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How Does Alcohol Affect Society?

Buddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Emily is a board-certified science editor who has worked with top digital publishing brands like Voices for Biodiversity, Study.com, GoodTherapy, Vox, and Verywell.

• Financial Cost
• Aggression and Violence
• Impact on the Family

Alcohol is the most commonly used drug among U.S. adults. Alcohol use is associated with a wide range of health risks and other problems for individuals. But the costs of alcohol don't just affect the person drinking. 

According to the Centers for Disease Control and Prevention (CDC), excessive alcohol use costs the U.S. almost a quarter trillion dollars a year. Economic costs are one part of the toll, but there are also other societal issues that are tied to alcohol use.

At a Glance

The real-world impact of alcohol abuse reaches far beyond the financial costs. When a loved one has a problem with alcohol, it can affect their marriage and their extended family. There's also a larger impact on the community, schools, the workplace, the healthcare system, and society as a whole.

How Alcohol Affects Society

Alcohol use can affect society in terms of:

• Economic costs linked to increased healthcare expenses, lost productivity, and legal costs
• Health consequences caused by health problems caused by alcohol as well as accidents, injuries, and violence connected to alcohol use
• Legal consequences , including increased crime, drunk driving accidents, and other issues related to law enforcement and criminal justice
• Family effects , including child abuse, neglect, intimate partner violence, and substance use problems in children
• Educational costs associated with worse academic performance and achievement

Such costs are often linked to those who have alcohol use disorders. According to the 2021 National Survey on Drug Use and Health (NSDUH), 29.5 million people over the age of 12 (10.6% of the population) had an alcohol use disorder in the past year. Estimates suggest that approximately 13.9% of people in the United States will meet the criteria for severe alcohol use disorder in their lifetimes.

However, it's not necessarily people with alcohol addiction having the biggest impact on these figures. It's estimated that 77% of the cost of excessive alcohol consumption in the U.S. is due to binge drinking , and most binge drinkers are not alcohol dependent.

The National Institute on Alcohol Abuse and Alcoholism states that 140,000 people die each year due to alcohol-related causes. Alcohol is the fourth leading preventable cause of death in the U.S.

Financial Costs of Alcoholism

According to the Centers for Disease Control and Prevention (CDC), the cost of excessive alcohol use in the U.S. alone reaches $249 billion annually. Around 77% of that is attributed to binge drinking , defined as four or more alcoholic beverages per occasion for women or five or more drinks per occasion for men.

The CDC estimates that 40% of the cost of binge drinking is paid by federal, state, and local governments.

The CDC suggests that the most significant economic costs of alcohol use are due to the following:

• Lost workplace productivity (72% of the total cost)
• Healthcare expenses (11% of the total cost)
• Criminal justice expenses (10% of the total cost)
• Motor vehicle crash expenses (5% of the total cost)

The CDC estimates that these figures are all underestimated because alcohol's involvement in sickness, injury, and death is not always available or reported. These figures also do not include some medical and mental health conditions that are the result of alcohol abuse.

Also not included in these figures are the work days that family members miss due to the alcohol problems of a loved one.

Healthcare Expense of Alcohol Abuse

Alcohol consumption is a risk factor in numerous chronic diseases and conditions, and alcohol plays a significant role in certain cancers, psychiatric conditions, and numerous cardiovascular and digestive diseases. Additionally, alcohol consumption can increase the risk of diabetes, stroke, and heart disease.

An estimated $28 billion is spent each year on alcohol-related health care.

Alcohol-Related Aggression and Violence

Along with unintentional injury, alcohol plays a significant role in intentional injuries as a result of aggression and violence. Alcohol has been linked to physical violence by a variety of research studies.

On top of the healthcare cost of alcohol-related intentional violence in the United States, the estimated annual cost to the criminal justice system is another $25 billion.

Impact of Alcoholism on the Family

The social impact of alcohol abuse is a separate issue from the financial costs involved, and that impact begins in the home, extends into the community, and often affects society as a whole, much like the financial impact does.

Research on the effects of alcohol abuse on families shows that alcohol abuse and addiction play a role in intimate partner violence, cause families' financial problems, impair decision-making skills, and play a role in child neglect and abuse.

Long-term alcohol use leads to changes in the brain that affect decision-making, emotional processing, and self-control, making people who drink more susceptible to aggression and violence. According to the U.S. Department of Justice, alcohol makes intimate partner violence more frequent and severe.

As with the financial costs of alcohol abuse, studies have found occasional binge drinking can also affect families. Research suggests that the risk of intimate partner violence rises not only in the context of frequent drinking but also when a partner has consumed a large volume of drinks in one sitting.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database .

Alcohol Abuse and Children

Fetal alcohol spectrum disorders (FASDs) are one of the most common direct consequences of parental alcohol use in the United States, caused by alcohol consumption by the mother during pregnancy. Children with FAS display various symptoms, many of which are lifelong and permanent.

Children who grow up in a home with a loved one dealing with alcohol addiction may be affected as well; they are at significant risk of developing alcohol use disorders themselves.

Growing up in a home where at least one parent has a severe alcohol use disorder can increase a child's chances of developing psychological and emotional problems.

The Bottom Line

Alcohol's effects go beyond it's effects on individual health and well-being; it also has steep economic and societal costs. The excess use of alcohol leads to billions in lost productivity and healthcare costs. It also has a heavy strain on families, communities, and society as a whole. Increased violence, injuries, accidents, child abuse, and intimate partner violence are all linked to alcohol use.

Centers for Disease Control and Prevention. Excessive drinking is draining the U.S. economy .

National Institute on Alcohol Abuse and Alcoholism. Alcohol use disorder (AUD) in the United States: Age groups and demographic characteristics .

Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: Results From the National Epidemiologic Survey on Alcohol and Related Conditions III . JAMA Psychiatry. 2015;72(8):757-766. doi:10.1001/jamapsychiatry.2015.0584

Esser MB, Hedden SL, Kanny D, Brewer RD, Gfroerer JC, Naimi TS. Prevalence of Alcohol Dependence Among US Adult Drinkers, 2009-2011 . Prev Chronic Dis. 2014;11:E206. doi:10.5888/pcd11.140329

National Institute on Alcohol Abuse and Alcoholism. Alcohol-related emergencies and deaths in the United States .

Rehm J. The Risks Associated With Alcohol Use and Alcoholism . Alcohol Res Health . 2011;34(2):135-143.

Centers for Disease Control and Prevention. The cost of excessive alcohol use .

Wilson IM, Graham K, Taft A. Alcohol interventions, alcohol policy and intimate partner violence: a systematic review .  BMC Public Health. 2014;14:881. doi:10.1186/1471-2458-14-881

Lander L, Howsare J, Byrne M. The impact of substance use disorders on families and children: From theory to practice . Soc Work Public Health . 2013;28(3-4):194-205. doi:10.1080/19371918.2013.759005

Sontate KV, Rahim Kamaluddin M, Naina Mohamed I, et al. Alcohol, aggression, and violence: From public health to neuroscience .  Front Psychol . 2021;12:699726. doi:10.3389/fpsyg.2021.699726

U.S. Department of Justice, Office of Justice Programs. Who facts on: Intimate partner violence and alcohol .

Centers for Disease Control and Prevention. Basics about FASDS .

Moss HB. The impact of alcohol on society: A brief overview . Soc Work Public Health. 2013;28(3-4):175-177. doi:10.1080/19371918.2013.758987

Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 National and State Costs of Excessive Alcohol Consumption . Am J Prev Med . 2015;49(5):e73-e79. doi:10.1016/j.amepre.2015.05.031

By Buddy T Buddy T is a writer and founding member of the Online Al-Anon Outreach Committee with decades of experience writing about alcoholism. Because he is a member of a support group that stresses the importance of anonymity at the public level, he does not use his photograph or his real name on this website.

