Alcohol – what low-risk drinking means, and how to cut down

A smaller share of South Africans drink than in many countries — but those who do drink consume among the highest amounts per drinker in the world, and much of it in single heavy sessions rather than spread out.

That pattern is what drives the harm: injuries, road deaths, violence, and liver and heart damage. It also makes 'I only drink on weekends' a weaker reassurance than it sounds.

Guidance is written in standard drinks, and almost nobody pours one. A standard drink is roughly 10 g of pure alcohol.

• About 340 ml of ordinary-strength beer — one can or one small bottle.
• About 120 ml of wine, which is a good deal less than most people pour.
• About 25 ml of spirits, which is a single tot.
• A 750 ml bottle of wine is roughly six standard drinks, not two or three.
• Ciders and flavoured spirit coolers are usually stronger than they taste.

• Anyone pregnant or trying to conceive. There is no established safe amount, and South Africa has among the highest rates of foetal alcohol spectrum disorder in the world.
• Anyone with liver disease, pancreatitis or a history of alcohol dependence.
• Anyone driving, operating machinery, or responsible for a small child overnight.
• Anyone taking metronidazole, and anyone taking sedatives, strong painkillers or sleeping tablets, where the combination suppresses breathing.
• Anyone on TB treatment or certain HIV medicines, where the liver is already under load — ask a pharmacist about your specific regimen.

1. 1Count for one week before changing anything. Most people are surprised, and it makes the target concrete.
2. 2Set alcohol-free days first — usually easier than drinking less on the days you do drink.
3. 3Pour a measure rather than free-pouring. The size of the glass drives the amount more than thirst does.
4. 4Alternate each drink with water. It slows the session and reduces the hangover.
5. 5Eat first. Alcohol on an empty stomach is absorbed far faster.
6. 6Do not keep large stock at home. Availability predicts consumption better than intention does.
7. 7Have an answer ready for being offered a drink. 'I'm driving' or 'I'm on medication' ends the conversation without a debate.

Some signs point to dependence rather than habit: needing more for the same effect, drinking to stop feeling shaky or anxious, failing at repeated attempts to cut down, or drinking in the morning.

Treatment exists and works. Counselling, group programmes and medication are all available in South Africa, including through the public sector. SADAG's helpline can point you to services near you, and is listed on the emergency numbers page.