Almost nobody drinks the measures the guidelines are written in. A glass of wine at home is roughly two, and the arithmetic everyone does in their head is quietly wrong by half.

What you poured, not what you counted

Build a normal week from the containers you really use. The tool converts it to grams of alcohol and standard drinks, and then shows the same week counted the way most people count it — in pub measures and small glasses — so the gap between the two is visible. It then asks how that week was spread, because the same weekly total is a different problem concentrated into one night than it is across seven evenings — the weekly figure is where the long-term harm lives, the single occasion is where the ambulances are.

Why the arithmetic goes wrong

• A standard drink is about ten grams of alcohol — roughly a small 100–125 ml glass of wine, a 250 ml glass of ordinary beer, or a 25–30 ml measure of spirits. Every guideline number is written in these, and hardly anybody drinks in them.
• The home pour is the main culprit. Poured by eye into a large modern wine glass, a “glass” is commonly 200–250 ml. That is two to two and a half standard drinks, from one glass, counted as one.
• Strength has crept up. Wine that was 11% is now often 13–14%; a craft beer at 6–8% in a 500 ml can is three to four standard drinks in a single container that looks like one beer.
• Spirits at home are not measures. A free-poured gin or whisky is routinely double a bar measure, and mixers hide it completely.
• “A bottle between two” is not half a bottle each in practice, and the person doing the pouring is usually the one who ends up with more.
• Rounds, top-ups and holidays never get counted at all, which is why the week people describe is reliably lighter than the week they had.

What the dose actually does

The relationship is a gradient rather than a cliff: the risk of most alcohol-related harm rises with the amount, without a threshold below which it is zero. That is not an argument for despair — it means every reduction counts, which is a more useful fact than a safe limit would be.

• Cancer is the harm people have never heard of. Alcohol is an established cause of cancers of the mouth, throat, oesophagus, liver, bowel and breast, and the risk starts rising at low intakes. Most drinkers can name the liver and nothing else on that list.
• Blood pressure responds quickly, in both directions: heavy drinking raises it measurably, and cutting down lowers it within weeks. It is one of the fastest wins available.
• The liver is silent until it is not. Fatty liver is common, reversible and symptomless; by the time there are symptoms the damage is often advanced. Ordinary blood tests miss a lot of it.
• The heart-protection story has not survived scrutiny. The apparent benefit of light drinking largely disappears once ex-drinkers who stopped because they were ill are separated out, and alcohol clearly causes atrial fibrillation and, in quantity, heart-muscle damage.
• The brain, in two ways: alcohol is a well-established contributor to dementia risk, and heavy drinking can cause a specific, partly reversible memory disorder through vitamin B1 deficiency — which is why thiamine is given to heavy drinkers in hospital.
• Injury is the immediate one. Falls, burns, drownings, road deaths, assaults, hypothermia and drowning are all alcohol-heavy, and this is the harm that arrives tonight rather than in twenty years.

The part that is genuinely dangerous to get wrong

Physical dependence is not about character or quantity alone: it is the state in which the body has adapted, and it is the one situation where stopping suddenly is more dangerous than continuing.

• The signs of dependence are mostly about need, not amount: drinking earlier than you meant to, needing it to sleep or to stop feeling ill, shakes or sweats when you have not drunk, planning the day around it, and drinking through consequences you can already see.
• Tolerance is a warning, not an achievement. Being able to drink a lot without feeling it means the brain has adapted, which is the same adaptation that makes withdrawal dangerous.
• Blackouts are neurological events, not funny stories: the brain has stopped recording. They mark a blood level high enough to be dangerous in itself.
• Thiamine matters. Heavy drinkers become deficient in vitamin B1, which can cause a sudden confusional state and permanent memory damage. Replacement is cheap and is standard in any decent detox — ask about it.
• Medication exists and is under-used. Several drugs reduce craving or relapse, and they are prescribed far less often than they could be. Ask what is available rather than assuming willpower is the only tool.
• Cutting down is a legitimate goal. For most people who drink too much but are not dependent, reduction is a real target with real health gains, and it succeeds more often than an abstinence goal nobody chose.

