Alcohol is the most widely used legal drug. Its use has been sanctioned by long-standing use and efforts to ban it have been largely unsuccessful, as the Prohibition movement found out during the years 1920-1933 when the production, importation, transportation, and sale of alcoholic beverages was completely banned in the US, after the 18th Amendment to the US constitution was easily passed in 1919. While private ownership and consumption of alcohol were not made illegal federally, some local jurisdiction did make those illegal too.
The legacy of prohibition is mixed.
The overall effects of Prohibition on society are disputed and hard to pin down. Some research indicates that alcohol consumption declined substantially due to Prohibition, while other research indicates that Prohibition did not reduce alcohol consumption in the long term. Americans who wanted to continue drinking alcohol found loopholes in Prohibition laws or used illegal methods to obtain alcohol, resulting in the emergence of black markets and crime syndicates dedicated to distributing alcohol. By contrast, rates of liver cirrhosis, alcoholic psychosis, and infant mortality declined during Prohibition. Because of the lack of uniform national statistics gathered about crime prior to 1930, it is difficult to draw conclusions about Prohibition’s effect on crime at the national level. Support for Prohibition diminished steadily throughout its duration, including among former supporters of Prohibition.
The 18th Amendment was repealed by the 21st Amendment passed in 1933, ending that experiment.
That drinking alcohol causes or exacerbates problems is clear, with men being the key drivers.
Even at lower levels of drinking, men are more likely to engage in impaired driving, commit violence or experience drownings and falls, scientists have found.
“Men drink more, binge-drink more and generally do dumber things when impaired,” said Tim Naimi, director of the Canadian Institute for Substance Use Research and another author of the alcohol report.
Men account for roughly three-quarters of alcohol-attributable deaths in the United States and Canada, Dr. Naimi continued, and they are responsible for a majority of “secondhand harms.”
Men have almost triple the number of emergency department visits for alcohol-specific diagnoses than women, according to national figures released on Thursday, with nearly four million visits each year on average in 2021 and 2022. The figure for women is 1.37 million emergency room visits.
Among men, the risk of dying from something related to drinking starts to exceed 1 in 1,000 at six and a half drinks a week, Dr. Rehm and his colleagues found. Among women, the threshold is roughly the same, more than seven drinks a week.
At eight and a half drinks a week, the risk exceeds 1 in 100 for both men and women.
“For low levels of use, at the same level of use, men are at a similar risk of health harms from alcohol use compared to women,” according to the internal H.H.S. document.
The overall death toll from alcohol, for both men and women, far exceeds that from drug overdoses. According to the Centers for Disease Control and Prevention, more than 178,000 U.S. deaths in 2020-21 were attributable to alcohol.
The figure includes deaths immediately linked to drinking — including those caused by alcohol poisoning and motor vehicle accidents — as well as those resulting from cancer and suicides.
Alcohol causes 8 percent of breast cancer deaths, for example, and nearly half of deaths in men who develop a certain type of esophageal cancer.
But what to do about alcohol consumption remains problematic to this day, with questions such as how much alcohol consumption (if any) can be considered ‘safe’ and what guidelines should be recommended to the public. While some recommendations, such as that pregnant women should not drink any alcohol at all, seem to be firm, what limits should recommended for others has fluctuated. Trump’s HHS secretary has nixed proposed changes to the existing recommendations that would have recommended more stringent limits, that both men and women limit themselves to one drink per day, and he has made even the existing ones vaguer.
Federal dietary guidelines long recommended limits on alcohol consumption for Americans: one drink daily for women, two for men. But last spring, health officials seriously considered a dramatic redefinition of moderate drinking for men, according to two people with knowledge of the process who spoke anonymously because they feared reprisals.
The officials proposed lowering the cap for men to one drink a day, the recommended limit for women.
…When Robert F. Kennedy Jr., the health secretary, and other officials unveiled the new guidelines earlier this month, they included a vague directive telling Americans only to “limit” alcohol. Even the long-established caps for men and women were gone.
The alcohol industry opposes any reduction in the limits and pointed to some studies that suggested that moderate levels of drinking led to lower all-cause mortality and lower cardiovascular mortality. But while people invoke many reasons to drink alcohol, Dr. Ned Calonge, an epidemiologist at the University of Colorado Anschutz Medical Campus who led the NASEM panel on alcohol, said “There are a lot of reasons people drink alcohol. …What we’re saying is health shouldn’t be one of them. Doctors should not recommend that people drink alcohol for any reason.”
Beliefs about gender also complicate the picture.