America Has a Drinking Problem

A little alcohol can boost creativity and strengthen social ties. But there’s nothing moderate, or convivial, about the way many Americans drink today.

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This article was published online on June 1, 2021.

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F ew things are more American than drinking heavily. But worrying about how heavily other Americans are drinking is one of them.

The Mayflower landed at Plymouth Rock because, the crew feared, the Pilgrims were going through the beer too quickly. The ship had been headed for the mouth of the Hudson River, until its sailors (who, like most Europeans of that time, preferred beer to water) panicked at the possibility of running out before they got home, and threatened mutiny. And so the Pilgrims were kicked ashore, short of their intended destination and beerless. William Bradford complained bitterly about the latter in his diary that winter, which is really saying something when you consider what trouble the group was in. (Barely half would survive until spring.) Before long, they were not only making their own beer but also importing wine and liquor. Still, within a couple of generations, Puritans like Cotton Mather were warning that a “flood of RUM” could “overwhelm all good Order among us.”

George Washington first won elected office, in 1758, by getting voters soused. (He is said to have given them 144 gallons of alcohol, enough to win him 307 votes and a seat in Virginia’s House of Burgesses.) During the Revolutionary War, he used the same tactic to keep troops happy, and he later became one of the country’s leading whiskey distillers. But he nonetheless took to moralizing when it came to other people’s drinking, which in 1789 he called “ the ruin of half the workmen in this Country. ”

Hypocritical though he was, Washington had a point. The new country was on a bender, and its drinking would only increase in the years that followed. By 1830, the average American adult was consuming about three times the amount we drink today. An obsession with alcohol’s harms understandably followed, starting the country on the long road to Prohibition.

What’s distinctly American about this story is not alcohol’s prominent place in our history (that’s true of many societies), but the zeal with which we’ve swung between extremes. Americans tend to drink in more dysfunctional ways than people in other societies, only to become judgmental about nearly any drinking at all. Again and again, an era of overindulgence begets an era of renunciation: Binge, abstain. Binge, abstain.

Right now we are lurching into another of our periodic crises over drinking, and both tendencies are on display at once. Since the turn of the millennium, alcohol consumption has risen steadily, in a reversal of its long decline throughout the 1980s and ’90s. Before the pandemic, some aspects of this shift seemed sort of fun, as long as you didn’t think about them too hard. In the 20th century, you might have been able to buy wine at the supermarket, but you couldn’t drink it in the supermarket. Now some grocery stores have wine bars, beer on tap, signs inviting you to “shop ’n’ sip,” and carts with cup holders.

Actual bars have decreased in number, but drinking is acceptable in all sorts of other places it didn’t used to be: Salons and boutiques dole out cheap cava in plastic cups. Movie theaters serve alcohol, Starbucks serves alcohol, zoos serve alcohol. Moms carry coffee mugs that say things like This Might Be Wine , though for discreet day-drinking, the better move may be one of the new hard seltzers, a watered-down malt liquor dressed up—for precisely this purpose—as a natural soda.

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Even before COVID-19 arrived on our shores, the consequences of all this were catching up with us. From 1999 to 2017, the number of alcohol-related deaths in the U.S. doubled , to more than 70,000 a year—making alcohol one of the leading drivers of the decline in American life expectancy. These numbers are likely to get worse: During the pandemic, frequency of drinking rose, as did sales of hard liquor. By this February, nearly a quarter of Americans said they’d drunk more over the past year as a means of coping with stress.

Explaining these trends is hard; they defy so many recent expectations. Not long ago, Millennials were touted as the driest generation—they didn’t drink much as teenagers, they were “sober curious,” they were so admirably focused on being well —and yet here they are day-drinking White Claw and dying of cirrhosis at record rates . Nor does any of this appear to be an inevitable response to 21st-century life: Other countries with deeply entrenched drinking problems, among them Britain and Russia, have seen alcohol use drop in recent years.

Media coverage, meanwhile, has swung from cheerfully overselling the (now disputed) health benefits of wine to screeching that no amount of alcohol is safe, ever ; it might give you cancer and it will certainly make you die before your time. But even those who are listening appear to be responding in erratic and contradictory ways. Some of my own friends—mostly 30- or 40-something women, a group with a particularly sharp uptick in drinking—regularly declare that they’re taking an extended break from drinking, only to fall off the wagon immediately. One went from extolling the benefits of Dry January in one breath to telling me a funny story about hangover-cure IV bags in the next. A number of us share the same (wonderful) doctor, and after our annual physicals, we compare notes about the ever nudgier questions she asks about alcohol. “Maybe save wine for the weekend?” she suggests with a cheer so forced she might as well be saying, “Maybe you don’t need to drive nails into your skull every day?”

What most of us want to know, coming out of the pandemic, is this: Am I drinking too much? And: How much are other people drinking? And: Is alcohol actually that bad?

The answer to all these questions turns, to a surprising extent, not only on how much you drink, but on how and where and with whom you do it. But before we get to that, we need to consider a more basic question, one we rarely stop to ask: Why do we drink in the first place? By we , I mean Americans in 2021, but I also mean human beings for the past several millennia.

Let’s get this out of the way: Part of the answer is “Because it is fun.” Drinking releases endorphins, the natural opiates that are also triggered by, among other things, eating and sex. Another part of the answer is “Because we can.” Natural selection has endowed humans with the ability to drink most other mammals under the table. Many species have enzymes that break alcohol down and allow the body to excrete it, avoiding death by poisoning. But about 10 million years ago , a genetic mutation left our ancestors with a souped-up enzyme that increased alcohol metabolism 40-fold.

This mutation occurred around the time that a major climate disruption transformed the landscape of eastern Africa, eventually leading to widespread extinction. In the intervening scramble for food, the leading theory goes, our predecessors resorted to eating fermented fruit off the rain-forest floor. Those animals that liked the smell and taste of alcohol, and were good at metabolizing it, were rewarded with calories. In the evolutionary hunger games, the drunk apes beat the sober ones.

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But even presuming that this story of natural selection is right, it doesn’t explain why, 10 million years later, I like wine so much. “It should puzzle us more than it does,” Edward Slingerland writes in his wide-ranging and provocative new book, Drunk: How We Sipped, Danced, and Stumbled Our Way to Civilization , “that one of the greatest foci of human ingenuity and concentrated effort over the past millennia has been the problem of how to get drunk.” The damage done by alcohol is profound: impaired cognition and motor skills, belligerence, injury, and vulnerability to all sorts of predation in the short run; damaged livers and brains, dysfunction, addiction, and early death as years of heavy drinking pile up. As the importance of alcohol as a caloric stopgap diminished, why didn’t evolution eventually lead us away from drinking—say, by favoring genotypes associated with hating alcohol’s taste? That it didn’t suggests that alcohol’s harms were, over the long haul, outweighed by some serious advantages.

Versions of this idea have recently bubbled up at academic conferences and in scholarly journals and anthologies (largely to the credit of the British anthropologist Robin Dunbar). Drunk helpfully synthesizes the literature, then underlines its most radical implication: Humans aren’t merely built to get buzzed—getting buzzed helped humans build civilization. Slingerland is not unmindful of alcohol’s dark side, and his exploration of when and why its harms outweigh its benefits will unsettle some American drinkers. Still, he describes the book as “a holistic defense of alcohol.” And he announces, early on, that “it might actually be good for us to tie one on now and then.”

Slingerland is a professor at the University of British Columbia who, for most of his career, has specialized in ancient Chinese religion and philosophy. In a conversation this spring, I remarked that it seemed odd that he had just devoted several years of his life to a subject so far outside his wheelhouse. He replied that alcohol isn’t quite the departure from his specialty that it might seem; as he has recently come to see things, intoxication and religion are parallel puzzles, interesting for very similar reasons. As far back as his graduate work at Stanford in the 1990s, he’d found it bizarre that across all cultures and time periods, humans went to such extraordinary (and frequently painful and expensive) lengths to please invisible beings.

