Background: People encounter large amounts of sometimes-inconsistent information about risks and benefits of alcohol consumption, and about what constitutes "low-risk" or "moderate" drinking.
Methods: We used 150 in-depth interviews linked to questionnaire data to learn how people define moderate drinking and to describe the relationships between definitions, attitudes, and beliefs about moderate drinking and individuals' drinking patterns.
Results: People adhere to definitions of moderate alcohol consumption that could put them, or others, at risk for short- or long-term negative consequences of drinking. Definitions that confused increased tolerance of alcohol with moderate drinking, and those that defined moderate drinking by the absence of short-term negative consequences or ability to maintain control over drinking, ignore long-term risks of heavy consumption. Individuals with risky attitudes were also more likely to report at-risk drinking practices.
Conclusions: Americans have complex beliefs about benefits and risks of alcohol consumption, and public health officials have not succeeded in conveying strong or clear messages about what constitutes low-risk drinking or about dose-response effects. Different (but more consistent) approaches to public education may be needed to increase knowledge about drinking-related risks. The prevalence of diverse norm-based definitions suggests that alternative normative information could help people reassess their own consumption.