© Samantha Pillay 2021.
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Will Drinking Alcohol Ever Go Out of Fashion?

Why responsible drinking is an oxymoron

Med Camp, held before the commencement of Year 1 Medical School, was run by the existing medical students. As a 16-year-old, one of three daughters, from an all-girl school, this was my introduction to university life. Alcohol consumption was excessive, and there were many casualties that week, with trainee doctors getting hands-on experience caring for their sick colleagues.

As a university student and young doctor, alcohol consumption revolved around social activities, rather than at home, due to financial constraints and constantly studying for exams. Surgical training meant my life evolved around studying into my thirties. Even with exams behind me, fortunately, the demands of my profession curtailed my alcohol consumption.

During my thirties and forties, my income increased, and I could afford a good wine at a restaurant or with an evening meal at home. As I matured, I overindulged less often but enjoyed a couple of glasses of wine regularly.

As a medical professional, I was well aware of the toll of excessive alcohol on the body. I encountered people in my social network who seemed to show no sign of slowing down their alcohol consumption as they aged. In comparison, I thought my alcohol consumption was 'normal' for my demographic. There were occasional lapses in judgement where I overindulged, the after-effects more noticeable with age. Stress was the primary motivator for alcohol consumption. The more taxing my day, the more likely I was to have a drink to unwind at the end of the day.

There had been a few prolonged periods of alcohol abstinence, up to 18 months duration, during my life. Some were for health reasons; pregnancy, breastfeeding; a hip replacement—others during intense studying periods for university and surgical exams.

The most unexpected period of abstinence was in my twenties when I took a year off to travel the world. No commitments, work or study – a year to do as I pleased. Backpackers often have a reputation for heavy drinking. I had never had so much fun in my life. I was enjoying every moment to its fullest. I didn't want or need anything to dampen the experience, and six weeks into my adventure, I stopped drinking alcohol altogether. Finances were tight, and this helped immensely.

As I entered my fifties, with age came increased self-awareness. Even one or two glasses of wine reduced my sleep quality. A temporary escape from stress or problems didn't provide any solution or changes. In fact, by not resolving issues, they accumulated, only allowing my stress to increase and driving the need to escape. I knew one of the effects of alcohol withdrawal with excessive consumption was anxiety which only caused people to drink more. I wondered, could only one drink cause anxiety as the effects wore off? Were there levels of addiction that drove perpetual drinking, even low levels of alcohol consumption?

I began to analyse the impact of low levels of alcohol. When socialising, I realised that sober, I was more interesting, entertaining, polite, a better listener, and more considerate of others. I was more engaged and present in the moment and had more meaningful and memorable experiences. Without even one glass of alcohol, I was a better and more involved parent.

My time at home was more productive. I solved problems, became more organised, achieving far more with my time. I started spending my downtime learning – my lifelong passion. I consumed audiobooks and online courses instead of alcohol. My productivity and happiness grew, and my stress reduced. I made positive changes in my life. I fulfilled a lifelong dream of writing and publishing a book. When writing, I would become lost in the words, relaxing without a negative health impact.

Instead of using alcohol to endure social activities I didn't enjoy, I was selective, only attending events I enjoyed.

These changes drove me to want to consume less alcohol. I wasn't avoiding or using any effort to resist alcohol. I had merely taken the time to stop and analyse my alcohol consumption.

By working towards the life I wanted one step at a time, I didn't need to escape. I now viewed alcohol as something that would take me away from my goals, life and enjoyment. I stopped drinking alcohol without making a conscious decision and effort to stop. I had just ceased to have any relevance in my life.

I started to notice other benefits; less tendency to weight gain, better conversations and relationships with others, more patience and tolerance, better skin condition and looking younger.

My savings were staggering; restaurant bills were almost halved. No Ubers required; I could drive. I would go home earlier and start the days with more energy. I made better decisions in every aspect of my life. I saw alcohol as an unnecessary expense.