In 2012, Slingerland and several scholars in other fields won a big grant to study religion from an evolutionary perspective. In the years since, they have argued that religion helped humans cooperate on a much larger scale than they had as hunter-gatherers. Belief in moralistic, punitive gods, for example, might have discouraged behaviors (stealing, say, or murder) that make it hard to peacefully coexist. In turn, groups with such beliefs would have had greater solidarity, allowing them to outcompete or absorb other groups.

Around the same time, Slingerland published a social-science-heavy self-help book called Trying Not to Try . In it, he argued that the ancient Taoist concept of wu-wei (akin to what we now call “flow”) could help with both the demands of modern life and the more eternal challenge of dealing with other people. Intoxicants, he pointed out in passing, offer a chemical shortcut to wu-wei —by suppressing our conscious mind, they can unleash creativity and also make us more sociable.

At a talk he later gave on wu-wei at Google , Slingerland made much the same point about intoxication. During the Q&A, someone in the audience told him about the Ballmer Peak—the notion, named after the former Microsoft CEO Steve Ballmer, that alcohol can affect programming ability. Drink a certain amount, and it gets better. Drink too much, and it goes to hell. Some programmers have been rumored to hook themselves up to alcohol-filled IV drips in hopes of hovering at the curve’s apex for an extended time.

His hosts later took him over to the “whiskey room,” a lounge with a foosball table and what Slingerland described to me as “a blow-your-mind collection of single-malt Scotches.” The lounge was there, they said, to provide liquid inspiration to coders who had hit a creative wall. Engineers could pour themselves a Scotch, sink into a beanbag chair, and chat with whoever else happened to be around. They said doing so helped them to get mentally unstuck, to collaborate, to notice new connections. At that moment, something clicked for Slingerland too: “I started to think, Alcohol is really this very useful cultural tool .” Both its social lubrications and its creativity-enhancing aspects might play real roles in human society, he mused, and might possibly have been involved in its formation.

He belatedly realized how much the arrival of a pub a few years earlier on the UBC campus had transformed his professional life. “We started meeting there on Fridays, on our way home,” he told me. “Psychologists, economists, archaeologists—we had nothing in common—shooting the shit over some beers.” The drinks provided just enough disinhibition to get conversation flowing. A fascinating set of exchanges about religion unfolded. Without them, Slingerland doubts that he would have begun exploring religion’s evolutionary functions, much less have written Drunk .

Which came first, the bread or the beer? For a long time, most archaeologists assumed that hunger for bread was the thing that got people to settle down and cooperate and have themselves an agricultural revolution. In this version of events, the discovery of brewing came later—an unexpected bonus. But lately, more scholars have started to take seriously the possibility that beer brought us together. (Though beer may not be quite the word. Prehistoric alcohol would have been more like a fermented soup of whatever was growing nearby.)

For the past 25 years, archaeologists have been working to uncover the ruins of Göbekli Tepe, a temple in eastern Turkey. It dates to about 10,000 B.C.—making it about twice as old as Stonehenge. It is made of enormous slabs of rock that would have required hundreds of people to haul from a nearby quarry. As far as archaeologists can tell, no one lived there. No one farmed there. What people did there was party. “The remains of what appear to be brewing vats, combined with images of festivals and dancing, suggest that people were gathering in groups, fermenting grain or grapes,” Slingerland writes, “and then getting truly hammered.”

Over the decades, scientists have proposed many theories as to why we still drink alcohol, despite its harms and despite millions of years having passed since our ancestors’ drunken scavenging. Some suggest that it must have had some interim purpose it’s since outlived. (For example, maybe it was safer to drink than untreated water—fermentation kills pathogens.) Slingerland questions most of these explanations. Boiling water is simpler than making beer, for instance.

Göbekli Tepe—and other archaeological finds indicating very early alcohol use—gets us closer to a satisfying explanation. The site’s architecture lets us visualize, vividly, the magnetic role that alcohol might have played for prehistoric peoples. As Slingerland imagines it, the promise of food and drink would have lured hunter-gatherers from all directions, in numbers great enough to move gigantic pillars. Once built, both the temple and the revels it was home to would have lent organizers authority, and participants a sense of community. “Periodic alcohol-fueled feasts,” he writes, “served as a kind of ‘glue’ holding together the culture that created Göbekli Tepe.”

Things were likely more complicated than that. Coercion, not just inebriated cooperation, probably played a part in the construction of early architectural sites, and in the maintenance of order in early societies. Still, cohesion would have been essential, and this is the core of Slingerland’s argument: Bonding is necessary to human society, and alcohol has been an essential means of our bonding. Compare us with our competitive, fractious chimpanzee cousins. Placing hundreds of unrelated chimps in close quarters for several hours would result in “blood and dismembered body parts,” Slingerland notes—not a party with dancing, and definitely not collaborative stone-lugging. Human civilization requires “individual and collective creativity, intensive cooperation, a tolerance for strangers and crowds, and a degree of openness and trust that is entirely unmatched among our closest primate relatives.” It requires us not only to put up with one another, but to become allies and friends.

As to how alcohol assists with that process, Slingerland focuses mostly on its suppression of prefrontal-cortex activity, and how resulting disinhibition may allow us to reach a more playful, trusting, childlike state. Other important social benefits may derive from endorphins, which have a key role in social bonding. Like many things that bring humans together—laughter, dancing, singing, storytelling, sex, religious rituals—drinking triggers their release. Slingerland observes a virtuous circle here: Alcohol doesn’t merely unleash a flood of endorphins that promote bonding; by reducing our inhibitions, it nudges us to do other things that trigger endorphins and bonding.

Over time, groups that drank together would have cohered and flourished, dominating smaller groups—much like the ones that prayed together. Moments of slightly buzzed creativity and subsequent innovation might have given them further advantage still. In the end, the theory goes, the drunk tribes beat the sober ones.

But this rosy story about how alcohol made more friendships and advanced civilization comes with two enormous asterisks: All of that was before the advent of liquor, and before humans started regularly drinking alone.

The early Greeks watered down their wine; swilling it full-strength was, they believed, barbaric—a recipe for chaos and violence. “They would have been absolutely horrified by the potential for chaos contained in a bottle of brandy,” Slingerland writes. Human beings, he notes, “are apes built to drink, but not 100-proof vodka. We are also not well equipped to control our drinking without social help.”

Distilled alcohol is recent—it became widespread in China in the 13th century and in Europe from the 16th to 18th centuries—and a different beast from what came before it. Fallen grapes that have fermented on the ground are about 3 percent alcohol by volume. Beer and wine run about 5 and 11 percent, respectively. At these levels, unless people are strenuously trying, they rarely manage to drink enough to pass out, let alone die. Modern liquor, however, is 40 to 50 percent alcohol by volume, making it easy to blow right past a pleasant social buzz and into all sorts of tragic outcomes.

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Just as people were learning to love their gin and whiskey, more of them (especially in parts of Europe and North America) started drinking outside of family meals and social gatherings. As the Industrial Revolution raged, alcohol use became less leisurely. Drinking establishments suddenly started to feature the long counters that we associate with the word bar today, enabling people to drink on the go, rather than around a table with other drinkers. This short move across the barroom reflects a fairly dramatic break from tradition: According to anthropologists, in nearly every era and society, solitary drinking had been almost unheard‑of among humans.

