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Saturday, June 15, 2024

Is That Drink Worth It to You? - The New York Times

Is That Drink Worth It to You?

"Alcohol is riskier than previously thought, but weighing the trade-offs of health risks can be deeply personal.

A photo illustration of a glass of wine with thorns on the stem.
Photo illustration by Ricardo Tomás

About a year ago, a friend of mine started evading my invitations to grab a drink. It was only when we caught up for a walk that she explained she wasn’t putting me off for any personal reason — it was just that she had stopped drinking. She wasn’t a heavy drinker — she had a glass of wine with dinner, the occasional Aperol spritz — but she’d been hearing on podcasts and reading in the news that even a small amount of alcohol was much worse for her health than had previously been understood. 

Listen to this article, read by Kirsten Potter

My friend was picking up on a swing in the public-health messaging around alcohol. For many years, she might have felt that she was making a healthy choice in having a glass of wine or a beer with dinner. Right around the time when she came of legal age to drink, the early 1990s, some prominent researchers were promoting, and the media helped popularize, the idea that moderate drinking — for women, a drink a night; for men, two — was linked to greater longevity. The cause of that association was not clear, but red wine, researchers theorized, might have anti-inflammatory properties that extended life and protected cardiovascular health. Major health organizations and some doctors always warned that alcohol consumption was linked to higher cancer risk, but the dominant message moderate drinkers heard was one of not just reassurance but encouragement.

More recently, though, research has piled up debunking the idea that moderate drinking is good for you. Last year, a major meta-analysis that re-examined 107 studies over 40 years came to the conclusion that no amount of alcohol improves health; and in 2022, a well-designed study found that consuming even a small amount brought some risk to heart health. That same year, Nature published research stating that consuming as little as one or two drinks a day (even less for women) was associated with shrinkage in the brain — a phenomenon normally associated with aging.

Drinking increased during the pandemic, which may be why news of any kind about alcohol seems to have found a receptive audience in recent years. In 2022, an episode of the podcast “Huberman Lab” that was devoted to elaborating alcohol’s various risks to body and brain was one of the show’s most popular of that year. Nonalcoholic spirits have gained such traction that they’ve started forming the basis for entire nightlife guides; and more people are now reporting that they consume cannabis than alcohol on a daily basis.

Some governments are responding to the new research by overhauling their messaging. Last year, Ireland became the first country to pass legislation requiring a cancer warning on all alcohol products sold there, similar to those found on cigarettes: “There is a direct link between alcohol and fatal cancers,” the language will read. And in Canada, the government has revised its alcohol guidelines, announcing: “We now know that even a small amount of alcohol can be damaging to health.” The guidelines characterize one to two drinks a week as carrying “low risk” and three to six drinks as carrying “moderate risk.” (Previously the guidelines suggested that women limit themselves to no more than two standard drinks most days, and that men place that limit at three.)

No amount of alcohol is good for you — that much is clear. But one might reasonably ask: Just how bad is it? The information we receive on health risks often glide over the specifics of how much actual risk a person faces, as if those were not details worth knowing. These days, when I contemplate a drink with dinner, I find myself wondering about how much to adjust my behavior in light of this new research. Over the years, we’ve been told so many things are either very good or very bad for us — drinking coffee, running, running barefoot, restricting calories, eating all protein, eating all carbs. The conversation in my head goes something like this: “Should I worry? Clearly, to some degree, yes. But how much, exactly?”

The Trick of Defining ‘Low Risk’

Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research, is one of the people most responsible for our cultural course correction on alcohol, a credit that’s all the more notable since he used to be convinced of its health benefits. Stockwell believed so strongly in the soundness of moderate drinking that he wrote, in a commentary in Australia’s premier medical journal in 2000, that skeptics on that subject might reasonably be lumped into the same category as “doubters of manned lunar missions and members of the Flat Earth Society.”

Not long after that, Stockwell received a phone call from Kaye Middleton Fillmore, a sociologist at the University of California, San Francisco, who told him that she had her doubts about the research that Stockwell considered so sound. Fillmore was concerned about possible misleading variables in the studies: To start, they included ex-drinkers in the category of “abstainers,” which meant they were failing to account for the possibility that some people had stopped drinking specifically because of illness. The moderate drinkers looked healthy by comparison, creating the illusion that a moderate amount of alcohol was beneficial.

Fillmore was looking for funding to prove her point, and after listening to her talk for a while, Stockwell was intrigued enough that he not only found her a source of funding but joined ranks with her. The results of this collaboration, published in 2006, confirmed Fillmore’s suspicions. Stockwell, increasingly convinced that an entire field of research suffered from the same fundamental error, continued with the line of research, work that led to the 2023 meta-analysis, which triggered many of the headlines and reappraisals we’re seeing now. Stockwell and his colleagues detected a statistically significant increase in risk for all-cause mortality — the risk of dying from any cause, be it medical or accidental — for women who drank just under two drinks a day and for men who consumed more than three a day. 

A photo illustration of a glass of liquor with metal barbs on the rim.
Photo illustration by Ricardo Tomás

Based on the research that formed the basis of Canada’s new guidelines, which he helped write, Stockwell walked me through the risks for a woman my age: If I indulged in, say, around six drinks a week, he said, I was increasing my lifetime risk of dying from an alcohol-related cause by a factor of 10, compared with those who drank about only one or two drinks a week. That jump sounded worrisome, until Stockwell put it in context. If I consumed six drinks a week, the risk I was facing of dying of some alcohol-related cause was still, by any measure, small on average — only about 1 percent. And if my risk of all-cause mortality was pretty low — Stockwell assured me that at 53, it was — then any incremental added risk on top of that was also clearly going to be very low.