What actually works to cut down

1. Count for two weeks first. Not to judge yourself — to get a real baseline, because everybody underestimates. The counting itself reduces intake, reliably, before any decision is made.
2. Set alcohol-free days and make them fixed, not aspirational. Three specific days a week is easier to keep than a vague target of “less”, and it also tells you quickly whether not drinking is comfortable.
3. Change the container. Smaller glasses, measured spirits, single cans instead of bottles, low-alcohol versions in the same glass. Volume is the lever most people have never touched, and it works without willpower.
4. Do not stock what you cannot ration. The strongest predictor of tonight's intake is what is in the house, which makes the shop a better place to make the decision than the kitchen at nine.
5. Plan the awkward moments, because they are what breaks the plan: the round at work, the family meal, the first hour after a bad day. One prepared sentence and one decided drink handles almost all of it.
6. Take the two-week test seriously. If stopping for a fortnight feels impossible, or if you feel physically unwell when you try, that is information rather than failure — and it is the point at which help, not effort, is the right next step.

Sleep and mood, where the loop closes

• Alcohol is a sedative, not a sleep aid. It shortens the time to fall asleep and then fragments the second half of the night as it clears, which is why so many people wake at four and cannot get back.
• The morning anxiety is chemistry, not character. As alcohol leaves the system the brain rebounds into a more aroused state, which produces the jittery, dread-tinged mornings that then get treated with another drink in the evening.
• Depression and drinking make each other worse, in both directions, and treating only one usually fails. If somebody is drinking to manage low mood, both need naming.
• It sabotages every other health effort: blood pressure treatment, blood sugar control, weight, exercise recovery, and the effectiveness of antidepressants.
• Two weeks off is a fair test. Sleep quality, morning anxiety, blood pressure and resting heart rate all shift within a fortnight, which makes a two-week break an experiment with a readable result rather than a moral exercise.
• Do not use it as a painkiller either. Alcohol plus paracetamol is a liver problem, plus anti-inflammatories a stomach-bleeding problem, and plus sedatives or opioids a breathing problem.

The situations where the numbers change

• Medicines. Sedatives, sleeping tablets, opioids, some antidepressants and antihistamines all multiply the sedation; metronidazole and some others cause a violent reaction; and blood thinners plus alcohol plus a fall is a bad combination. Ask the pharmacist, who will answer in a sentence.
• Pregnancy and trying to conceive: no amount is established as safe, the harm is dose-related, and the honest advice is none. This is one of the few places where the guidance is not a gradient.
• Breastfeeding is manageable rather than forbidden: alcohol clears from milk as it clears from blood, so timing a feed matters more than pumping and discarding.
• Young people. The teenage brain is more vulnerable and adolescent heavy drinking predicts later problems, which makes the age of first regular drinking one of the more consequential parenting variables.
• Older people get drunk on less: less body water, slower clearance, more medicines, worse balance. The same two glasses at seventy are a bigger dose and a bigger fall risk than at thirty.
• Driving the morning after. The body clears roughly one standard drink an hour, and no coffee, shower or breakfast speeds it up. A heavy night can leave you over the limit at eight in the morning, and impaired well below any legal limit.

If somebody is unconscious after drinking

“Sleeping it off” on their back on a sofa is how people die of alcohol at parties — not from the alcohol itself but from inhaling vomit while unrousable.

Talking to somebody about their drinking

• Drop the label. “Alcoholic” ends conversations and invites a denial that then has to be defended. Specific observations — what you have seen, and when — are much harder to argue with and much less shaming.
• Choose a sober moment, not the middle of an evening. Nothing said to somebody who has been drinking is remembered accurately, including by you.
• Lead with the health question, not the moral one. Blood pressure, sleep, the mornings, the medicine interaction: these are neutral and true, and they are the doorway most people will actually walk through.
• Offer the concrete thing. Booking the appointment, going along, doing the two-week count together, taking the car keys tonight — specific offers get accepted where general concern does not.
• Say the withdrawal warning out loud, because the most dangerous outcome of a good conversation is somebody deciding to stop alone tomorrow.
• Look after yourself too. Living with somebody else's drinking is its own load, family support groups exist for exactly this, and you are allowed to use them whether or not the drinker ever changes.

The drill: 16 decisions

Sixteen ordinary moments — a glass poured at home, a round at work, a friend asleep on a sofa, a decision to stop on Monday. Most have an instinctive answer that is wrong by half or dangerous outright. Pick your move; every answer explains why.

The card

Print it for the fridge, or for whoever is counting with you.

🖨️ Print the card