The social context of drinking turns out to matter quite a lot to how alcohol affects us psychologically. Although we tend to think of alcohol as reducing anxiety, it doesn’t do so uniformly. As Michael Sayette, a leading alcohol researcher at the University of Pittsburgh, recently told me, if you packaged alcohol as an anti-anxiety serum and submitted it to the FDA, it would never be approved. He and his onetime graduate student Kasey Creswell, a Carnegie Mellon professor who studies solitary drinking, have come to believe that one key to understanding drinking’s uneven effects may be the presence of other people. Having combed through decades’ worth of literature, Creswell reports that in the rare experiments that have compared social and solitary alcohol use, drinking with others tends to spark joy and even euphoria, while drinking alone elicits neither—if anything, solo drinkers get more depressed as they drink.

Sayette, for his part, has spent much of the past 20 years trying to get to the bottom of a related question: why social drinking can be so rewarding. In a 2012 study, he and Creswell divided 720 strangers into groups, then served some groups vodka cocktails and other groups nonalcoholic cocktails. Compared with people who were served nonalcoholic drinks, the drinkers appeared significantly happier, according to a range of objective measures. Maybe more important, they vibed with one another in distinctive ways. They experienced what Sayette calls “golden moments,” smiling genuinely and simultaneously at one another. Their conversations flowed more easily, and their happiness appeared infectious. Alcohol, in other words, helped them enjoy one another more.

This research might also shed light on another mystery: why, in a number of large-scale surveys, people who drink lightly or moderately are happier and psychologically healthier than those who abstain. Robin Dunbar, the anthropologist, examined this question directly in a large study of British adults and their drinking habits. He reports that those who regularly visit pubs are happier and more fulfilled than those who don’t—not because they drink, but because they have more friends. And he demonstrates that it’s typically the pub-going that leads to more friends, rather than the other way around. Social drinking, too, can cause problems, of course—and set people on a path to alcohol-use disorder. (Sayette’s research focuses in part on how that happens, and why some extroverts, for example, may find alcohol’s social benefits especially hard to resist.) But solitary drinking—even with one’s family somewhere in the background—is uniquely pernicious because it serves up all the risks of alcohol without any of its social perks. Divorced from life’s shared routines, drinking becomes something akin to an escape from life.

Southern Europe’s healthy drinking culture is hardly news, but its attributes are striking enough to bear revisiting: Despite widespread consumption of alcohol, Italy has some of the lowest rates of alcoholism in the world. Its residents drink mostly wine and beer, and almost exclusively over meals with other people. When liquor is consumed, it’s usually in small quantities, either right before or after a meal. Alcohol is seen as a food, not a drug. Drinking to get drunk is discouraged, as is drinking alone. The way Italians drink today may not be quite the way premodern people drank, but it likewise accentuates alcohol’s benefits and helps limit its harms. It is also, Slingerland told me, about as far as you can get from the way many people drink in the United States.

Americans may not have invented binge drinking, but we have a solid claim to bingeing alone, which was almost unheard-of in the Old World. During the early 19th century, solitary binges became common enough to need a name, so Americans started calling them “sprees” or “frolics”—words that sound a lot happier than the lonely one-to-three-day benders they described.

In his 1979 history, The Alcoholic Republic , the historian W. J. Rorabaugh painstakingly calculated the stunning amount of alcohol early Americans drank on a daily basis. In 1830, when American liquor consumption hit its all-time high, the average adult was going through more than nine gallons of spirits each year. Most of this was in the form of whiskey (which, thanks to grain surpluses, was sometimes cheaper than milk), and most of it was drunk at home. And this came on top of early Americans’ other favorite drink, homemade cider. Many people, including children, drank cider at every meal; a family could easily go through a barrel a week. In short, Americans of the early 1800s were rarely in a state that could be described as sober, and a lot of the time, they were drinking to get drunk.

Rorabaugh argued that this longing for oblivion resulted from America’s almost unprecedented pace of change between 1790 and 1830. Thanks to rapid westward migration in the years before railroads, canals, and steamboats, he wrote, “more Americans lived in isolation and independence than ever before or since.” In the more densely populated East, meanwhile, the old social hierarchies evaporated, cities mushroomed, and industrialization upended the labor market, leading to profound social dislocation and a mismatch between skills and jobs. The resulting epidemics of loneliness and anxiety, he concluded, led people to numb their pain with alcohol.

The temperance movement that took off in the decades that followed was a more rational (and multifaceted) response to all of this than it tends to look like in the rearview mirror. Rather than pushing for full prohibition, many advocates supported some combination of personal moderation, bans on liquor, and regulation of those who profited off alcohol. Nor was temperance a peculiarly American obsession. As Mark Lawrence Schrad shows in his new book, Smashing the Liquor Machine: A Global History of Prohibition , concerns about distilled liquor’s impact were international: As many as two dozen countries enacted some form of prohibition.

Yet the version that went into effect in 1920 in the United States was by far the most sweeping approach adopted by any country, and the most famous example of the all-or-nothing approach to alcohol that has dogged us for the past century. Prohibition did, in fact, result in a dramatic reduction in American drinking. In 1935, two years after repeal, per capita alcohol consumption was less than half what it had been early in the century. Rates of cirrhosis had also plummeted, and would remain well below pre-Prohibition levels for decades.

The temperance movement had an even more lasting result: It cleaved the country into tipplers and teetotalers. Drinkers were on average more educated and more affluent than nondrinkers, and also more likely to live in cities or on the coasts. Dry America, meanwhile, was more rural, more southern, more midwestern, more churchgoing, and less educated. To this day, it includes about a third of U.S. adults—a higher proportion of abstainers than in many other Western countries.

What’s more, as Christine Sismondo writes in America Walks Into a Bar , by kicking the party out of saloons, the Eighteenth Amendment had the effect of moving alcohol into the country’s living rooms, where it mostly remained. This is one reason that, even as drinking rates decreased overall, drinking among women became more socially acceptable. Public drinking establishments had long been dominated by men, but home was another matter—as were speakeasies, which tended to be more welcoming.

After Prohibition’s repeal, the alcohol industry refrained from aggressive marketing, especially of liquor. Nonetheless, drinking steadily ticked back up, hitting pre-Prohibition levels in the early ’70s, then surging past them. Around that time, most states lowered their drinking age from 21 to 18 (to follow the change in voting age)—just as the Baby Boomers, the biggest generation to date, were hitting their prime drinking years. For an illustration of what followed, I direct you to the film Dazed and Confused .

Drinking peaked in 1981, at which point—true to form—the country took a long look at the empty beer cans littering the lawn, and collectively recoiled. What followed has been described as an age of neo-temperance. Taxes on alcohol increased; warning labels were added to containers. The drinking age went back up to 21, and penalties for drunk driving finally got serious. Awareness of fetal alcohol syndrome rose too—prompting a quintessentially American freak-out: Unlike in Europe, where pregnant women were reassured that light drinking remained safe, those in the U.S. were, and are, essentially warned that a drop of wine could ruin a baby’s life. By the late 1990s, the volume of alcohol consumed annually had declined by a fifth.

And then began the current lurch upward. Around the turn of the millennium, Americans said To hell with it and poured a second drink, and in almost every year since, we’ve drunk a bit more wine and a bit more liquor than the year before. But why?

One answer is that we did what the alcohol industry was spending billions of dollars persuading us to do. In the ’90s, makers of distilled liquor ended their self-imposed ban on TV advertising. They also developed new products that might initiate nondrinkers (think sweet premixed drinks like Smirnoff Ice and Mike’s Hard Lemonade). Meanwhile, winemakers benefited from the idea, then in wide circulation and since challenged, that moderate wine consumption might be good for you physically. (As Iain Gately reports in Drink: A Cultural History of Alcohol , in the month after 60 Minutes ran a widely viewed segment on the so-called French paradox—the notion that wine might explain low rates of heart disease in France—U.S. sales of red wine shot up 44 percent.)

