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The Russian roulette of moderate alcohol consumption

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This month, millions of Americans are taking part in “Dry January” in an effort to give up alcohol for a month and cleanse themselves of holiday excesses.

Alcohol is the most abused drug in the world, including in the United States

In 2020, nearly 70% of people ages 18 and older in the United States reported having consumed an alcoholic beverage in the past year, according to the National Survey of Drug Use and Health. In addition, 24% of respondents said they had consumed alcohol – defined for women as four or more drinks per occasion and five or more drinks per occasion for men – in the previous month.

The COVID-19 pandemic has caused significant changes in alcohol consumption. A nationally representative sample found that while the number of people who reported consuming alcohol in the past year remained constant from 2019 to 2021, the number of people who consumed alcohol daily increased from 6.3% to 9.6%.

In part because alcohol is such a commonly used, heavily marketed, and glamorized substance in pop culture, Americans’ comfort and acceptance of its use in daily life is remarkably high. But should it be?

I research alcohol consumption and the associations between alcohol consumption and a wide range of problems. Although the growing opioid epidemic has received a lot of attention in recent years, the number of alcohol-attributable deaths each year is comparable to the total number of annual drug overdose deaths, both increasing rapidly over the past few years. recent years.

Drinking just one drink a day can have a negative effect on your health.

What about moderate drinking?

Over the past two decades, the idea that moderate alcohol consumption may in fact have beneficial health effects has gained traction, supported by preliminary and limited evidence. This has led to the widespread idea in popular media that a glass of red wine a day reduces the risk of cardiovascular disease and diabetes.

But there was a major flaw in many of the studies used to support the claim that a glass of red wine is good for your health. They compared those who drink at moderate levels to people who don’t drink alcohol, rather than comparing heavy drinkers to lower levels.

There are many reasons why people who drink at moderate levels may be fundamentally different — and healthier — than those who don’t drink at all. For example, many people who develop new illnesses unrelated to their alcohol use stop drinking, making the group of alcohol abstainers appear less healthy than those who consume alcohol at levels weak or moderate.

In 2018, the National Institutes of Health launched a large randomized controlled trial — the gold standard for understanding causal relationships — to examine the benefits of moderate drinking.

This trial was designed to detect the cardiac benefits of drinking one drink a day, but was not going to be able to detect the negative consequences of moderate alcohol consumption, such as increased breast cancer. breast. Due to its inability to detect known alcohol-related harms and fears that the study was co-funded by the alcohol industry, the trial was halted after a few months.

A landmark study from 2022 found that even low levels of alcohol consumption can be dangerous.

Link between alcohol and cancer and other harms

Through lobbying by the powerful alcohol industry, the dangers of alcohol can be downplayed and its benefits exaggerated. There are many well-established problems associated with alcohol consumption, even at moderate levels, which likely outweigh the potential benefits.

Alcohol is the third leading cause of premature death in the United States and one of the leading modifiable causes of death worldwide, while receiving the least media and political attention. Worryingly, the number of deaths attributed to alcohol increased by 25% between 2019 and 2020 – a faster rate of increase than the percentage increase in all deaths – 17% – in the first year of the COVID-19 pandemic. These rates increased most rapidly among people aged 25 to 44.

The lifetime prevalence of alcohol use disorder – defined as an impaired ability to stop or control alcohol consumption despite adverse social, occupational or health consequences – is nearly 30%. In other words, nearly a third of the population has been seriously affected by their drinking at some point in their lives.

Alcohol consumption, even at low levels, is linked to a number of cancers, including breast, colorectal, liver and esophagus. Alcohol contributes to approximately 75,000 cancer cases and 19,000 cancer deaths per year. Additionally, a recent study found that more than 50% of adults in the United States are unaware of the cancer risks associated with alcohol consumption.

Alcohol also causes a number of serious harms to others, many of which are related to violence. These include the increased risk of child abuse, physical abuse, domestic violence, sexual assault and gun violence. Alcohol-related road deaths in the United States – after several decades of decline – rose 14% to 11,654 in 2020.

Disparities in alcohol-related consequences

The effects of alcohol are not felt in the same way by everyone: the most vulnerable among us suffer the heaviest consequences. In the United States, black and Latino drinkers experience more of the social consequences of alcohol consumption than white drinkers, especially among groups that consume alcohol at low levels. These consequences include arguments or fights, accidents, and work, legal, and health problems.

Additionally, studies show that teens who report having a minority sexual orientation tend to start drinking at a younger age and continue binge drinking more frequently into adulthood. These differences in alcohol-related problems at the same level of alcohol consumption contribute to disparities in many other health outcomes for these populations.

Higher taxes and a drinking age could offset the damage

There are a number of things the United States could do to reduce the burden of alcohol consumption through public policy. A proven effective policy is to increase alcohol excise taxes, which are selective sales taxes on the purchase of alcohol. Other policies that have proven effective include restrictions on the number of stores that sell alcohol, restrictions on hours of sale, and increases in the minimum legal drinking age from 18 to 21. While the current minimum drinking age in the United States is 21, prior to 1984 the minimum drinking age varied from state to state, with some states allowing drinking as young as 18.

Although the alcohol industry often opposes many of these policies and regulations, they are relatively easy to implement. Despite this, in the United States, alcohol control policies have declined in recent decades, with many states moving to privatize alcohol sales – in direct opposition to what experts know can reduce harm. alcohol related. Privatization, which removes state monopolies on alcohol sales, dramatically increases per capita alcohol sales and consumption.

Although alcohol plays a central role in American culture, in my opinion, the undisputed consequences of alcohol consumption make it unwise to recommend alcohol as a pathway to better health and well-being. . In my view, the small reductions in cardiovascular disease that are arguably linked to low levels of consumption are barely outweighed by the considerable harms of alcohol to individual and population health.

Christina Mair is an Associate Professor of Behavioral and Community Health Sciences at the University of Pittsburgh.


The Conversation was born out of deep concern about the diminishing quality of our public discourse and recognition of the vital role that academic experts could play in the public arena. Information has always been essential to democracy. It is a social good, like drinking water. But many now find it hard to trust the media and experts who have spent years researching a topic. Instead, they listen to those with the loudest voices. These uninformed views are amplified by social media that rewards those who spark outrage instead of thoughtful insight or discussion. The Conversation seeks to be part of the solution to this problem, to bring the voices of real experts to the table and make their knowledge available to everyone. The Conversation publishes nightly at 9 p.m. on FlaglerLive.


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