Stockwell offered me another way of thinking about it, which is even more bottom-line oriented: How much time does a certain amount of drinking shave off your life? For those who have two drinks a week, that choice amounts to less than one week of lost life on average, he said. Consume seven alcoholic beverages a week, and that amount goes up to about two and a half months. Those who push five drinks a day or more face the risk of losing, on average, upward of two years, said Stockwell. He emphasized that all those numbers were averages — and that it was impossible to predict the level of impact an individual person would experience.

Stockwell might be expected to have the zeal of the convert, but his role in the Canadian working group suggests otherwise. He objected to the group’s decision to label one or two drinks a week “low risk” since it increased a person’s risk of mortality by a mere 0.1 percent, compared with those who didn’t drink at all. “I think the three-to-six-drinks-a-week category would be more like what I would call ‘low risk,’” Stockwell said. The language in such guidelines is somewhat subjective, he pointed out.

It can be hard to address the assumptions of the past without overcorrecting. An article in The Washington Post earlier this year, for example, ran with the headline “More Than One Alcoholic Drink a Day Raises Heart Disease Risk for Women.” The cardiologist behind the study, Jamal Rana, who is with the Permanente Medical Group, was quoted as saying that even young and middle-aged women who drank eight or more drinks a week and who binge drink “are at risk for coronary heart disease.” Women are at increased risk, based on his research, but his phrasing lacked context; it seems loaded with the intent of shaping behavior rather than fully informing people about how to understand that risk. 

Asked about his findings, Rana acknowledged that the increased risk is, in fact, “small and incremental” — and emphasized that he considered his work important in that it further contradicted the notion that drinking was good for the heart.

Individual Risks vs. Collective Harms

The cultural grip of alcohol is so powerful, its symbolism as a source of pleasure so entrenched that even I, a halfhearted drinker at most, was nearly at a loss for figuring out how I would socialize with a dear friend if it wasn’t with a cocktail in front of each of us. Consider the millions of love affairs that would have gone unstarted but for a few drinks, the workplace rapport that can dramatically transform for the better after one fun night out at a bar. Bonding comes of that collective loosening, from the mutual decision that two or more people make to let go, even a little, in each other’s presence. “History shows that without good food and (often many) good drinks, very little international diplomacy gets done,” said J.T. Rogers, whose play “Oslo,” about the Oslo peace accords, reflected the role that alcohol played in building trust among figures taking great political risks. 

Its outsize role in our culture is only one reason it is challenging to fit alcohol into the usual kinds of risk-benefit analyses that apply to so many routine choices. Most of those choices — like driving, or taking certain medications — have some practical offset that make the downsides justifiable; few of them are addictive. Alcohol is somewhat unusual in that its upside, most broadly conceived, is pleasure. 

Alcohol’s risk profile also has an added layer: the direct risk posed to others. A woman who has two strong cocktails with friends or a man who has three beers on a night out may be more likely than someone sober to do harm to those around them — more likely to make an ill-advised left turn as another car is speeding their way; or to fail to notice, once home, that the baby has something in her mouth; or to have unsafe sex. 

That’s why thinking about alcohol in terms of your own individual risk is a limited exercise, says Jim McCambridge, chair in addictive behaviors and public health at the University of York in England. He encourages the public to think instead about the number of lives lost globally to alcohol, which research puts at about three million a year. (For perspective, that’s about four times more than the number of women who die of breast cancer every year.) Individual risk associated with moderate consumption may be small, but across the population, the damage of alcohol is vast because the number of people who consume it is so high. Even as drinking has declined among young people in the United States and Britain, among those middle-aged and older, and among women, consumption is up. 

The Centers for Disease Control and Prevention has reported that alcohol-related deaths in the United States each year have, if anything, increased. They compared data from 2020-21 with data from 2016-17 and found a rise of 29.3 percent, which they largely attribute to the pandemic, the greater availability of alcohol and its recently dropping cost when adjusted for inflation: The last time a federal tax increase was put on alcohol was 1991, and taxes on some spirits were actually cut in late 2020. “Any sentence about drug policy that doesn’t end with ‘raise alcohol taxes’ is an incoherent sentence,” the influential drug-policy researcher Mark Kleiman once told The Washington Post, pointing out that at that time, if you tripled the alcohol tax, you would have 6 percent fewer homicides without putting a single additional person in prison. 

The more I thought about alcohol and its collective harms, the more I questioned why I drank at all. I briefly resolved to limit myself to just a drink or two a week, but alcohol was like a friend who kept turning up in my life despite my ambivalence, tugging at my attention at a graduation party or a gathering with friends to celebrate some good news. One function that drinking plays in so many people’s lives — and one reason it’s so heavily associated with important life events, like weddings and wakes — is that it’s a way to turn off the part of our brains that unhappily obsesses over rational calculations, allowing us to feel like we’re living in the moment, even as we’re blaming ourselves for not finding another, healthier way to do so.

I recently went to an annual neighborhood party where mixed drinks, beautifully presented with garnishes and frozen melon balls for ice, were on offer. I sipped on something strong and sweet, trying to remember if I’d had one or two glasses of wine the night before. I sat for a bit with the friend who had told me weeks earlier that she was abstaining altogether, partly as a way to hold myself accountable. I left on the early side and texted her the next day to debrief about the night. 

“I drank!” she wrote back. “Too much!”

Read by Kirsten Potter

Narration produced by Emma Kehlbeck and Krish Seenivasan

Engineered by Jeremy McLennan

Source photographs for illustrations: Tomohiro Iwanaga/Getty Images; Natasha Breen/Getty Images

Susan Dominus is a staff writer for The New York Times Magazine. In 2018, she was part of a team that reported on workplace sexual harassment issues and won a Pulitzer Prize for public service. More about Susan Dominus

See more on: Centers for Disease Control and Prevention"

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