But this doesn’t explain why Americans have been so receptive to the sales pitches. Some people have argued that our increased consumption is a response to various stressors that emerged over this period. (Gately, for example, proposes a 9/11 effect—he notes that in 2002, heavy drinking was up 10 percent over the previous year.) This seems closer to the truth. It also may help explain why women account for such a disproportionate share of the recent increase in drinking.

Although both men and women commonly use alcohol to cope with stressful situations and negative feelings, research finds that women are substantially more likely to do so. And they’re much more apt to be sad and stressed out to begin with: Women are about twice as likely as men to suffer from depression or anxiety disorders—and their overall happiness has fallen substantially in recent decades .

In the 2013 book Her Best-Kept Secret , an exploration of the surge in female drinking, the journalist Gabrielle Glaser recalls noticing, early this century, that women around her were drinking more. Alcohol hadn’t been a big part of mom culture in the ’90s, when her first daughter was young—but by the time her younger children entered school, it was everywhere: “Mothers joked about bringing their flasks to Pasta Night. Flasks? I wondered, at the time. Wasn’t that like Gunsmoke ?” (Her quip seems quaint today. A growing class of merchandise now helps women carry concealed alcohol: There are purses with secret pockets, and chunky bracelets that double as flasks, and—perhaps least likely of all to invite close investigation—flasks designed to look like tampons.)

From the April 2015 issue: Gabrielle Glaser on the irrationality of Alcoholics Anonymous

Glaser notes that an earlier rise in women’s drinking, in the 1970s, followed increased female participation in the workforce—and with it the particular stresses of returning home, after work, to attend to the house or the children. She concludes that women are today using alcohol to quell the anxieties associated with “the breathtaking pace of modern economic and social change” as well as with “the loss of the social and family cohesion” enjoyed by previous generations. Almost all of the heavy-drinking women Glaser interviewed drank alone—the bottle of wine while cooking, the Baileys in the morning coffee, the Poland Spring bottle secretly filled with vodka. They did so not to feel good, but to take the edge off feeling bad.

Men still drink more than women, and of course no demographic group has a monopoly on either problem drinking or the stresses that can cause it. The shift in women’s drinking is particularly stark, but unhealthier forms of alcohol use appear to be proliferating in many groups. Even drinking in bars has become less social in recent years, or at least this was a common perception among about three dozen bartenders I surveyed while reporting this article. “I have a few regulars who play games on their phone,” one in San Francisco said, “and I have a standing order to just refill their beer when it’s empty. No eye contact or talking until they are ready to leave.” Striking up conversations with strangers has become almost taboo, many bartenders observed, especially among younger patrons. So why not just drink at home? Spending money to sit in a bar alone and not talk to anyone was, a bartender in Columbus, Ohio, said, an interesting case of “trying to avoid loneliness without actual togetherness.”

Last August, the beer manufacturer Busch launched a new product well timed to the problem of pandemic-era solitary drinking. Dog Brew is bone broth packaged as beer for your pet. “You’ll never drink alone again,” said news articles reporting its debut. It promptly sold out. As for human beverages, though beer sales were down in 2020, continuing their long decline, Americans drank more of everything else, especially spirits and (perhaps the loneliest-sounding drinks of all) premixed, single-serve cocktails, sales of which skyrocketed.

Not everyone consumed more alcohol during the pandemic. Even as some of us (especially women and parents) drank more frequently, others drank less often. But the drinking that increased was, almost definitionally, of the stuck-at-home, sad, too-anxious-to-sleep, can’t-bear-another-day-like-all-the-other-days variety—the kind that has a higher likelihood of setting us up for drinking problems down the line. The drinking that decreased was mostly the good, socially connecting kind. (Zoom drinking—with its not-so-happy hours and first dates doomed to digital purgatory—was neither anesthetizing nor particularly connecting, and deserves its own dreary category.)

As the pandemic eases, we may be nearing an inflection point. My inner optimist imagines a new world in which, reminded of how much we miss joy and fun and other people, we embrace all kinds of socially connecting activities, including eating and drinking together—while also forswearing unhealthy habits we may have acquired in isolation.

But my inner pessimist sees alcohol use continuing in its pandemic vein, more about coping than conviviality. Not all social drinking is good, of course; maybe some of it should wane, too (for example, some employers have recently banned alcohol from work events because of concerns about its role in unwanted sexual advances and worse). And yet, if we use alcohol more and more as a private drug, we’ll enjoy fewer of its social benefits, and get a bigger helping of its harms.

Let’s contemplate those harms for a minute. My doctor’s nagging notwithstanding, there is a big, big difference between the kind of drinking that will give you cirrhosis and the kind that a great majority of Americans do. According to an analysis in The Washington Post some years back , to break into the top 10 percent of American drinkers, you needed to drink more than two bottles of wine every night. People in the next decile consumed, on average, 15 drinks a week, and in the one below that, six drinks a week. The first category of drinking is, stating the obvious, very bad for your health. But for people in the third category or edging toward the second, like me, the calculation is more complicated. Physical and mental health are inextricably linked, as is made vivid by the overwhelming quantity of research showing how devastating isolation is to longevity. Stunningly, the health toll of social disconnection is estimated to be equivalent to the toll of smoking 15 cigarettes a day .

To be clear, people who don’t want to drink should not drink. There are many wonderful, alcohol-free means of bonding. Drinking, as Edward Slingerland notes, is merely a convenient shortcut to that end. Still, throughout human history, this shortcut has provided a nontrivial social and psychological service. At a moment when friendships seem more attenuated than ever , and loneliness is rampant, maybe it can do so again. For those of us who do want to take the shortcut, Slingerland has some reasonable guidance: Drink only in public, with other people, over a meal—or at least, he says, “under the watchful eye of your local pub’s barkeep.”

After more than a year in relative isolation, we may be closer than we’d like to the wary, socially clumsy strangers who first gathered at Göbekli Tepe. “We get drunk because we are a weird species, the awkward losers of the animal world,” Slingerland writes, “and need all of the help we can get.” For those of us who have emerged from our caves feeling as if we’ve regressed into weird and awkward ways, a standing drinks night with friends might not be the worst idea to come out of 2021.

This article appears in the July/August 2021 print edition with the headline “Drinking Alone.”

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Alcohol: Balancing Risks and Benefits

Moderate drinking can be healthy—but not for everyone. You must weigh the risks and benefits.

– Introduction – What’s Moderate Alcohol Intake? What’s a Drink? – The Downside of Alcohol – Possible Health Benefits of Alcohol – Genes Play a Role – Shifting Benefits and Risks – The Bottom Line: Balancing Risks and Benefits

Introduction

Throughout the 10,000 or so years that humans have been drinking fermented beverages, they’ve also been arguing about their merits and demerits. The debate still simmers today, with a lively back-and-forth over whether alcohol is good for you or bad for you.

It’s safe to say that alcohol is both a tonic and a poison. The difference lies mostly in the dose. Moderate drinking seems to be good for the heart and circulatory system, and probably protects against type 2 diabetes and gallstones. Heavy drinking is a major cause of preventable death in most countries. In the U.S., alcohol is implicated in about half of fatal traffic accidents. [1] Heavy drinking can damage the liver and heart, harm an unborn child, increase the chances of developing breast and some other cancers, contribute to depression and violence, and interfere with relationships.

Alcohol’s two-faced nature shouldn’t come as a surprise. The active ingredient in alcoholic beverages, a simple molecule called ethanol, affects the body in many different ways. It directly influences the stomach, brain, heart, gallbladder, and liver. It affects levels of lipids (cholesterol and triglycerides) and insulin in the blood, as well as inflammation and coagulation. It also alters mood, concentration, and coordination.

What’s Moderate Alcohol Intake? What’s a Drink?

Loose use of the terms “moderate” and “a drink” has fueled some of the ongoing debate about alcohol’s impact on health.

