The Good and the Evil of Alcohol

It may not be that alcohol produces these benefits, but that people who lead good lives are moderate drinkers, not teetotalers. What does this say about what we should teach about alcohol?
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"If you mean the demon drink that poisons the mind, pollutes the body, desecrates family life, and inflames sinners, then I'm against it. But if you mean the elixir of Christmas cheer, the shield against winter chill, the taxable potion that puts needed funds into public coffers to comfort little crippled children, then I'm for it. This is my position, and I will not compromise!"

-- A Congressman's response about his attitude toward whiskey.

We are returned to this politician's "insight" (is that the same thing as "equivocation") by "a major new study" referenced in the Telegraph (U.K.): "Moderate drinkers have lower rates of heart disease, obesity and depression than people who abstain from alcohol entirely, the report indicates."

Personal disclosure
: I earn my living from treating alcoholism and addiction, as well as writing and lecturing about them. I have also received money from alcohol producers. I receive many times as much for the former through my Life Process Program, which is the basis for a residential treatment center - as much in a good month as I have received in the last decade from the latter. I was an adviser on substance use disorders in the American Psychiatric Association's manual, DSM-IV.

Publication disclosure: In the August issue of Addiction Research and Theory, I have a commentary entitled, "Alcohol as Evil - Temperance and Policy" and a rejoinder to comments - one from an English-speaker, the other Italian - entitled, "Civil War in Alcohol Policy: Northern vs. Southern Europe."

A brief history of alcohol in America: Americans drank between three and four times as much per capita in the Colonial period as they do today. Since then, alcohol use has ebbed and flowed in arcing cycles in the United States; a national binge at the turn of the twentieth century led to Prohibition from 1920-1933. Sociologists have analyzed Prohibition as a war between a nativistic Protestant America and an immigrant Catholic one. Cities dominated by immigrants - like New York, Boston, and Detroit - barely acknowledged Prohibition. This split, although attenuated, is still highly evident in America. Twice the percentage of residents of Northeastern states drink alcohol (although still only about two thirds) as do in Southern states such as Kentucky and Tennessee (one third).

But wait. The last two states (33 percent and 30 percent drinkers respectively) are famous whiskey-distilling and moonshine states. Ah, therein lies a story. A remarkable number of Southern counties are still "dry," requiring people to drive to neighboring counties to drink or to drink illegally produced alcohol - both of which are associated with binge drinking.

A brief international analysis of alcohol consumption: After decades of casual observations that Scandinavians and English-speakers are binge drinkers and Southern Europeans drink wine casually with meals, the European Comparative Alcohol Study (ECAS), conducted by Scandinavians, found this was true. Scandinavians, the English and Irish are frequent bingers; Greeks, the Spanish, Italians and French rarely binge. But here's the rub - not only do the latter nations have fewer alcohol-related social problems, they actually have lower death rates due to drinking, even though Southern nations, due to their steady imbibing, drink more! Remarkably, ECAS found an inverse correlation between the amount of alcohol consumed in a country and that country's rate of alcohol-related mortality.

So some people drink alcohol well and healthily; and some binge, which can result in deadly accidents and culminate in periods - perhaps lifetimes - of alcohol abuse and alcoholism.

Is alcohol good or bad? As comments on this post may indicate, people hold different opinions. For some, the deathly, disease-like traits of the substance predominate; for some, the positive, fun and even health-seeking aspects prevail.

Positive and negative attitudes towards alcohol and good and bad experiences with alcohol are related. But - oh, the paradox - the former precede and determine the latter. The Telegraph article cited above noted that, while "recent research has highlighted the health-giving properties of wine and some other alcoholic drinks, the authors of the latest study sound a note of caution."

It may not be that alcohol produces these benefits, but that people who lead good lives are moderate drinkers, not teetotalers. What does this say about what we should teach about alcohol? People with better lives have more positive views of alcohol and alcohol contributes to their lives. (Residents in my treatment program - this does not include you - you have reached a different place at this point in your lives!)

P.S. Please don't send me comments like one I listened to from an active woman alcoholic (NOT a patient): "Don't tell me that your parents teaching you how to drink prevents you from becoming alcoholic - my father took me and my sister into the basement and made us both drink until we became sick - then he said, 'See what drinking does!' And look what happened to me."

I feel she missed my point. She's an example of how conveying negative attitudes about alcohol becomes self-fulfilling. On second thought, go ahead and make such comments.

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