In the 1980s, the dietary guidelines said all adults could have one to two servings of alcohol a day, except during pregnancy. The separate recommendations for men and women, introduced in 1990, were based on the fact that men and women are biologically different.
But the idea that men could drink more was never rooted in solid scientific evidence, some experts have said, and it may have been influenced in part by paternalistic attitudes toward women.
The biological differences are real enough: Men are taller and heavier than women on average, and women metabolize alcohol differently because they have both a higher percentage of body fat (alcohol is water-soluble) and lower levels of a liver enzyme that’s responsible for metabolizing alcohol.
But men are more likely to engage in risky behaviors when drinking, and they have higher rates of habits, like smoking, that compound the harms of alcohol, scientists say.
The social pressures to drink alcohol begin early. It is associated with being an adult and popular culture sees drinking as something sophisticated people routinely do. The culture of bars as popular meeting places add to the pressure. But the problem is that many people do not stop at one drink or even two but go further. The resulting loss of inhibitions and control can lead to dangerous behavior. Asking such people to just ‘drink less’, without specific guidelines such as one drink per day, would likely be useless since drinkers very likely tend to have an inflated opinion of how much they can drink without becoming impaired, like car drivers who all think they are ‘above average’ in driving ability.
For some activities, it is better to advise total abstaining rather than moderation. For actual alcoholism sufferers, it is more successful to avoid it 100%, rather than to allow just one drink per day.
If you had a friend who was trying to quit heroin, you would not suggest just cutting back.
Even for people addicted to eating carbohydrates, it can be easier to avoid carbs entirely than to simply cut back some.
It is better to completely replace alcohol with non-addictive substances. Here is a link about alcarelle, a syntheic safe substitute.
.https://share.google/udzWO5LjjC7kJz17N
My understanding is that, for people who actually are addicted to it, alcohol is one of the absolute worst drugs to detox from. One of the most likely to kill you, and one of the most likely to make you hurt other people in the process. And this is something I’ve heard from nurses who’ve had to deal with it.
Fortunately the number of people who actually have that level of physical addiction to alcohol is fairly small. Unfortunately, you generally don’t know who’s susceptible to addiction until they’ve already gone over the line.
My family is mostly light social drinkers, rarely more than two or three drinks per week. I tend to stick to about one drink per week myself. But in some ways I got the good end of the stick on this: not only were they relatively light drinkers themselves, my parents introduced me to small amounts from wine and cider back before I was technically legal (and the legal drinking age here in Canada is 18 or 19 depending on province), which meant that by the time I was away at University, alcohol had no sense of mystery to me. I had absolutely no interest in the over-indulgence that some Freshers do when they’re finally ‘off the chain’.
For the actual title of the OP, ‘how much drinking of alcohol is safe’… the answer is probably not a large amount. For most people I expect something like one glass of wine with dinner is perfectly fine, or at least the wine is unlikely to be the most risky thing involved.
Agreed that Prohibition doesn’t generally work, especially not by itself. We have moved the needle on drinking (especially when coupled with driving), as well as smoking, through a combination of social pressure, ‘sin’ taxes, and insurance rates. Just saying ‘you can’t do it’ inflames the ‘you can’t tell me what to do’ sorts, and leaves a market opening for those willing to risk ignoring the law. But taking a more multi-generational approach of social discouragement, while also providing workable and ideally better alternatives, seems to be much more likely to work in the long run.
(Honestly in a lot of places the biggest addiction problem these days might actually be gambling rather than anything chemical.)
WHO: No level of alcohol consumption is safe for our health
I have seen an alcohol addict in my immediate family dying from Alheimer’s dementia. It is not pretty.
Jörg @#4,
Thanks for the link to that article. Makes me glad that I do not drink alcohol.
Metabolising alcohol is a matter of physiology, not identity.
Note the weasel wording: some experts, may have been influenced by. The rest? They take the opposite position, i.e. the generally accepted position: males people can generally take more alcohol than female.
Prohibition will never completely succeed for any substance, whether it is relatively socially acceptable alcohol or one of the less accepted drugs like cocaine. A total ban makes for a lucrative smuggling trade, as the risk of criminal penalty guarantees a high unit price, and every cent of the money taken goes to the producers and distributors, with none of it being seen by the tax man. Such laws will depress availability and consumption due to fear of penalty, but there will always be some fraction of people still willing.
@ Holms
Holms, I’ll be mindful you’ve been banned from talking about transgender people, but for the general audience: The differences are due to hormone-driven secondary sexual characteristics not, of course, a historical label assigned at birth.