In some studies, the term “moderate drinking” refers to less than 1 drink per day, while in others it means 3-4 drinks per day. Exactly what constitutes “a drink” is also fairly fluid. In fact, even among alcohol researchers, there’s no universally accepted standard drink definition. [2]

In the U.S., 1 drink is usually considered to be 12 ounces of beer, 5 ounces of wine, or 1½ ounces of spirits (hard liquor such as gin or whiskey). [3] Each delivers about 12 to 14 grams of alcohol on average, but there is a wider range now that microbrews and wine are being produced with higher alcohol content.

Is Red Wine Better?

The definition of moderate drinking is something of a balancing act. Moderate drinking sits at the point at which the health benefits of alcohol clearly outweigh the risks.

The latest consensus places this point at no more than 1-2 drinks a day for men, and no more than 1 drink a day for women. This is the definition used by the U.S. Department of Agriculture and the Dietary Guidelines for Americans 2020-2025, [3] and is widely used in the United States.

The Dark Side of Alcohol

Not everyone who likes to drink alcohol stops at just one. While many people drink in moderation, some don’t.

Problem drinking also touches drinkers’ families, friends, and communities. According to the National Institute on Alcohol Abuse and Alcoholism and others:

• In 2014, about 61 million Americans were classified as binge alcohol users (5 or more drinks on the same occasion at least once a month) and 16 million as heavy alcohol users (5 or more drinks on the same occasion on 5 or more days in one month). [6]
• Alcohol plays a role in one in three cases of violent crime. [7]
• In 2015, more than 10,000 people died in automobile accidents in which alcohol was involved. [8]
• Alcohol abuse costs about $249 billion a year. [9]

Even moderate drinking carries some risks. Alcohol can disrupt sleep and one’s better judgment. Alcohol interacts in potentially dangerous ways with a variety of medications, including acetaminophen, antidepressants, anticonvulsants, painkillers, and sedatives. It is also addictive, especially for people with a family history of alcoholism.

Alcohol Increases Risk of Developing Breast Cancer

There is convincing evidence that alcohol consumption increases the risk of breast cancer, and the more alcohol consumed, the greater the risk. [10-14]

• A large prospective study following 88,084 women and 47,881 men for 30 years found that even 1 drink a day increased the risk of alcohol-related cancers (colorectum, female breast, oral cavity, pharynx, larynx, liver, esophagus) in women, but mainly breast cancer, among both smokers and nonsmokers. 1 to 2 drinks a day in men who did not smoke was not associated with an increased risk of alcohol-related cancers. [15]  
• In a combined analysis of six large prospective studies involving more than 320,000 women, researchers found that having 2-5 drinks a day compared with no drinks increased the chances of developing breast cancer as high as 41%. It did not matter whether the form of alcohol was wine, beer, or hard liquor. [10] This doesn’t mean that 40% or so of women who have 2-5 drinks a day will get breast cancer. Instead, it is the difference between about 13 of every 100 women developing breast cancer during their lifetime—the current average risk in the U.S.—and 17 to 18 of every 100 women developing the disease. This modest increase would translate to significantly more women with breast cancer each year.

A lack of folate in the diet or folic acid, its supplement form, further increases the risk of breast cancer in women. [14] Folate is needed to produce new cells and to prevent changes in DNA. Folate deficiency, as can occur with heavy alcohol use, can cause changes in genes that may lead to cancer. Alcohol also increases estrogen levels, which fuel the growth of certain breast cancer cells. An adequate intake of folate, at least 400 micrograms a day, when taking at least 1 drink of alcohol daily appears to lessen this increased risk. [16, 17]

• Researchers found a strong association among three factors—genetics, folate intake, and alcohol—in a cohort from the Nurses’ Health Study II of 2866 young women with an average age of 36 who were diagnosed with invasive breast cancer. Those with a family history of breast cancer who drank 10 grams or more of alcoholic beverages daily (equivalent to 1 or more drinks) and ate less than 400 micrograms of folate daily almost doubled their risk (1.8 times) of developing the cancer. Women who drank this amount of alcohol but did not have a family history of breast cancer and ate at least 400 micrograms of folate daily did not have an increased breast cancer risk. [14]

Folate , the B vitamin that helps guide the development of an embryo’s spinal cord, has equally important jobs later in life. One of the biggest is helping to build DNA, the molecule that carries the code of life. In this way, folate is essential for accurate cell division.

Alcohol blocks the absorption of folate and inactivates folate in the blood and tissues. It’s possible that this interaction may be how alcohol consumption increases the risk of breast, colon, and other cancers.

Getting extra folate may cancel out this alcohol-related increase. In the Nurses’ Health Study, for example, among women who consumed 1 or more alcoholic drinks a day, those who had the highest levels of this B vitamin in their blood were 90% less likely to develop breast cancer than those who had the lowest levels of the B vitamin. [18] An earlier study suggested that getting 600 micrograms a day of folate could counteract the effect of moderate alcohol consumption on breast cancer risk. [17] There was no association with folate and increased breast cancer risk among women who drank low or no alcohol daily.

Alcohol and Weight Gain

However, a prospective study following almost 15,000 men at four-year periods found only an increased risk of minor weight gain with higher intakes of alcohol. [19] Compared to those who did not change their alcohol intake, those who increased their intake by 2 or more drinks a day gained a little more than a half-pound. It was noted that calorie intake (not from alcohol) tended to increase along with alcohol intake.

Possible Health Benefits of Alcohol

What are some of the possible health benefits associated with moderate alcohol consumption?

Cardiovascular Disease

More than 100 prospective studies show an inverse association between light to moderate drinking and risk of heart attack, ischemic (clot-caused) stroke, peripheral vascular disease, sudden cardiac death, and death from all cardiovascular causes. [20] The effect is fairly consistent, corresponding to a 25-40% reduction in risk. However, increasing alcohol intake to more than 4 drinks a day can increase the risk of hypertension, abnormal heart rhythms, stroke, heart attack, and death. [5, 21-23]

Learn more about the results of some large prospective cohort studies of alcohol consumption and cardiovascular disease.

* compared with non-drinkers

The connection between moderate drinking and lower risk of cardiovascular disease has been observed in men and women. It applies to people who do not have heart disease, and also to those at high risk for having a heart attack or stroke or dying of cardiovascular disease, including those with type 2 diabetes, [32, 33] high blood pressure, [34, 35] and existing cardiovascular disease. [34, 35] The benefits also extend to older individuals. [36]

The idea that moderate drinking protects against cardiovascular disease makes sense biologically and scientifically. Moderate amounts of alcohol raise levels of high-density lipoprotein (HDL, or “good” cholesterol), [37] and higher HDL levels are associated with greater protection against heart disease. Moderate alcohol consumption has also been linked with beneficial changes ranging from better sensitivity to insulin to improvements in factors that influence blood clotting, such as tissue type plasminogen activator, fibrinogen, clotting factor VII, and von Willebrand factor. [37] Such changes would tend to prevent the formation of small blood clots that can block arteries in the heart, neck, and brain, the ultimate cause of many heart attacks and the most common kind of stroke.

Drinking Patterns Matter

A review of alcohol consumption in women from the Nurses’ Health Study I and II found that smaller amounts of alcohol (about 1 drink per day) spread out over four or more days per week had the lowest death rates from any cause, compared with women who drank the same amount of alcohol but in one or two days. [39]

The most definitive way to investigate the effect of alcohol on cardiovascular disease would be with a large trial in which some volunteers were randomly assigned to have 1 or more alcoholic drinks a day and others had drinks that looked, tasted, and smelled like alcohol but were actually alcohol free. Many of these trials have been conducted for weeks, and in a few cases months and even up to 2 years, to look at changes in the blood, but a long-term trial to test experimentally the effects of alcohol on cardiovascular disease has not been done.  A recent successful effort in the U.S. to launch an international study was funded by the National Institutes of Health.  Although the proposal was peer-reviewed and initial participants had been randomized to drink in moderation or to abstain, post hoc the NIH decided to stop the trial due to internal policy concerns .  Unfortunately, a future long trial of alcohol and clinical outcomes may never be attempted again, but nevertheless, the connection between moderate drinking and cardiovascular disease almost certainly represents a cause-and-effect relationship based on all of the available evidence to date.

