi, transit or a bed for the night. If you are driving, your number is zero.
- Know the signs of alcohol poisoning: confusion, vomiting, slow or irregular breathing, pale or blue-tinged skin, a seizure, or not staying awake [8]. Call your local emergency number (for example 911 in Canada and the US, 999 in the UK, 000 in Australia).
- While you wait, stay with them. If they have passed out, put them on their side in the recovery position and check their breathing. Do not give them more alcohol or coffee, and do not put them in a cold shower [8].
- Watch for withdrawal. If you need a drink in the morning to get going, or you shake or sweat when you stop, see a doctor before you cut down. Withdrawal can bring seizures, and a doctor can plan a safe stop [4].
You leave every night out with a ride booked, and you know which signs mean calling for help, both for you and for a friend.
Step 5: Step Down With a Sunday Review
WHY THIS MATTERS
Drinking drifts back up with holidays, stress and celebrations, so a plan made once fades. If-then plans lose their effect over time [6], which is why you renew them every week.
- Every Sunday, spend 5 minutes on 4 questions: How many grams against my number? How many alcohol-free days? What was the hardest moment? What one fix will I try next week?
- Rewrite your 2 if-then plans on paper, aimed at that hardest moment [6].
- Every 2 weeks, if you met your number, lower it by 1 or 2 drinks. Stop lowering once you reach WHO's brief-advice level of no more than 20 g a day on 5 days a week [4], or go lower if you choose. There is no risk-free level of drinking [1].
- Practise one refusal line out loud until it comes easily: "I'm driving," "I'm on a break this month" or "I've got an early start." Use it the first time someone offers.
- After a slip, write down what happened in the Sunday review and restart the next day.
By week 8 your weekly total is lower and steady, with more alcohol-free days and no driving after drinking.
Track It
For the next 7 days, write down one number each evening: the grams of alcohol you drank that day (0 counts too). On day 7, add them up and compare the total with your weekly number. Every Sunday, check your number again.
Go further
- Check How Much You Really Drink
- Drink More Safely on a Night Out
- Stop Heavy Drinking Safely
- Do a 30-Day Alcohol-free Reset and Track What Changes Week by Week
