
Here’s yet another reason for “Dry January,” if not “dry indefinitely”: US Surgeon General Vivek Murthy says alcohol consumption causes cancer, that it is responsible for 100,000 cases of cancer and 20,000 cancer deaths annually.
“The direct link between alcohol consumption and cancer risk is well-established for at least seven types of cancer including cancers of the breast, colorectum, esophagus, liver, mouth (oral cavity), throat (pharynx), and voice box (larynx), regardless of the type of alcohol (e.g., beer, wine, and spirits) that is consumed. For breast cancer specifically, 16.4% of total breast cancer cases are attributable to alcohol consumption.”
Do we need warning labels on every bottle, as he’s proposing? Setting aside the fact that it won’t happen due to pushback from the alcoholic beverage industry, I think it would probably be a waste of time and money, because it’s not likely to change anyone’s behavior. Most people who drink already know that alcohol can be harmful to the body, because they’ve had one or more harmful experiences, or “negative consequences” as we say in healthcare, and yet they keep drinking anyway. But that’s the cynic in me talking.
The optimist in me says, Yes, even if it only moves the needle 10%, that could save 200 lives! More, given the many ways that drinking can lead to death. While most people don’t heed warning labels, some do, and although it won’t help the folks who are committed to drinking regardless of risk, it may get the attention of those who are concerned about their health and want to increase their chances of living a long and healthy life.
His advisory has already got our attention – I’ve seen half a dozen news articles on the topic in the past week – and talking about it could lead to behavior change. We can’t change that which we are unaware of, so the first step in change is awareness.
If you’re skeptical of this news, that’s not surprising. After all, hasn’t the medical community been telling us for decades that moderate drinking is safe, even a healthy habit?
Here’s what I know, based on my training as a substance abuse counselor, over 40 years of experience counseling adults who drink too much, and my own personal experience. In a nutshell:
* Alcohol is both an intoxicant and a toxin
* Its addictive potential is strong
* In small amounts, it produces some pleasant benefits, like relieving social anxiety and stress
* But it comes with serious risks, including painful illness and death, which are not always proportionate to the amount consumed.
* It is so ubiquitous in our society that if you don’t drink you’re considered odd, and if you do, it’s very easy to consume too much.
How much is too much? That’s a key question. Do you know that before the 1980’s, a standard drink was considered to be 1 oz of spirits, or 4.2 oz of wine? You could get six drinks from one bottle of wine. But drinks, like food, got supersized, so that now the standard drink is 1.5 oz spirits, 12 oz beer and 5 oz wine. Many restaurants offer 6 or 8 oz pours of wine, while craft beers and hard seltzers have a higher alcohol content. Right there you can see how easy it is to overdrink, and how common it’s become. (Here’s a standard drink chart for reference.)
The notion that moderate drinking is healthy originally came from Scandanavian health survey data, which showed a correlation between “moderate” alcohol consumption and low rates of disease. First, correlation is not causation. Moderate drinkers might have good genes, or a healthy lifestyle, or get health checkups more often. Second, it turns out that “moderate” drinkers in those surveys were those who drank “more than none,” anywhere from 1-2 drinks a year up to 1 drink a day. From this data, our American healthcare experts extrapolated that it must be healthier to have a drink a day than none at all!
To be clear, alcohol is not a health food, and there is no universe in which it’s healthier to drink alcohol than to abstain. Doctors who have “prescribed” a drink a day, or assured their patients that “moderate drinking is perfectly safe” are either uninformed, afraid to offend their patients, or in denial about their own alcohol consumption. But we can’t just blame doctors; most people want to believe that 1 to 2 drinks a day is okay.
In reality, for most people most of the time, drinking is a pleasant experience. Alcohol is an effective mood enhancer, at least initially, and it can anesthetize physical pain as well as numb emotional pain. Because it lowers anxiety and inhibitions, it serves as a “social lubricant” for many people. Many people like the taste, and enjoy trying different drinks.
Can something be both good for you and bad? Sure, consider acetominophen (Tylenol). It’s available over the counter, so it must be safe, right? Yes, if you take 325 – 1,000 mg every 4-6 hrs, as the label directs. But wait – just 4,000 mg over 24 hrs can cause liver damage! The same is true of ibuprophen (Advil), which is safe for pain relief if taken as directed, but can destroy your stomach lining if you take it in large quantities. There’s a fine line between a safe amount and a risky amount, just as with alcohol. (And fentanyl, which I had for a recent surgery, but obviously wasn’t given a 12-pack to take home!)