As an academic and 'learnaholic', I knew my brain was my greatest asset. We are entering a new era where people regularly live to one hundred years. How we live our first fifty years may determine our second fifty years' quality of life. Something that has not been a primary concern in previous generations. I wanted to preserve my health as long as possible. Born with hip dysplasia, I knew first hand what it was like to live life with limitations.

Alcohol is so ubiquitous in our society it is rare for it not to be available at a social function. I was amazed during COVID lockdowns when bottle shops were given the same "essential service" status as supermarkets and allowed to stay open. So deep is our cultural dependence on alcohol that people will risk their lives to access alcohol in a pandemic crisis.

By relying on alcohol to deal with stress, we fail to develop other, better tactics to manage stress. When a major event comes along in our lives, faced with the fears and uncertainty of a pandemic, many people were only equipped with alcohol to deal with the situation. Yet alcohol impairs decision making and judgment. When people need to make good decisions in a crisis, whether it be a pandemic, financial stress, or relationship breakdown, they turn to alcohol, only impairing their judgment.

An important aspect in life is taking the time to stop and think about what you are doing, what changes you want, and how to make them. Alcohol stopped me from making these critical analyses and adjustments in my downtime, spending years on the same treadmill. Alcohol allowed me to stop or slow down the treadmill periodically, only to get back onto the same treadmill afterwards. By not addressing my goals, the need to escape continued.

Alcohol consumption in the elderly

I was surprised to learn that the highest rates of daily drinkers were the over 70's. When my mother spent a period of respite in a nursing home, alcohol was served daily with lunch and dinner. Their surprise that she didn't drink alcohol equalled my surprise at the reduction in the daily accommodation fee without alcohol included. At a time in life when time is running out, alcohol has a more significant impact on the elderly health and cognition, increasing the risk of falls, interacting with medication and reducing their ability for self-advocacy.

Alcohol and Productivity

A highly functioning alcoholic may still perform in a responsibly and productive way, outperforming most others, but how much more productive would they be if they didn't drink alcohol? When I think of people who don't drink, I think of those at the top of their game, athletes and astronauts. I recall the times I performed at my peak studying for surgical exams, alcohol-free. Warren Buffett is a famous teetotaler.

Low levels of alcohol are dangerous!

Even as a doctor, I believed this urban myth that a glass of red wine was good for you. I was surprised to learn there is no recommended or safe level of alcohol. There is no longer sufficient evidence to support that red wine or alcohol at low levels is good for you.

I discovered what I had considered low level is defined as moderate alcohol consumption.

Moderate alcohol consumption is up to 2 standard drinks per day for men and one for women.

The US National Institute on Alcohol Abuse and Alcoholism defines heavy alcohol consumption as > 4 drinks on any day or > 14 drinks a week for men and >3 drinks on any day or >7 drinks per week for women. Binge drinking is heavy alcohol consumption on five or more days in a month. Current advice is that drinking more than two standard drinks a day can seriously affect your health long-term.

When I discovered 'safe alcohol' was not backed by science, I became interested in other long-term health effects of what I had previously considered a safe alcohol consumption level.

Alcohol Causes Cancer Even at Low Levels

Women who have three alcoholic drinks per week have a 15% higher risk of breast cancer than women who don't drink, with an estimated 10% risk increase for each additional regular daily drink.

One to two standard drink per day increases your risk of stomach and bowel cancer. Three to four drinks per day increases your risk of liver cancer.

Alcohol increases the risk of cancer of the mouth, throat, oesophagus, prostate, kidney, and pancreas, melanoma and non-Hodgkin lymphoma. The optimum number of drinks per day to minimise your risk is zero.

Other Long-term Alcohol Effects

As a doctor, I was surprised by how unaware I was of the scientific data on alcohol's effects. I might have stopped drinking alcohol years earlier if I had known. The information was readily available; had it not been reaching me, or did I somehow choose to ignore it?

Memory: Chronic alcohol consumption affects memory cognition and causes dementia. Studies have demonstrated loss of brain tissue in the hippocampus, the structure vital to learning and memory. The effects on the brain are more significant in women.

