Barbara E. Kaplan, MHDL

Counseling for Individuals, Couples, Partners, Marriages, Families




According to a Substance Abuse and Mental Health Services Administration (SAMHSA) 2014 National Survey on Drug Use and Health of people 12 years and older in the civilian population (excluding those people institutionalized) of the United States, there were:


  • 139.7 million past month alcohol drinkers.  Of these users, 60.9 million were binge alcohol drinkers (5 or more drinks on the same occasion on at least one day during past 30 days) and 16.3 were heavy alcohol drinkers (5 or more drinks on the same occasion on 5 or more days in the past 30 days).
  • in 2014, about 1 in 10 people who used illicit drug in past 30 days.  Most of the illicit drug use was marijuana.
  • about 21.5 million people in 2014 who had a substance use disorder in the past year of which 7.1 million with an illicit use disorder, 17 million with an alcohol use disorder and 2.6 million had both disorders.
  • in 2014, approximately 3.3 percent of adults who had both a substance use disorder and another mental health disorder (excluding developmental disorders) in the past year.

According to the World Health Organization (WHO), worldwide, “3.3 million deaths every year result from harmful use of alcohol.”  According to National Institute of Health (NIH), in the United States, there were almost 88,000 deaths from alcohol–related causes yearly; in 2014, 9,967 were alcohol-impaired fatalities.  And according to the Centers for Diseases and Prevention (CDC), in the United States, drugs, “other than alcohol (legal and illegal) are involved in about 16% of motor vehicle crashes.”

Effects of Alcohol

Alcohol affects people differently depending on a number of factors such as the age, amount of food consumed prior to drinking, use of medications and drugs, race, ethnicity, gender, health and family history of the person as well as the amount and frequency of consumption of alcohol.  For instance, alcohol is situated mostly in a person’s body water.  The more water in the body, the more diluted the alcohol.  Regarding one gender factor, women tend to have less water in their bodies than men.  Therefore, in general, if a man and a woman of the same weight both consume the same amount of alcohol, she will tend to have more alcohol content in the blood than the man.  The higher the concentration of alcohol in the bloodstream, the greater the impairment by the effects of alcohol (e.g., reduced inhibitions, motor impairment, slurred speech, memory problems, breathing and concentration problems).  (Please note that according to information on a Brown University website, if a person is transgender, and not taking hormones, it is likely that alcohol will be experienced as if the assigned gender at birth.)  Regarding one factor of aging, as people age, the body changes.  The older adult also tends to have less water in the body and therefore, when drinking the same amount of alcohol the person has always consumed in a given sitting, there may now be a greater blood alcohol concentration in the body.   It is worthy to note that signs of Alzheimer’s disease such as memory loss and confusion may instead be the symptoms of an alcohol problem that family and friends don’t recognize because the older person is not actually drinking larger amounts of alcohol!  This may also apply to other medical conditions.  Regarding one race factor, some people of Asian descent have skin flushing, a rapid heartbeat and nausea when drinking alcohol.  This is due to an acetaldehyde dehydrogenase enzyme deficiency.

Medication and Herbal Remedies

It is important to check with a physician as to whether or not it is safe to drink alcohol if the person is taking any prescribed or over-the-counter medication or herbal remedies as they may be dangerous or even deadly if mixed together.  According to NIH, mixing alcohol with certain medication can put a person at risk "for internal bleeding, heart problems, and difficulties in breathing.  In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic" to the body.  Harmful effects may even occur if the medication is not taken at the same time as the alcohol intake.  According to NIH, the following medications “interact badly with alcohol": pain medication, aspirin, Acetaminophen, medications for anxiety and depression, sleeping pills, cough syrup, medications for cold and allergies.  However, please keep in mind that this is not an inclusive list of medications that may have a detrimental impact if mixed with alcohol such as  a number of medications for high blood pressure, high cholesterol, seizures and diabetes.  Herbal remedies that may have an adverse and/or dangerous effect when mixed with alcohol are: Kava Kava, St. John’s Wort, Chamomile, Valerian, Lavender. 