Beyond the Heart

The benefits of moderate drinking aren’t limited to the heart. In the Nurses’ Health Study, the Health Professionals Follow-up Study, and other studies, gallstones [40, 41] and type 2 diabetes [32, 42, 43] were less likely to occur in moderate drinkers than in non-drinkers. The emphasis here, as elsewhere, is on moderate drinking.

In a meta-analysis of 15 original prospective cohort studies that followed 369,862 participants for an average of 12 years, a 30% reduced risk of type 2 diabetes was found with moderate drinking (0.5-4 drinks a day), but no protective effect was found in those drinking either less or more than that amount. [32]

The social and psychological benefits of alcohol can’t be ignored. A drink before a meal can improve digestion or offer a soothing respite at the end of a stressful day; the occasional drink with friends can be a social tonic. These physical and social effects may also contribute to health and well-being.

Genes Play a Role

Twin, family, and adoption studies have firmly established that genetics plays an important role in determining an individual’s preferences for alcohol and his or her likelihood for developing alcoholism. Alcoholism doesn’t follow the simple rules of inheritance set out by Gregor Mendel. Instead, it is influenced by several genes that interact with each other and with environmental factors. [1]

There is also some evidence that genes influence how alcohol affects the cardiovascular system. An enzyme called alcohol dehydrogenase helps metabolize alcohol. One variant of this enzyme, called alcohol dehydrogenase type 1C (ADH1C), comes in two “flavors.” One quickly breaks down alcohol, the other does it more slowly. Moderate drinkers who have two copies of the gene for the slow-acting enzyme are at much lower risk for cardiovascular disease than moderate drinkers who have two genes for the fast-acting enzyme. [44] Those with one gene for the slow-acting enzyme and one for the faster enzyme fall in between.

It’s possible that the fast-acting enzyme breaks down alcohol before it can have a beneficial effect on HDL and clotting factors. Interestingly, these differences in the ADH1C gene do not influence the risk of heart disease among people who don’t drink alcohol. This adds strong indirect evidence that alcohol itself reduces heart disease risk.

Shifting Benefits and Risks

• For a pregnant woman and her unborn child, a recovering alcoholic, a person with liver disease, and people taking one or more medications that interact with alcohol, moderate drinking offers little benefit and substantial risks.
• For a 30-year-old man, the increased risk of alcohol-related accidents outweighs the possible heart-related benefits of moderate alcohol consumption.
• For a 60-year-old man, a drink a day may offer protection against heart disease that is likely to outweigh potential harm (assuming he isn’t prone to alcoholism).
• For a 60-year-old woman, the benefit/risk calculations are trickier. Ten times more women die each year from heart disease (460,000) than from breast cancer (41,000). However, studies show that women are far more afraid of developing breast cancer than heart disease, something that must be factored into the equation.

The Bottom Line: Balancing Risks and Benefits

Given the complexity of alcohol’s effects on the body and the complexity of the people who drink it, blanket recommendations about alcohol are out of the question. Because each of us has unique personal and family histories, alcohol offers each person a different spectrum of benefits and risks. Whether or not to drink alcohol, especially for “medicinal purposes,” requires careful balancing of these benefits and risks.

• Your healthcare provider should be able to help you do this. Your overall health and risks for alcohol-associated conditions should factor into the equation.
• If you are thin, physically active, don’t smoke, eat a healthy diet, and have no family history of heart disease, drinking alcohol won’t add much to decreasing your risk of cardiovascular disease.
• If you don’t drink, there’s no need to start. You can get similar benefits with exercise (beginning to exercise if you don’t already or boosting the intensity and duration of your activity) or healthier eating.
• If you are a man with no history of alcoholism who is at moderate to high risk for heart disease, a daily alcoholic drink could reduce that risk. Moderate drinking might be especially beneficial if you have low HDL that just won’t budge upward with diet and exercise.
• If you are a woman with no history of alcoholism who is at moderate to high risk for heart disease, the possible benefits of a daily drink must be balanced against the small increase in risk of breast cancer.
• If you already drink alcohol or plan to begin, keep it moderate—no more than 2 drinks a day for men or 1 drink a day for women. And make sure you get adequate amounts of folate, at least 400 micrograms a day.
• However, the study’s results contradict these headlines, as its findings mirrored those from previous cohort studies showing the lowest CVD risk among light/moderate drinkers (1-15 drinks a week), and risk sharply increasing in heavy/abusive drinkers (averaging >20 drinks a week). Yet the authors concluded that it wasn’t light/moderate drinking that protected the heart; rather, it was lifestyle factors associated with light/moderate drinking like exercising more and not smoking (as predicted by people possessing certain gene variants). Interestingly the study found that light/moderate drinkers had healthier habits than even the abstainers. When adjusting for these healthy habits, the protective effect from alcohol lessened slightly. Regardless, their overall conclusion still showed that light/moderate drinkers had the lowest risk of CVD and supported the additional benefit of healthy lifestyle behaviors. It may also be worth noting that the genetic variants studied were associated with alcohol use disorder (AUD) and not specific to general alcohol intake.
• A 2018 analysis in The Lancet of the global impact of alcohol on injury and disease made headlines when it concluded that even moderate drinking is unsafe for health—and the risks outweigh any potential benefits. However, according to Dr. Walter Willett, professor of epidemiology and nutrition at Harvard T.H. Chan School of Public Health, it can be “misleading” to lump the entire world together when assessing alcohol’s risk. (For example, while tuberculosis is very rare in the U.S., it was the leading alcohol-related disease identified in the study.) In an interview with TIME , Willett said that while there is “no question” that heavy drinking is harmful, there are plenty of data supporting the benefits of moderate drinking, and it remains a decision that should be determined at the individual level: “There are risks and benefits, and I think it’s important to have the best information about all of those and come to some personal decisions, and engage one’s health care provider in that process as well.
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• Mukamal KJ, Chung H, Jenny NS, Kuller LH, Longstreth Jr WT, Mittleman MA, Burke GL, Cushman M, Psaty BM, Siscovick DS. Alcohol consumption and risk of coronary heart disease in older adults: the Cardiovascular Health Study. Journal of the American Geriatrics Society . 2006 Jan;54(1):30-7.
• Booyse FM, Pan W, Grenett HE, Parks DA, Darley-Usmar VM, Bradley KM, Tabengwa EM. Mechanism by which alcohol and wine polyphenols affect coronary heart disease risk. Annals of epidemiology . 2007 May 1;17(5):S24-31.
• Tolstrup J, Jensen MK, Anne T, Overvad K, Mukamal KJ, Grønbæk M. Prospective study of alcohol drinking patterns and coronary heart disease in women and men. BMJ . 2006 May 25;332(7552):1244.
• Mostofsky E, Mukamal KJ, Giovannucci EL, Stampfer MJ, Rimm EB. Key findings on alcohol consumption and a variety of health outcomes from the Nurses’ Health Study. American journal of public health . 2016 Sep;106(9):1586-91.
• Grodstein F, Colditz GA, Hunter DJ, Manson JE, Willett WC, Stampfer MJ. A prospective study of symptomatic gallstones in women: relation with oral contraceptives and other risk factors. Obstetrics and Gynecology . 1994 Aug;84(2):207-14.
• Leitzmann MF, Giovannucci EL, Stampfer MJ, Spiegelman D, Colditz GA, Willett WC, Rimm EB. Prospective study of alcohol consumption patterns in relation to symptomatic gallstone disease in men. Alcoholism: Clinical and Experimental Research . 1999 May;23(5):835-41.
• Conigrave KM, Hu BF, Camargo CA, Stampfer MJ, Willett WC, Rimm EB. A prospective study of drinking patterns in relation to risk of type 2 diabetes among men. Diabetes . 2001 Oct 1;50(10):2390-5.
• Djoussé L, Biggs ML, Mukamal KJ, Siscovick DS. Alcohol consumption and type 2 diabetes among older adults: the Cardiovascular Health Study. Obesity . 2007 Jul;15(7):1758-65.
• Hines LM, Stampfer MJ, Ma J, Gaziano JM, Ridker PM, Hankinson SE, Sacks F, Rimm EB, Hunter DJ. Genetic variation in alcohol dehydrogenase and the beneficial effect of moderate alcohol consumption on myocardial infarction. New England Journal of Medicine . 2001 Feb 22;344(8):549-55.
• Biddinger KJ, Emdin CA, Haas ME, Wang M, Hindy G, Ellinor PT, Kathiresan S, Khera AV, Aragam KG. Association of Habitual Alcohol Intake With Risk of Cardiovascular Disease. JAMA Network Open . 2022 Mar 1;5(3):e223849-.  Author disclosures: Dr. Haas reported receiving personal fees and stock and stock options from Regeneron Pharmaceuticals outside the submitted work. Dr. Ellinor reported receiving grants from Bayer AG and IBM Health and personal fees from Bayer AG, MyoKardia, Quest Diagnostics, and Novartis during the conduct of the study. Dr. Kathiresan reported being an employee of Verve Therapeutics; owning equity in Verve Therapeutics, Maze Therapeutics, Color Health, and Medgenome; receiving personal fees from Medgenome and Color Health; serving on the advisory boards for Regeneron Genetics Center and Corvidia Therapeutics; and consulting for Acceleron, Eli Lilly and Co, Novartis, Merck, Novo Nordisk, Novo Ventures, Ionis, Alnylam, Aegerion, Haug Partners, Noble Insights, Leerink Partners, Bayer Healthcare, Illumina, Color Genomics, MedGenome, Quest Diagnostics, and Medscape outside the submitted work. Dr. Khera reported receiving personal fees from Merck, Amarin Pharmaceuticals, Amgen, Maze Therapeutics, Navitor Pharmaceuticals, Sarepta Therapeutics, Verve Therapeutics, Silence Therapeutics, Veritas International, Color Health, and Third Rock Ventures and receiving grants from IBM Research outside the submitted work. Dr. Aragam reported receiving speaking fees from the Novartis Institute for Biomedical Research.

