Doctor's Note: If you drink large amounts every day, need a drink in the morning to get going, or feel shaky or sweaty when you stop, see a doctor before you cut down. Some people need a supervised plan to stop safely, because withdrawal can bring seizures or delirium [1]. If someone cannot stay awake, breathes slowly or has a seizure after drinking, call your local emergency number now [2]. If drinking is tied to thoughts of harming yourself, find a free helpline at findahelpline.com.
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 [3]. Each year it causes 2.6 million deaths, 4.7% of all deaths worldwide [4].
Each year it causes 2.6 million deaths, 4.7% of all deaths worldwide [[4]].
This Advanced version adds the numbers behind each step, myths, common questions and a progress table.
Here's What's Going On
Cutting back works best as a short loop: feedback on how much you drink, a clear goal, and a personal plan. That is the core of a "brief intervention", the short talk a doctor or nurse gives after a screening test [1]. A review of 69 trials with 33,642 people found that people who got one drank about 20 g less alcohol a week a year later than people who did not [5]. That is about 2 of the AUDIT's 10 g drinks a week [1]. The steps below let you run the same loop yourself.
Two facts explain why the details matter. First, risk follows the grams of alcohol, not the number of glasses, and glass sizes vary a lot [3]. Second, your liver clears alcohol at a fairly fixed rate once you have had more than a drink or two, so extra drinks stay in your blood longer than people expect [6].
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 [7]. A score of 4 or more for men, or 3 or more for women, flags drinking worth cutting back [7]. The 3 questions are the first part of WHO's 10-question AUDIT [1].
- Answer the 3 questions about the past year and add up your points (0 to 12) [1]:
- 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).
- Count questions 2 and 3 in 10 g drinks. The AUDIT assumes a standard drink of 10 g of alcohol, so a big glass or a strong beer counts as more than one [1].
- 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 [1]. 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 [1]. 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.
- 250 ml of 13% wine (a large glass): 25.7 g, more than 2.5 of the AUDIT's 10 g drinks.
- 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 [8]. 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 [8].
- Divide your weekly grams by 7 to get your daily average, then find your level [8]:
- 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 [1]. 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 [1]; 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.
- Keep no extra bottles at home. Buy only the week's number.
- On day 14, circle the times, places and moods that came before your extra drinks. Those are the moments Steps 3 and 5 plan for.
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 [9]. The same review found no clear effect on heavy drinking sessions [9], so on big nights you also need the money and ride limits below.
- Before you go out, write your number for the night and 2 if-then plans on paper [9]:
- "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 [1], 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. After the first few drinks your liver works at full speed and clears alcohol at a roughly steady rate [6]. In moderate drinkers, blood alcohol falls by about 15 mg per 100 ml an hour, and the normal range runs from 10 to 35 [6]. At that average, a blood alcohol of 80 mg per 100 ml takes over 5 hours to reach zero. 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 [2]. 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 [2].
- Watch for withdrawal. Questions 4 to 6 of the full AUDIT check for signs of dependence, including needing a drink in the morning to get going [1]. If that sounds like you, or you shake or sweat when you stop, see a doctor before you cut down. Supervised withdrawal care prevents seizures and delirium, and most milder cases can be handled at home with a doctor's plan [1].
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 [9], which is why you renew them every week. Each extra rung you drop on the risk ladder is linked to more benefit [8].
- 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 [9].
- 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 [1], or go lower if you choose. There is no risk-free level of drinking [3].
- 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.
3 Myths About Cutting Back
Myth 1: "If I stay under my weekly total, one big night is fine." False. WHO's low-risk level is set per day as well as per week: no more than 20 g a day on no more than 5 days [1].
Myth 2: "Coffee or a cold shower sobers you up." False. The liver clears alcohol at a fairly steady rate [6], and the NHS warns against giving coffee or a cold shower to someone who may have alcohol poisoning [2].
Myth 3: "Cutting back only counts if I quit completely." False. Dropping one WHO risk level is linked to fewer alcohol problems and better quality of life [8], and short advice sessions cut drinking by about 20 g a week [5].
FAQ
Is any amount of alcohol risk-free? No. WHO says no form of drinking is risk-free, and the risk rises with the total amount [3].
How long until I am safe to drive? There is no safe shortcut. Blood alcohol falls by about 15 mg per 100 ml an hour on average, and some people are slower [6]. If you drank, do not drive. Plan another way home.
I drink every day. Can I just stop tomorrow? Talk to a doctor first. Heavy daily drinkers can get withdrawal seizures, and a doctor can plan a safe stop, which for milder cases is often done at home [1].
Why are the numbers lower for women? The screening cut-off is 3 rather than 4 for women [7], and WHO's risk levels start at lower grams for women [8].
Track Your Progress
| Measure | How | When |
|---|---|---|
| Weekly grams | Add up the nightly log | Every Sunday |
| Risk level | Daily average against the Step 2 ladder [8] | Every 2 weeks |
| Alcohol-free days | Count on the calendar | Every Sunday |
| AUDIT-C score | The 3 questions [1] | Every 3 months |
| Nights over the plan | Count in the log | Every Sunday |
Aim to drop one risk level in your first 8 weeks, and keep it there.
Go further
- Check How Much You Really Drink: the full research behind the AUDIT-C and pour sizes.
- Drink More Safely on a Night Out: how food changes peak blood alcohol, drink spiking and getting home.
- Stop Heavy Drinking Safely: withdrawal, tapering and medical help in detail.
- Do a 30-Day Alcohol-free Reset and Track What Changes Week by Week: a full month off.
- Protect Your Heart, Muscles and Cancer Risk When You Drink: what alcohol does to each organ.
- Stay Sober and Smoke-free with Friends and at Work: handling social pressure.
- Quit Without Willpower: Unlearn the Beliefs That Keep You Smoking or Drinking: the thoughts behind the habit.
- Lower Anxiety by Fixing Caffeine, Hidden Stimulants and Drinking to Calm Down: drinking to calm down.