Drinking more than two standard drinks per day increases your risk of high blood pressure, type 2 diabetes, and heart disease, increasing your risk of heart attack and stroke.

Even one to two drinks per day increases the risk of cirrhosis of the liver.

Alcohol increases the risk of stomach ulcers, and even one drink per day can increase the ulcer bleeding risk.

Alcohol reduces male testosterone and fertility.

There is no safe level of alcohol during pregnancy or while trying to conceive.

Alcohol can impact sleep quality, sleep duration and cause sleep disruptions. Chronic alcohol consumption may cause long term damage to the circadian rhythm.

Alcohol use impacts mental health, drug addiction, gambling, obesity, depression, psychiatric disorders, and suicide.

In young people, alcohol can affect brain development and increase long-term alcohol dependence. They are more likely to be at risk of violence, road accidents, risky behaviour, poor decisions of sexual assault, use of other substances and break the law.

Is encouraging, endorsing and or supplying our children with alcohol in their best interests? Are we acting as the best role models? The best way to prevent future harm is to delay the introduction of alcohol as long as possible. Recent laws in my state of South Australia require that the supply of alcohol to teenagers in your home needs the parent's consent, supervision by a non-intoxicated parent and that the teenager is not intoxicated.

How would a shift in alcohol consumption come about?

A shift in behaviour would need to be driven by providing a solution to society's needs. Government regulation, taxes, restrictions on advertising or limitations on purchasing and where alcohol can be consumed will only go so far.

The risks of smoking were known for years before being able to turn the tide on smoking behaviour. I recall in the early '70s, both my parents smoked. As children, we were being educated through schools and a widespread community campaign about smoking risks. We hassled our parents daily until they quit. My father, a doctor, was aware of the evidence and an early adopter of the quit smoking movement.

Now, most people don't smoke because they don't want to, not because of regulation. They have either quit or avoided ever starting to smoke, educated about the effects. Even if you offered free cigarettes at a social function, the non-smokers wouldn't take up the offer. It has gone out of fashion. People have lost interest over time, and the responsible removal from media and visibility has helped.

LESSONS LEARNED FROM SMOKING

Male smoking rates peaked at 72% in Australia in 1945, compared to 12.8% smoking daily in 2019.

People smoked for their enjoyment, relaxation and to socialise. The decrease in smoking rates didn't mean people were no longer enjoying themselves; they found other ways.

Initially, people smoked without understanding the harmful effects. As the evidence mounted, they chose to ignore it, consumed by their busy lives, without stopping to analyse their behaviour.

Smoking was addictive, and it was going to take effort to change. It wasn't going to be easy. It was effortless to continue smoking when most of society smoked, especially celebrities and authority figures; politicians, doctors, lawyers. Cigarettes and tobacco were available everywhere.

Public education on the harmful effects of smoking was an important factor. As the evidence mounted, some early adopters spread the word at the grassroots level, like my father, who then continued to help his patients quit over the next four decades. Today the most disadvantaged groups continue to have the highest smoking rates.

Although we have more accessible information today, public education has become more challenging. Previously education came from reliable sources. Now the internet provides a confirmation bias where people can virtually access any information to support their beliefs. People have access to the most amazing resources but lack an understanding of scientific methods to analyse the data critically. Fake news is worse than no news. Celebrities compete with authority figures. Testimonials compete with scientific statistics.

Government policy can influence behaviour, but a shift in society's views drives, in turn, government policy and funding for public education, reform and research.

I wondered whether there were any lessons to be learned from the change in smoking behaviour seen in many countries over time.

Ending the Tobacco Problem: A Blueprint for the Nation, published in 2007, highlights important lessons from smoking history.

