The Data on Drinking

Drink?: The New Science of Alcohol and Health, by David Nutt

David Nutt is an English neuropsychopharmacologist, meaning he studies drugs that affect the brain. Of which alcohol is a big, bad one.

He was fired, or asked to resign, from his position as a government drug advisor for saying on primetime radio “that alcohol was the most harmful drug in the UK. At that time alcohol wasn’t even allowed to be considered a drug by the UK Advisory Council on the Misuse of Drugs – the ACMD – despite every scientist in the country knowing that it most certainly was a drug.”

He returns to this point that got him in trouble, asserting that neither the government nor the alcohol industry wants it classified as a drug, but from his perspective as a scientist examining alcohol’s affects on the brain’s neurotransmitters, that status is indisputable.

Drink? is a collection of information about some of alcohol’s neurological and other physiological effects, as well as data about the harm its use — even in alarmingly small amounts — can have on our behavior and lives. Plus the striking big picture impact: “In the US, drinking costs $249 billion a year of which $28 billion are health care costs and $23 billion from crime.”

There’s a lot of fascinating information and data here, but it’s mostly written like an extended heath department pamphlet. It’s undeniably important, but could it be any…drier (pun intended; I’m sorry.)

It’s sometimes just lists of statistics and data. Nevertheless, I still highly recommended it if you’re interested in the topic, and as a resource (plus it’s not very long so it’s not a massive time commitment). I’m especially interested, having come at it from multiple angles over time, both the weird feelings and treatment by those around you when you don’t drink, and later self-medicating with alcohol, as well as seeing its powerful and uncomfortable effects on and control over people I’ve been close to. So regardless of whether it’s the juiciest read or not, I wanted to learn from it and I did. If you feel similarly, it’s helpful.

He identifies there being a marketing push that “has altered our perception” of the way we consume alcohol, including its ubiquity in “every part of our lives” — he lists social bonding, drinking to close business deals, to celebrate births and commiserate deaths. Like I mentioned with this book, this is an area I want to know much more about and I can’t seem to find an in-depth resource for it.

There is a somewhat scary element, like when he writes that “Years before any health issues show up, alcohol is already affecting very organ and system of your body, including your brain. And there are more subtle changes happening too, “affecting health, sleep, work performance, skin, fitness, and sex life.” Or that “the safe limit of alcohol, if you applied food standards criteria, would be one glass of wine a year.” And to stay below the acceptable food standard risk for cancer in particular, you could consume “a maximum of two standard drinks a year.” Fuck.

His main message is that he doesn’t want you “to throw alcohol down your throat without thinking.” He argues for being conscious of what you’re drinking and why, and that drinking should be a “positive, active pleasure rather than a reflex and habit, or something you’ve always done, or self-medication for stress or anxiety.” And to understand what amount of alcohol makes sense for you in terms of your personal risk-benefit analysis. On this basis, I think this is a must-read for any drinker, whether you consider yours problematic or not.

It’s well-sourced and cited, but when it’s not I was left wondering. Like this: “Most of us have some level of social anxiety, and alcohol removes our fear and inhibitions.” For me, this is entirely true. But I’m curious about the broad assumption. Of course alcohol lowers inhibitions, but do most of us really have some level of social anxiety? On the one hand, I’m relieved at being less alone; on the other, I’m suspicious just based on a lifetime of observation.

The bottom line, much as we don’t like to hear it, is that “no level of drinking is actually beneficial to health.” I suspected as much. He goes into a lot of detail around this which I appreciated and find valuable, because as he notes, “everyone who drinks loves to read all the reasons why it’s a good idea, right?” And they love to parrot these, but the reality is that research shows that “any protection (by red wine against stroke, for example) would be more than cancelled out by the negative effects.”

It also contained a fascinating look at how many lives have been saved, albeit controversially, by raising the federally mandated drinking age in the US to 21 in the 1980s — something I found Europeans constantly marveled at, since most European countries sell beer and wine from age 16. He says it’s credited with saving hundreds of thousands of live in road accidents, since “Young people’s driving is much more impaired by a given level of alcohol.”

One section I loved and wished I’d heard about a long time ago was the prevalence of problematic drinking among expats. This happened to me and every single one of my close expat friends, yet I had no idea it was a widespread occurrence, I thought it was just us, which now seems ridiculous. For factoids like that, I found this very helpful and I think anyone with questions or issues around consumption would be likely to find some kind of answer or direction for pursuing further research here.

And it has actionable sections, like in how to deal with people who badger you about not drinking, providing some helpful statements. Sadly, one of these is a reminder of the advice that “No is a complete sentence.” Which bums me out that some people are so aggressively uncomfortable with non-drinkers that you have to use the same words as when dating an asshole. Drinking culture fascinates me for this reason, and this is a good step in learning more about it, if a bit clinical.

Also interesting: the author owns a wine bar in London, despite having lost a job for refusing to compromise on acknowledging the dangers of alcohol and insisting it be classified as a drug. I sense some curious cognitive dissonance, although again, his main message is to be conscious of what, why, and how you’re drinking and adjust your ideas of moderation even lower, not to abandon it completely. Whether it’s realistic and achievable for most, I’m not sure.

Drink?: The New Science of Alcohol and Health
by David Nutt
published December 22, 2020 by Hachette

I received an advance copy courtesy of the publisher for unbiased review.