Contrary to What a Number of People Think

Contrary to what a number of people think, beer and wine are not safer to drink than liquor.   One standard drink (in the United States) contains about 0.6 fluid ounces or 14 grams of pure alcohol which means it is, in general, equivalent to:

          12 fluid ounces of beer (about 5% alcohol) or

          8 to 9 fluid ounces of malt liquor (about 7% alcohol) or

          5 fluid ounces of table wine (about 12% alcohol) or

          1.5 fluid ounces of 80-proof distilled spirits (40% alcohol)

For additional information about counseling regarding alcohol issues or counseling in general, please call 704 333-1510.

This article is solely for information purposes.   It is not advice.   It is not intended for minors, and minors are instructed to leave the site.   It is not intended and it does not constitute professional or clinical advice.  The user of this page should not take any steps, or refrain from taking any steps, based on the information in this page, but should instead consult a qualified mental health professional.

  • drinking alcohol as a way to cope with stress
  • repeatedly unable to stop alcohol use when desired
  • driving a vehicle while impaired from alcohol
  • giving up or reducing participation in pursuits that were enjoyable because there is a preference to drink alcohol instead or due to recovering from the negative effects of alcohol use
  • alcohol use is repeatedly causing arguments with others or making the arguments or the relationship worse
  • receiving complaints or concerns from others about one's alcohol use
  • repeated cravings for alcohol
  • repeatedly can't wait to get off from work to drink alcohol
  • alcohol use interferes in caring for family, meeting household or school obligations
  • absences from work or repeatedly going into work late due to alcohol use
  • repeatedly spending a lot of time in alcohol use or recovering from the negative effects of use
  • the same amount of alcohol consumed for some time has less of an effect than it use to have
  • withdrawal symptoms are causing impairment in functioning or are very bothersome
  • morning alcohol use in an effort to relieve the hangover
  • if you think you have a problem with alcohol use

Contrary to what a number of people think, the blood alcohol content (BAC) (also called blood alcohol level) in a person’s body is not changed by the intake of caffeine.  Caffeine does not sober the person up!  Intoxication isn’t reduced by the intake of the caffeine.  It is noteworthy to consider that caffeine intake can mask the sedentary effects (e.g., sluggish, sleepy, tired) of alcohol so that the person actually feels more energized and less drunk even though the blood alcohol level has not changed.  Therefore, this false perception may lead the person to drink even more alcohol or may think that it is ok to drive a vehicle.

Also, contrary to what some people think, blood alcohol content in a person’s body is not changed by vomiting!

For most of the alcohol to get out of the body, it has to be metabolized by the body, primarily in the liver.  Metabolism also takes place in other tissue (brain, pancreas, gastrointestinal tract).  In addition, there is an exit of a small amount of alcohol through breath, urine and sweat, feces, milk and saliva.  It takes time for the body to metabolize alcohol.  Contrary to what a number of people think, a cold shower, sleeping, running and drinking water will not speed up the process.  The amount metabolized every hour is contingent on a number of factors such as body mass or different variations of enzymes.  According to the National Highway Traffic Safety Administration, in general, the body decreases the blood alcohol concentration at a rate of .015% per hour.   Please remember that this is in general and by no means and exact number!  So it is possible that it takes longer!

Contrary to what some people think, a person may be negatively affected/impaired even before legally drunk (.08 Blood Alcohol Concentration) as according to the National Highway Traffic Safety Administration (NHTSA), there is the typical effect of some loss of judgment even at .02% BAC.   At .05%, typical effects are impairment in concentration and judgment, lowered alertness and may be a loss of small muscle control.  Please keep in mind that these are “typical effects” only.  For safety, don't drink and then drive or drink alcohol while driving.  If drinking alcohol, stay put in a hotel or the friend’s residence where drinking occurred or call someone whose body is free of alcohol for transportation to a designated place.  It is also important to have someone whose body is void of alcohol to be with a person who is walking or bicycling while impaired from alcohol.