  • Smoking is highly addictive.
  • Smoking was so embedded in the American culture that many physicians openly smoked and sometimes even promoted the product.
  • People had a distorted perception of the risk and harm from smoking, especially young smokers.
  • Heavy smoking rates were seen among vulnerable populations.
  • Nicotine dependence is associated with the development of tolerance and withdrawal symptoms of stress, anxiety and irritability.
  • Nicotine is rapidly absorbed and passes to the brain.
  • 90% of smokers started smoking before age 18 years.
  • Adolescents were less likely to believe the risk of addiction and health consequences applied to them.
  • The longer you smoke, the harder it is to quit.
  • Adolescents tended to exaggerate the benefits of smoking and believed that they could quit.
  • Many people neglected the long term health risks because they were not likely to materialise for decades.
  • From what we now know, cigarettes would not be allowed into the marketplace if introduced today.
  • Attempts were made to market light cigarettes as healthier when they were not.
  • The cessation of smoking in bars and restaurants had little impact on patronage.
  • Parents as role models were a major factor in determining children's future smoking behaviour, with children of smokers twice as likely to start smoking before age 21.

Public Health Initiatives that reduced smoking rates:

  • Public education was the first line of remedial action.
  • School-based programs were introduced.
  • Anti-tobacco advocacy and grass-root efforts played a key role.
  • Warning labels on packaging.
  • Tobacco taxes.
  • Restrictions were placed on where people could smoke.
  • Reduced access.
  • Banning advertising.
  • Prevention programs in schools and health care systems.
  • Media campaigns.
  • Cessation programs.
  • The risk of smoking endangered non-smokers. This lead to smoking bans in the workplace, with government workplaces first.
  • Promoting the harm to children from smoking in the home and car.

The Foundation for Alcohol Research and Education (FARE) in Australia is working to stop the harm caused by alcohol through numerous activities, including lobbying for a reduction in false advertising to promote alcohol as healthy if low carb or low sugar, and end alcohol advertising in sport.

Will drinking alcohol ever go out of fashion?

What other factors might influence people's drinking behaviour in the future? Alcohol impacts learning. Gone are the days when people studied after school, then continued in their career with little further education. As the rate of change in our world accelerates, people will require lifelong learning to prevent falling behind. Future skill sets will be more complex as machines take on less complicated skills. In a world of driverless cars and automation, will those training for a space mission be able to drink alcohol?

I would argue the impact of alcohol on others is far more significant and far wider-reaching than smoking. Consider gambling, crime, violence, self-harm, domestic violence, child abuse, road accidents, sexual harassment and sexual violence. Recent problems of bullying, harassment and even sexual violence within organisational cultures and workplaces link to alcohol consumption. Workplaces are likely to become the first alcohol-free places as we saw with smoking. Will those companies with responsible alcohol policies attract the best generation Y and Z workers?

Has the consumption of alcohol by others around you ever impacted your enjoyment? Some significant economic impacts and shifts would occur in response to reduced alcohol consumption in society. Businesses would rethink the way they do business. Profit margins in hospitality can be more significant from alcohol than food supply. Yet, I would pay entry to an alcohol-free venue, an even higher profit margin when there is no need to supply food or alcohol for an experience.

Alcohol helps people socialise, but it can inhibit them from developing other social and communication skills. Think of people you know who, after a few drinks, still behave the same way they did as teenagers. Good communication is based on listening, not a self-absorbed rant. A demand in alcohol-free venues could become a business opportunity for some.

Will the lure of better social experiences, less stress, and more enjoyment from alcohol become an empty promise to an educated population with other resources available to them?

Will alcohol cease to have relevance in people's lives as they become more mindful, living enriched lives to the fullest?

Will societies expectations from our leaders in politics, law, medicine and business drive cultural change?

How will an audience read this article in fifty years?

DISCLAIMER

This article represents personal views and a personal experience. It is not intended as individual medical advice.

If you're a heavy drinker, it can be dangerous to reduce or quit alcohol without speaking to your doctor first. Further resources are listed at https://fare.org.au/ripple/need-more-support/.

If you are thinking about your drinking, here are some resources to help https://www.rethinkingdrinking.niaaa.nih.gov/.

For young people https://au.reachout.com/challenges-and-coping/alcohol-and-drugs.

For assistance with alcohol consumption contact services in your country like the Australian National Alcohol and Other Drug Hotline.

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