The comparison with fentanyl is more apt than with acetominophen, because of the potential for addiction. Nobody gets addicted to Tylenol. Why? It’s not an intoxicant, it doesn’t give you a buzz or mellow feeling. So understanding the addictive potential of alcohol is also an important factor in deciding whether it’s safe for you to drink.
For many years, people thought it was perfectly safe to smoke cigarettes, and they smoked in restaurants, offices, airplanes, even hospitals! We now know that for many years the tobacco companies spent lots of money to suppress the research that showed smoking causes cancer, and that nicotine is addictive. Now these are well-known facts, and yet, some people still choose to smoke. (Another US Surgeon General warned about smoking and cancer back in 1964, but smoking behavior didn’t change for decades.)
The risks associated with alcohol consumption are also known, and the alcoholic beverage industry has also tried to hide that research, but mostly, it just spends millions of dollars every year on marketing campaigns to convince you that everyone drinks (not true), and that drinking alcohol will make you happier, sexier, and a lot more popular!
These days, it’s a safe bet that most people who drink are drinking too much, and should drink less or quit, for their own good. So why don’t they? The most common reason people have trouble changing their drinking habits is simply that a habit can be difficult to change, especially when there’s so much encouragement for drinking in our society, and when it’s so readily available and relatively inexpensive.
Most people can drive over the speed limit without getting a ticket or having an accident, and we usually don’t even think of that as “risky” behavior. In the same way, we don’t tend to think about drinking as risky, and any negative consequences from drinking may seem so rare or unlikely to happen that they’re easy to dismiss as “it’ll never happen to me.” (By the way, that’s the title of a classic book about children of alcoholics, and ironically, if you have a parent who is or was an alcoholic, your odds of developing alcoholism increase by 50%.)
Another reason some people drink too much is they believe “everyone drinks like this, and that’s just how it is.” They think of drinking as a super fun activity to do with friends, which makes them feel sexy and no longer shy, and so what if they black out or have a terrible hangover the next day, doesn’t everyone? This thinking is common among people who may have started out with binge drinking in high school or college, and don’t know any other way to consume alcohol. (Binge drinking is defined as 5 or more drinks on one occasion.)
I have counseled hundreds of adults who have experienced “negative consequences” (blackouts, DUIs, relationship problems, health issues, job jeopardy) from drinking, and would like to learn how to avoid future negative consequences. None of them have wanted to quit completely, and most didn’t believe they needed to quit, because “I’m not an alcoholic, I just enjoy [the taste, the way it relaxes me, the social aspect]”. So we start with a treatment goal of drinking less, not quitting.
My experience has confirmed what the research shows: indeed, some people can learn to drink less, so that they lower their risks of negative consequences. Usually it’s younger people, who have been drinking for fewer than 10 years, who don’t have a family history of alcoholism. Occasionally it’s an older person who just needed to learn a few tips, like to drink only occasionally, not drink on an empty stomach, alternate alcohol with drinking water, stick to 1 or 2 drinks, and to say a firm “no thanks” to another one.
But most of my clients who have experienced one or more negative consequences from drinking haven’t been successful at moderation. They quit counseling instead, or in some cases, come to the decision that it might actually be easier to abstain completely, because it seems to require too much self-discipline to drink less.
Frankly, one major reason some people continue to drink too much despite negative consequences is that they’re already addicted and just don’t know it, because alcohol use and abuse exist on a spectrum, where the lines between “moderate drinking,” “risky or problem drinking,” and “alcoholism” are difficult to discern. If addiction has already taken hold, chances of learning to drink moderately are slim, no matter how much willpower a person has.
I believe it’s still worth trying to reduce a dependence on alcohol, so I support “Dry January,” and “Sober Curious,” and encourage you to consider other experiments in abstinence. Keep a log or journal of thoughts and feelings that arise when you’re choosing to not drink, and pay attention to what your mind and body tell you – it might be very informative!
If you’d like help figuring out your relationship to alcohol and whether it needs to change, please feel free to reach out to me. I’m not taking new patients for long-term therapy, but I am available for short-term consultation, assessment, and referral. I also recommend checking out the ReThinking Drinking website.
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