There is no doubt that alcohol can be a two-edged sword: while moderation can make the overwhelming majority of us healthier, heavy drinking and abuse has the potential to cause ill health, misery and death for an estimated seven to ten percent of the American population.
This is a very complex problem about which hundreds of books and scholarly articles have been written. Any treatment of this subject in a book such as this risks over-simplifying the problem; despite this risk, this is a subject that needs to be raised even though space here does not allow an exhaustive treatment.
Alcohol abuse, alcoholism, problem drinking, dependency: whatever it's called it should not be minimized. Everyone, not just alcohol consumers, should be aware of the signs of abuse and dependency. We should take quick, early action to stop drinking or seek treatment (or to urge a friend or loved one to stop or seek help) if drinking exceeds moderation.
People who abuse alcohol, according to substance abuse experts, usually have problems controlling other compulsive behavior. These people are often abusers of other substances -- almost always tobacco and frequently cocaine and other illegal drugs as well as tranquilizers and other prescription drugs. They also tend to have other compulsive disorders associated with food (obesity or anorexia) or behavior.
One of the most commonly used devices to help detect current or potential alcohol problems is the Michigan Alcohol Screening Test (MAST). A score of 5 or more on the test is considered an indication of dependency. Among many questions, the test asks if the person being tested:
-- Has ever been arrested for drunken driving (yes = 2 points).
-- Has ever gotten into trouble at work because of drinking (yes = 2 points).
-- Has ever neglected personal obligations (work or family) because they were drinking (yes = 2 points).
-- Has ever been in a hospital because of drinking (yes = 5 points).
-- Has ever been to anyone for help with drinking (yes = 5 points).
The test also asks the person if:
-- They feel they are a normal drinker (no = 2 points).
-- Their friends or relatives think they are normal drinkers (no = 2 points).
The MAST test aims at detecting more full-blown cases of alcohol abuse. Experts say that detecting a developing dependency is far more important to the individual because it is easier to treat the earlier it is detected.
Heavy drinking is usually one of the first signals. Although some people may develop a psychological dependence on one or two glasses per day, this is not common. The scientific definitions of moderate versus heavy drinking are discussed at length in this book's chapter on moderation. In general, however, the broad mass of scientific research defines moderate as 25 grams of alcohol per day (two to three drinks) and heavy drinking at about 50 grams per day or more.
Other signs which may be a warning of alcohol abuse include:
-- Orienting personal activities around drinking;
-- Drinking at the same time each day;
-- The inability to have fun without drinking;
-- Drinking for courage or to relieve sadness or depression;
-- Increased tolerance for alcohol (that is, it takes more alcohol to get intoxicated);
-- Frequent absences from work or family obligations due to drinking and
-- Physical withdrawal symptoms in the absence of alcohol such as nausea, nervousness, lack of concentration, sweating.
It's important to note that the the definition of heavy drinking and abuse have been blurred in recent years by anti-alcohol advocates who have consistently attempted to redefine "heavy" drinking as more than three to four glasses per week. Most substance abuse experts say this attempt to make the glass of wine-per-day sipper a "heavy drinker" devalues the impact of true abuse and, in the process, hinders their ability to treat those people who are truly alcoholics.
Many health industry experts say that this "ratcheting down" of the definition of heavy drinking is driven by the economic concerns of hospitals and clinics who have found substance abuse a very profitable medical practice and an efficient way to fill empty beds. It is in the economic self-interest of those in the alcohol treatment industry to diagnose as heavy drinkers people who are actually consuming moderate and healthy amounts of alcohol. The abuse treatment industry has an audience for its advertising and promotional efforts if, as some people assert, any amount of alcohol consumption is bad and unhealthy.
Some people should be especially careful when considering their choice to consume alcoholic beverages. They include:
-- The 7 to 10 percent of Americans who have compulsive disorders that make it impossible to consume moderately;
-- People suffering from mental illnesses, particularly manic depression;
-- People with hypertension, gout, ulcers or diabetes. Alcohol consumption does not cause these disorders, but heavy drinking can aggravate them. Moderate drinking with your doctor's consent, however, can have beneficial effects on diabetes and possibly hypertension;
-- Women, who are usually smaller and have less body fluids than men of the same size, resulting in higher blood alcohol concentration from the same amount of alcohol consumed;
-- Pregnant women, although a consistent body of more than two dozen studies have failed to find any association between up to 10 drinks per week and any effect on the developing fetus;
-- Women with a history of breast cancer in their immediate relatives (sisters, mothers) and
-- Men whose wives or significant others are trying to conceive.