So risk factors for medically transitioned people are those of cisgender people of the same gender, not cisgender people of the same birth-assigned sex label.
When you ask about safe levels, do you mean for yourself, your family, or the society at large? Lots of political noise is generated, because the question and the answer assume different contexts.
Biologically, humans do not need alcohol. There are billions of people who get the antabus reaction from drinking, because they lack the enzymes to digest alcohol.
But there are billions of people who have those enzymes. Clearly there is an evolutional pressure that selects for them. Alcohol can give a short energy boost to a hunter, or it can store food over times of scarcity.
In a social context alcohol decreases friction. Lonely people die younger, so alcohol increases their life expectancy.
Prohibition increased organised crime. When Prohibition ended, organised crime didn’t. They had a working organisation ready for other crimes, like distributing opiates and cocaine.
When I was a teenager, the US decided raise the drinking age from 18 to 21 (with certain exceptions such as active-duty military personnel on military bases and I think Washington DC and maybe Arizona?). There was a grandfather law that people who were 18 before (some arbitrary date) could continue to buy and consume alcohol in public. Most of my high school graduating class were in the 21 cohort, some by mere days.
This decision absolutely triggered the “you can’t tell me what to do” types. The result was that teens were drinking harder, quicker, and furtively--that led to them getting far more drunk and rowdy than if they could drink legally.
Another well-written post, Mano. I come from a family of daily alcohol drinkers and assumed the habit for most of my adult life. Its only been the past few years that I’ve steadily reduced my daily intake, mostly due to the ill effects on my ever more challenging sleep. The metabolic by-products of alcohol can cause arousals from sleep and complicate underlying issues of Insomnia and Sleep Apnea. Between that and having red wine trigger migraines has helped make this an easier process.
One small and insignificant possible correction: my understanding is that CAFFEINE is the world’s most used legal drug, and this makes sense since it is in coffee, tea, E drinks, colas, chocolates, etc…
frankensteen @#11,
It is interesting how family practices can influence people in different ways. I grew up in a society (Sri Lanka) and family where males (including my father and his brothers) drank alcohol a lot. However I did not like what I saw close up, how their behavior deteriorated so much because of alcohol, so I was never tempted to drink. In fact, I was repulsed by it. But I knew many people who followed in their fathers’ footsteps and also drank to excess.
Luckily for me, I was part of a group of friends most of whom did not drink either so I was spared the peer pressure that causes so many young people to succumb.
It is true that caffeine can be addictive and perhaps should be included more often in the list of drugs. I am not aware of studies that suggest that caffeine has serious negative effects on behavior or mortality rates or other social costs, but I have not looked for them.
In the interests of not derailing this post from alcohol to “common drugs”, my dictionary gives the following meaning of “drug”:
A “medicine or other substance” is anything. And every substance has a physiological effect when introduced to the body, even rocks. So for the record, the most common legal drug is neither caffeine nor alcohol, it’s Hydrogen Hydroxide.
These advisory limits for “drinks” or “servings” leave me perplexed. But today I learn that US standard drinks are apparently 1.8 units (14g) so I suppose it’s easy enough to convert back to unambiguous units (at the start of the evening).
@ ^
This is Australian but I think it’s not that different.
https://galaxytraining.com.au/Pages/decoding-the-essential-guide-to-standard-drinks-in-australia
Roughly a standard “drink” is the equivalent of ~12g of pure alcohol.
My medical doctor told me two years ago that a huge broad over-time metastudy showed that there is no safe amount of ethanol. This is then the Kaiser Permanente recommendation: do not drink. For those industry-sponsored studies showing that moderate drinking helped improve this thing or that, there were other diseases that ethanol nevertheless aggravated to a greater, more likely to kill you, degree. The this or that benefits were also shown to be more modest or unprovable than those studies reported.
@Bruce #1 The Centers for Disease Control (and Kaiser Permanente) diet for diabetes and safe weight loss absolutely includes carbohydrates.
I am told polynesian cava -- the substance from a tuber -- is less malign and does not lead to aggression. There are differences in tubers from different Islands so it may be difficult to generalise.
birgerjohansson #17
https://en.wikipedia.org/wiki/Kava
Kava is really not that benign when taken out of context.
Dear Mano,
Many in my family don’t drink alcohol. A few will have 1 or 2 beers a week.
A friend (who also doesn’t drink) has a comic tee shirt and as a sarcastic play on words of the old adage it says: ‘work is the curse of the drinking class’.
As you well know, these are times that would tempt some to drink a lot.