The good news is that Alcohol Use Disorder is a treatable disorder and according to National Institute on Alcohol Abuse and Alcoholism (NIAA), most people can benefit from treatment.  Treatment may consist of assessment, treatment planning, relapse prevention, counseling and/or medication.  According to SAMHSA, medications are underused for this disorder.  The medications of Naltrexone, Acamprosate, Disulfiram each have a specific purpose such as reducing cravings for alcohol, eliminating euphoria or causing sickness with alcohol use.  Please note that these medications may not be effective for all people and there are possible side effects and safety concerns with their use.  A physician can assess the appropriateness of a given medication for an individual.  Other than possible medication use, treatment may consist of individual, group, family therapy in in-patient and/or out-patient services.   Hospitalization may be appropriate such as for detoxification.  In addition, treatment may be supplemented by participation in support groups.  However, the effectiveness of Alcoholics Anonymous is difficult for researchers to determine due to the anonymity of its participants.  Please be aware that this 12-step group is not confidential!

Of the different types of treatment, common therapies are Cognitive Behavioral Therapy and Motivational Enhanced Therapy.  Motivational Enhanced Therapy views motivation as crucial to change.  It tends to be used to assist the client in developing internal motivation for change, to overcome the ambivalence to participate in therapy/stop alcohol use.  It is a brief non-judgmental, and non-confrontational therapy, usually consisting of an assessment session followed by an additional 2 - 4 sessions.  It is a therapy that focuses to resolve ambivalence rather than focusing on recovery.  Therefore, it may serve as pretreatment, used to transition to specific treatment focused on recovery.  According to National Institute on Drug Abuse, Motivational Enhanced Therapy has been met with success for its intended use with people addicted to alcohol.  Cognitive Behavioral Therapy (CBT) recognizes that one’s feelings and behavior are largely influenced by one’s thought(s).  Cognitive Behavioral Therapy consists of identifying, testing and correcting distorted and unhealthy thinking to change the view of self and the world in an effort to decrease psychological disturbance, unwanted, problematic and self-destructive behaviors and improve functioning.  There is a focus on acquiring skills.  These learned skills may be applied during and following counseling to aid in obtaining and maintaining abstinence from alcohol use and throughout life to apply to other issues or problems such as relationship difficulties, stress, anxiety, depression, anger.  This type of therapy is evidence-based, meaning it has been extensively and scientifically researched and found to be an effective treatment for alcohol use disorders and numerous other psychiatric disorders.  According to the National Institute on Drug Abuse, a "central element of CBT is anticipating likely problems and enhancing patients’ self-control by helping them develop effective coping strategies.  Research indicates that the skills individuals learn through cognitive-behavioral approaches remain after the completion of treatment.”



For information about Cognitive Behavioral Therapy, please click on the following link:




Something to Consider in Making a Decision to Seek Professional Assistance


People may wonder when to seek help for alcohol use.  Although not an exhaustive list, the following may be considered in making a decision to seek professional assistance:

Heavy alcohol use is defined above.  According to the CDC, the 2016-2020 Dietary Guidelines for Americans Eighth Edition defines moderate alcohol use for adults of drinking age to be up to 1 drink for females per day and up to 2 drinks for males per day.  This amount is in a given day, not an average over a number of days.

The rate of absorption of the alcohol once in the body can vary according to a number of factors (e.g., concentration of the alcohol, amount and type of food in stomach prior to drinking alcohol, if the drink is carbonated, how fast a person drinks, medications the person is taking).  The absorption is more rapid if drinking on an empty stomach.  Carbonated alcohol drinks can be absorbed more quickly.

This article was written some time between January 1, 2016 and January 22, 2019.

(For more information on the 2014 SAMHSA survey, please see http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf)