There is nothing wrong with drinking modest and sensible amounts of alcohol but fitness, physical health, mental health and long-term health all suffer as a result of medium- or heavy- drinking1 and the health risks to the baby when pregnant mothers drink2 are well-known. Aside from the effects on the individual, alcohol misuse impacts on entire economies3 via increased health service costs, policing costs and lost days' work. Worldwide, alcohol misuse is "among the top five risk factors for disease, disability and death" and is a "cause of more than 200 disease and injury conditions in individuals, most notably alcohol dependence, liver cirrhosis, cancers and injuries"4. "In 2012... 5.9% of all global deaths, were attributable to alcohol consumption"5. Deaths from chronic alcohol misuse have been rising for decades, and so has violence, abuse, vandalism and crime all associated with alcohol over-use. The aggression and crime associated with alcohol in some Western countries infringes on the human rights of those who want nothing to do with such behaviour. Many of the social effects of alcohol are psychological and cultural; i.e., people don't have to behave criminally or destructively whilst drunk - it is a culturally learned behaviour. Experiments have shown that behaviour can be controlled: Those who do not wish to behave badly whilst drunk, will not do so.
|Alcohol Consumption (2016)7|
|Pos.||Lower is better|
|Alcohol Consumption (2016)7|
|Pos.||Higher is worse|
The data in the charts to the right shows total annual consumption per person aged 15+, in 2010 and comes from the latest World Health Organisation (2014) report on international alcohol consumption. The measurement is of total litres of pure alcohol. The worldwide average in 2010 was equal 6.2 litres8.
It is apparent that the worst rates of consumption is found in Russia and countries that were once part of the Soviet bloc in Europe, followed by a general smattering of other European countries. "In general, the greater the economic wealth of a country, the more alcohol is consumed [and] high-income countries have ... the highest prevalence of heavy episodic drinking"9.
The best rates (the lowest) are all in highly Muslim countries, whom try to prohibit alcohol consumption.
In the Immediate Term:
Immediately, alcohol makes you react slower, make less good decisions and impairs the ability to perform accurate tasks. In harsh conditions, you fare much less well; to drink when very hot or very cold is suicidal. It makes you less alert.10. Alcohol makes you feel warm because it causes your capillaries to allow more blood to the surface of the skin; but this also increases the rate that you lose heat through your skin. You think you are warmer, but you are actually losing heat quicker. Alcohol simultaneously makes you more confident but less capable of acting and thinking.
In the Short Term:
An Army publication, relying on expert medical data, finds that alcohol has the following effects:
- Interferes with fitness; heart and lungs work less efficiently
- It damages muscles
- It can lead to increased weight
- It increases the risk of accidents and injuries
- It damages the immune system, making you more prone to infection
- It increases the time needed to recover from injuries and illnesses
- It causes dehydration, making exercise dangerous and unpleasant
Even a moderate drinker gets ill more, has more accidents and is less fit. Certainly, no sportsman wants to be anything but a light drinker!
In the Long Term:
Alcohol effects the brain in various ways, "but two effects seem most important":
“First, alcohol kills nerve cells - but in a highly selective fashion. In the January 30, 1981 issue of Science, Charles Golden and his associates report that alcohol tends to destroy brain tissue primarily in the dominant hemisphere. The behavioural changes associated with chronic drunkenness tend to support Golden's findings. For example, the slurred speech, the inability to think logically and to plan effectively, and the emotional outbursts shown by many alcoholics all suggest that alcohol disrupts the dominance normally shown by the left hemisphere. Indeed, Golden and his colleagues believe these symptoms result from the right hemisphere's attempts to take over the functions lost through destruction of tissue in the left hemisphere.”
Chronic liver disease. Deaths from cirrhosis have increased in the UK - by 900% from 1970 to 2000. The primary cause of cirrhosis is too much drink12.
“Because alcohol provides calories [...] heavy drinkers often reduce their intake of food. But the calories provided by alcohol are empty; they do not supply the nutrients essential for health. Alcohol also contributes directly to malnutrition by impairing the digestion of good and absorption of vitamins.
In older chronic alcohol abusers, a deficiency of B-complex vitamins can cause amnestic syndrome, a severe loss of memory for both recent and long-past events. These memory gaps are often filled in by reporting imaginary events (confabulation) that are highly improbable. [...]
Other common physiological changes include damage to the endocrine glands and pancreas, heart failure, hypertension, stroke, and capillary hemorrhages, which are responsible for the swelling and redness in the face, and especially of the nose, of chronic alcohol abusers.
Prolonged use of alcohol appears to damage brain cells, especially those in the frontal lobes, causing cortical atrophy and other changes in structure (Parkins, 1975). Alcohol also reduces the effectiveness of the immune system, resulting in increased susceptibility to infection and cancer.
Heavy alcohol consumption during pregnancy is the leading known cause of mental retardation. The growth of the fetus is slowed, and cranial, facial and limb anomalies are produced. The condition is known as fetal alcohol syndrome. Even moderate drinking can produce less severe but undesirable effects on the fetus, leading the National Institute on Alcohol Abuse and Alcoholism to counsel total abstention during pregnancy as the safest course.”
Cirrhosis of the liver is a disease in which some liver cells become engorged with fat and protein, impeding their function; some cells die, triggering an inflammatory process. When scar tissue develops, blood flow is obstructed. This disease is the ninth biggest cause of the death in the USA (1990), and is primarily caused by alcohol overuse12.
"Almost half of all victims of violence report that perpetrators were under the influence."12
"The role of alcohol in combination with other drugs should not be ignored. Violence seems to be more closely linked with excessive intake of alcohol than with many illegal drugs [...] - though there is room to argue that this is a culturally mediated effect rather than a necessary effect of alcohol."15
"In the Army 75% of violent offences are alcohol related. Time and resources are also wasted treating those who have injured themselves or made themselves ill through the misuse of alcohol"10
"Over 50% of men convicted of sexual assault and rape had been drinking prior to the attack. An equally high proportion of victims of rape had themselves been under the influence of alcohol at the time of the attack"10
There was one allusion above to the fact that the social effects of alcohol are cultural. This is discussed later.
The UK's National Health Service states that "experts are still unsure exactly how much alcohol is safe for you to have while you're pregnant, so the safest approach is not to drink at all while you're expecting" and says that this line is the one taken by the Department of Health, and if that you do drink, the quantity should only be equivalent to one small glass of wine once or twice a week, and this advice is mirrored by other organisations such as NICE and Royal College of Obstetricians & Gynaecologists16. The harm to babies comes from the fact that alcohol's small molecules pass very easily into the blood stream, and are passed on quickly to a fetus. There isn't evidence that mild drinking is harmful, but heavy drinking certainly is.
“If you drink heavily during pregnancy you double your risk of miscarriage and increase the chances of having a baby with a major abnormality. You should consume no more than a maximum of one or two units, once or twice a week. Over eight units a week is thought to cause fetal alcohol syndrome. It is best for you and your baby if you cut out alcohol completely.”
Cases have gone through UK courts involving children who were declared medically to have suffered developmental damage as a result of their mother's drinking (and in one case the mother was repeatedly warned by authorities that she was damaging her baby, but continued drinking heavily)18.
“If you drink heavily during pregnancy, you double your risk of miscarriage and increase the chances of having a baby with a major abnormality. The risks start to rise at the equivalent of four measures of spirits of glasses of wine, or two pints of beer of cider per day. [...] For reasons that are unknown, babies of women over the age of 35 fare worse than those of younger women, and black babies are seven times more vulnerable than white ones, possibly for genetic reasons.”
Public Health England19 reported in 2013 that parental behaviour is the basis for many bad habits later in life, specifically mentioning excessive alcohol consumption, and stating that prevention and early intervention are both much better than trying to reverse learned bad behaviour20. The World Health Organisation pointed out in 2014 that:
“A family history of alcohol use disorders is considered a major vulnerability factor for both genetic and environmental reasons. [...] Parents with alcohol use disorders ... increase the likelihood that their children will develop drinking patterns associated with high risk of alcohol use disorders when they are introduced to alcohol. Heavy drinking by parents affects family functioning, the parent-child relationship and parenting practices, which in turn affects child development adversely.”
Children of alcoholic parents have polarised reactions to alcohol:
“The findings by Valliant (1983) show that children who grow up in households with an alcoholic parent are as a group on average as likely to become teetotal as develop alcohol problems. [...] Crabbe and Goldman (1992) concluded that: 'As children growing up in alcoholic households have an increased risk of becoming either alcoholic or abstinent, it seems that increased risk of alcoholism depends partly on how a person reacts to his or her environment.”
Whether people become 'addicted' to alcohol or not is partially dependent on genetics; but upbringing and choice play a larger part.
“The evidence presented [...] demonstrates clearly that physiological and biochemical responses to alcohol and drug use are at least in part inherited. A wide range of evidence, from adoption and twin studies to the identification of biological markers for responses to drug and alcohol use, have supported the findings that certain traits associated with use are inherited.”
Our behaviour when drunk is a function of our character and our expectations about 'how drunk people act'. In cultures and paradigms where alcohol-fuelled violence (such as fighting in a pub or attacking the spouse) or crime (such as street vandalism and destructive behaviour), is not seen as the result of alcohol, then, drunk people do not behave in that way. In other words, to prevent petit crime associated with alcohol you could simply educate people, and get them to internalize, the truth that drunken behaviour isn't intrinsically violent. They could then learn to control themselves whilst drunk. This shows that alcohol-inspired drunken behaviour is psychosomatic. A series of experiments in the 1970s provided supporting evidence.
“It appears that some of the short-term effects of ingesting small amounts of alcohol are as strongly related to the drinker's expectations about the effects of the drug as they are to its chemical action on the body. For example, alcohol is commonly thought to stimulate aggression and increase sexual responsiveness. Research has shown, however, that these reactions may not be caused by alcohol itself but by the drinker's beliefs about alcohol's effects. In experiments demonstrating these points, participants are told that they are consuming a quantity of alcohol when they are actually given an alcohol-free beverage with its taste disguised. They subsequently become more aggressive (Lang et al., 1975) and report increased sexual arousal (Wilson & Lawson, 1976). People who actually drink alcohol also report increased sexual arousal, even though alcohol makes them less aroused physiologically (Farkas & Wilson, 1976). Once again, cognitions have a demonstratably powerful effect on behaviour.”
The 1980s saw further research complement and reinforce the evidence that expectation and assumption about drunken behaviour is an important cause of that behaviour:
“In the 1980 book Advances in Substance Abuse, G.A. Marlatt and D.J. Rohsenow report that most of the "social effects" of alcohol may be due to people's expectations about the drug. Subjects who drank tonic water but thought it was alcohol showed most of the 'classic' symptoms of intoxication, while subjects who drank alcohol but thought it was tonic water failed to get "high". [...]
Marlatt and Rohsenow also tested alcoholics by giving them tonic water but telling them it was vodka. The alcoholics experienced the same "craving" for more alcohol after drinking the tonic water as they typically did when consuming alcohol. They did not report this craving after drinking vodka they thought was tonic water.
Marlatt and Rohsenow conclude that the setting in which alcohol is consumed and the drinker's expectations are even more influential in determining the drinker's reactions than are the physical effects of the alcohol itself.”
From the 1990s, the Home Office Drugs Prevention Office has been investigating the behaviour of drugs and alcohol users. They comment that:
“The role of alcohol in combination with other drugs should not be ignored. Violence seems to be more closely linked with excessive intake of alcohol than with many illegal drugs [...] - though there is room to argue that this is a culturally mediated effect rather than a necessary effect of alcohol.”
"Drugs Misuse and the Criminal Justice System" by Prof. Michael Hough27
Placebo experiments in the 1970s on the effects of fake alcohol consumption, in the 1980s on the psychology of expectation and in the 1990s on criminal behaviour have all found that peoples' reactions to alcohol are partially determined by what they think the effects of alcohol should be, especially when it comes to crime and aggression. To curb street violence, increased education on what the effects of alcohol really are is required, and so is changing the nature of the environment in which alcohol is drunk (and especially where binge-drinking occurs). Both of these things require a change of the basic, common drinking habits of those who frequent pubs.
The UK has seen a 50-year growth in alcohol consumption and it has become a public-health crisis28. In 2007-8 it directly cost the NHS £3 billion28, and overall the national cost is up to £55 billion a year28,29. Across 2007-8, the UK had up to 40,000 alcohol-related deaths, including 350 from acute alcohol poisoning and 8,000 from cirrhosis of the liver28. Consumption has doubled since the late 1950s, whilst in other developed countries such as France and Italy, it has more than halved30; liver disease rates are falling in the EU, but the UK's rises31. The price of alcohol is half what it was in the 1970s30. Between 1995 and 2001, binge drinking increased by 35% in the UK30 . The increase in drinking "is reflected in rising death rates from chronic liver disease, the primary cause of which is too much drink", and the UK has some of Europe's worst rates of childhood drunkenness and several thousands of babies are born each year with foetal alcohol syndrome28, which has lifelong effects.
We have seen that light drinking can have some beneficial medical effects on the body, and the World Health Organisation report that the least problematic way to drink alcohol is with food32, in sensible quantities. Unfortunately, many people drink far too much daily or weekly, and binge drink, which is then related to alcoholism, violence, crime, sexual offences, ill-health, mental disease and wider social problems.
“There's no mystery about how to curb this kind of boozing. In Alcohol - No Ordinary Commodity, a book part-funded by the World Health Organisation, [it is argued] that we know what policies are likely to be most successful. [...] Top of the pile, they conclude, are increasing the price of booze and limiting its availability. [...] In the UK today, alcohol costs roughly half in real terms what it did in the 1970s [...]. Governments everywhere have shown a serious reluctance to keep taxes on alcohol in line with inflation, let alone use them to temper soaring rates of drinking.”
New Scientist (2004)12
The WHO's 2014 report did not deviate from the already well-known advice above:
“The accumulated research findings indicate that population-based policy options - such as the use of taxation to regulate the demand for alcoholic beverages, restricting their availability and implementing bans on alcohol advertising - are the "best buys" in reducing the harmful use of alcohol as they are highly cost-effective in reducing the alcohol attributable deaths and disabilities at population level.
Setting low limits (0.02% to 0.05%) for blood alcohol concentration (BAC) and enforcingthem by random breath testing (RBT) are effective not only in reducing road traffic injuries,but also in reducing alcohol consumption among drivers.”
Raising the price of alcohol, they have shown, also reduces alcohol-related dangers such as car accidents, liver disease, violence and crime. "What's more, younger kids with less money are the most sensitive to price hikes. 'A key finding is that increases in prices are effective in reducing not just drinking, ' says Chaloupka, 'but binge drinking, especially in kids.' That's especially good news because younger drinkers tend to be more influenced by group behaviour".12
Other methods to reduce alcohol use, apart from raising alcohol taxes, are: restricting hours or days of sale, lowering the blood alcohol limits for driving and restricting density of retail outlets"12. Despite the positive effects of reducing the legal limit for drivers, "the UK has the highest legal limit for drivers' blood alcohol in Europe"12 (which is 80mg of blood alcohol)10. It seems, perversely, that the UK has the most problems with alcohol and the least safe road laws!
Some methods that do not work at reducing binge drinking are: School education, voluntary advertising codes and alternative entertainment. The results of market manipulation are far more effective than education. And unfortunately, it appears that the heaviest and most aggressive alcohol abusers are less affected by price hikes34. The trick is, then, to curb intake before users develop patterns of heavy consumption.
Men are five times as likely to become alcoholic as women35.
"Worldwide about 16.0% of drinkers aged 15 years or older engage in heavy episodic drinking"36 (binge drinking).
"Binge drinkers are 14 times more likely to drive while impaired compared to people who drink sensible amounts"12.
Do you have a problem? You do if you:10"
“Data also indicate that problem drinking in human beings runs in families, suggesting a genetic component. Several studies have shown that relatives and children of problem drinkers have higher than expected rates of alcohol abuse or dependence. Twin studies have revealed greater concordance for alcohol abuse [...] in identical twins than in fraternal twins, pointing again toward a possible role of heredity.[...] Adoption studies add further supports for the importance of a genetic diathesis in both alcohol and drug abuse.
Some ethnic groups, such as Asians, may have a low rate of alcohol abuse because of their physiological intolerance, which is caused by an inherited deficiency in an enzyme that metabolizes alcohol. About three-quarters of Asians experience unpleasant effects from small quantities of alcohol. Noxious effects of the drug may then protect a person from alcohol abuse.”
“The use of alcoholic beverages has been an integral part of many cultures for thousands of years. Prior to the modern era, fermented alcoholic beverages were known in all tribal and village societies except in Australia, Oceania and North America. In societies where there was no aboriginal alcohol consumption, the encounter with alcoholic beverages was often abrupt and highly problematic. Where alcohol was traditionally consumed, production of alcoholic beverages commonly occurred on a small scale as a household or artisanal activity, particularly when and where agricultural surpluses were available. Drinking alcohol was thus often an occasional and communal activity, associated with particular communal festivals. There are many places in the world today where versions of these traditional patterns originating from tribal and village societies persist.
[Commercial] production and consumption ... developed in European empires ... during early modern industrialization. ... This increased supply and availability often proved disastrous for indigenous economies and public health [and] often catastrophic elsewhere in the world. By the nineteenth century, leaders of industry were viewing alcohol as a major impediment to industrial livelihoods.”
“Research has indicated that people who regularly drink very modest, sensible amounts of alcohol tend to live longer, and enjoy better health, than either abstainers or those who abuse alcohol. Drinking more than the recommended limits can drastically reverse those benefits and greatly increase the risks of disease and death.”
"Alcohol And Drugs", British Army publication10
“Tantalizing evidence suggests positive health benefits for some people. Light drinking (fewer than three drinks a day), especially of wine, has been related to decreased risk for coronary heart disease in both men and women.”