While abstinence may seem like the best way to prevent abuse, experiments with prohibition in America and draconian control in Europe show this is not practical. What's more, the scientifically proven connection between alcohol and beneficial health effects for most people show that abstinence is not always desirable.
Given all that, the important personal health issue is to determine what puts people at greater risk of abuse, and then decide how to reduce or eliminate that risk.
Alcohol abuse seems to have some genetic connection. Studies on twins have shown that it's more likely that identical twins will abuse alcohol than will fraternal twins.
Likewise, family studies have shown that children of abusers are more likely to be abusers themselves. Some genetic predisposition is undoubtedly at work in both cases, but most studies show that family behavior and what children learn in the home is far more important.
A number of studies have shown that families in which one parent was an alcoholic, but which continue to carry on with rituals, such as regular dinner times and holiday celebrations, produce fewer alcoholic children in later life. A study conducted by psychiatrist Dr. Stephen Wolin, M.D., at George Washington University and anthropologist Linda Bennett at Memphis State University studied 68 married men and women who had an alcoholic parent. Of the 31 whose parents were least deliberate at carrying on family rituals, there were 24 alcoholics. But among the 12 whose parents were the most deliberate at maintaining family rituals, there were only 3 alcoholics.
Indeed, the study also found a markedly reduced incidence of abuse among children of alcoholics who married people coming from families with strong rituals.
Societal rituals, practices and expectations also exert enormous influence over drinking and help promote or control abuse. The Mediterranean model of alcohol consumption, where alcohol is freely available and consumed but which has relatively little alcoholism contrasts with northern Europe and America where alcohol consumption is strictly controlled (by guilt, religion and government), consumed in smaller amounts and where alcoholism is a far greater problem.
According to the U.N.'s World Health Organization (WHO), Italy, which makes more wine than any other country in the world and has the second highest wine consumption in the world (approximately 19 gallons per person per year), has less than one-seventh the rate of alcoholism (500 per 100,000) as the United States (3,750 per 100,000) which drinks only about one half gallon of wine per person per year.
Wine is a key part of this equation since it is the beverage most often consumed moderately and with food. Bingers most often use beer and spirits. In fact, in one key indicator of the tragic consequences of alcohol abuse -- drunk-driving accidents -- the U.S. Department of Transportation reported that wine was a factor in only 2 percent of the incidents.
In Italy and Greece, wine is consumed in small amounts and almost always with food. People who drink too much are social outcasts. Wine in these cultures is simply another food to be enjoyed and is notable by its lack of specialness. Unfortunately, many northern European habits are working their ways south, among them a shift to liquor and beer which are drunk mostly by themselves, especially by young "hip" Italians. This has resulted in an unfortunate increase in alcoholism and alcohol-related traffic accidents.
By contrast, in northern Europe, especially in the Scandinavian countries, alcohol is heavily regulated, punitively taxed and imbued with great moral significance. The relatively rare state-controlled alcohol stores in Finland and Sweden are sterile and unappealing by American standards; advertising is not allowed and taxes are double or triple those in other European countries. In Sweden, each community has a Temperance Board to which people who may have a drinking problem are referred. Despite the best intentions of these liberal countries' social engineers, public drunkenness and binge drinking is common. In Finland, strict sales and advertising controls on alcohol, and a national Department of Sobriety, along with moral approbation for almost any level of consumption, have produced:
-- A Finnish rate of arrests for drunkenness of about 7 percent of the population, higher than any other European country;
-- Government estimates that Finns consume more illegally brewed alcohol than is bought in stores and
-- A death rate from acute alcohol poisoning that is about five times higher than Denmark which, alone of the Scandinavian countries, lacks draconian alcohol control laws.
To their credit, however, the Scandinavian countries have reduced drunk-driving accidents to approximately 10 percent of driving accidents, as opposed to the estimated 25 to 50 percent in the U.S. Research shows that this is partly due to strict penalties for drunk driving, but mostly because of efficient and extensive public transportation which reduces the reliance on automobiles.
So it seems that, in addition to cutting heart attack risks in half and decreasing the overall death rate by more than 10 percent, moderate consumption of alcohol, especially wine, with meals is an effective way to reduce the risk of abuse, except for the 7 to 10 percent of Americans who cannot consume it moderately and for whom abstinence seems to be the best option. But since research indicates that taxation, availability control and moral prohibitions do not work, and, further, that much of the abuse seems to be learned rather than inherited, the best protection of all against abuse may be:
-- a moderation mindset, combined with
-- education and
-- a coherent family with strong rituals.