Last reviewed April 2022

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Alcoholism as a social problem Essay

1. introduction.

First and foremost, the introduction provides a definition of alcoholism. A more nuanced definition is required nowadays, with our understanding of how chronic heavy alcohol use can be a disease now well developed. This definition is crucial so as to examine the impact of alcoholism; hence, it will be explored in greater length later. Alcoholism can be defined as illegal drinking, being unable to control the amount of alcohol that is drunk and constantly requiring more alcohol to feel its effects. Secondly, the introduction discusses the prevalence of alcoholism in society. It is important for this to be explored and established, so the true extent of alcohol abuse can be realised. This can lead to the acquisition of statistics and in-depth analysing upon this, therefore, objectively rationalising what the true social problem really is. These statistics can be immensely valuable, and will definitely show the scale of the problem. This can later associate to why it is considered as a social problem; the density of text can be balanced with researched authoritative source and the holistic view to form a solid, forceful argument. Each individual statement written is completed with the way methodically research is needed in order to enrich the argument. It was identified that it is essential to reflect on reported case and statistical findings instead of accepting social perceptions for a critical appreciation of the effects of alcohol consumption on different groups of people within society. Furthermore, research findings were indicated. It was crucial to understand the detection and diagnosis from a biological, as well as a sociological standpoint. An academic background on molecular biology and psychology was given in order to understand such.

1.1. Definition of alcoholism

The text should never be read or interpreted as a formal clinical assessment of alcoholism and should not be used in place of an officially recognized diagnostic process. It is important to seek help from a medical professional to receive an accurate diagnosis of the disorder. If a person does have alcoholism, it should be treated as a serious medical condition. There are many effective treatments available. For many cases of the disorder, the patient will require medical detox and round-the-clock medical care for the first few days of treatment, as the toxic effects of alcohol withdrawal can be life-threatening. Treatment and recovery are based on the notion that alcoholism is a chronic, relapsing disorder. However, the long and varied history of Alcoholics Anonymous, which began in the 1930s, shows that for years there have been overcome alcoholics, or those in rehabilitation support groups, who remain alcohol-free for the rest of their lives. This is not to say that alcoholism is not an inherently dangerous condition, as it still is, but rather there is evidence that the cycle of sobriety, relapse, rehabilitation, and further sobriety is a state that can be permanently achieved with a robust and ongoing support network for the sufferer.

1.2. Prevalence of alcoholism in society

The magnitude, severity, and urgency of this problem can be measured by statistics on alcoholism. More than 76 million people suffered from alcoholism in the year of 2010, a 400% increase from 1970. In the US alone, alcoholism leads to 100,000 deaths annually and untold misery for children and family members. Alcohol abuse and alcoholism can affect all aspects of a person's life. Long-term alcohol use can cause serious health complications, damage emotional stability, finances, career, and impact one's family, friends, and community. With the overwhelming evidence of the alcohol-related harm in society, some people still have this misperception that the US is a nation of drinkers. It is normal for people to hide drinking problems and to drink in secret. But the statistics and the research studies tell us a different story. A study comparing the alcohol consumption and alcohol dependence between 11 countries, International Journal of Alcohol Research and Public Health, showed that the prevalence of alcohol dependence status varies considerably between countries, from 0.4% in Canada to 3.4% in Ukraine. The study of WHO report in 2011 on global status report on alcohol and health stated that the alcohol consumption in the US is 2 times more than the world's average and, in general, drinking patterns differ by age and gender. 20 percent of alcohol drinkers consume 80 percent of alcohol in the US. 30-50% of alcoholism risk is genetically predetermined. People who start drinking at an early age have a much higher chance of developing alcohol problems at some point in their lives. Also, a study of National Institute on Alcohol Abuse and Alcoholism shows that people living in poverty are more likely to suffer from alcoholism or to use alcohol in harmful ways. The statistics and research results show that people having more than $70,000 or more annually had the highest percentage of "People who drank in the last 30 days" with a percentage of 60.9% alcohol users and 10% alcohol dependence status. And it dropped sharply to 42% for the income group of $20,000 - $29,000 yearly and steep to 30% for less than $10,000 family income. The relationship between family income and alcohol drinkers consuming percentage was found a decreasing linear relationship between the alcohol consumption and annual family income. These researches and statistics provide us a better understanding of the problem and what leads to or what behaviors associate with alcoholism. It can provide a platform to further improve and design prevention programs to decrease the alcohol-related problems.

1.3. Impact of alcoholism on individuals and communities

Alcoholism affects the drinker first and foremost, but also those around him like family, friends, and work colleagues. This, in turn, affects society at large. There are two types of drinkers in the UK: those with a physical dependence on alcohol and those without. For both types of drinkers, the effects of alcoholism on each affected person are never exclusive to them. Alcoholics can often drink large quantities of alcohol, which can cause a biochemical change in the brain. This can change their behavior and mood and make the person more and more reckless. The effects of alcoholism on families can cause more damage and pain than any other internal or external influence on the family unit. The social impact of alcohol abuse is a key factor in alcoholism. As a primary health problem, alcoholism creates a secondary impact in the social environment which leads to numerous social problems, such as violent behavior, relationship conflicts, and power battles. Many symptoms of alcoholism can cause social problems such as the breakdown of relationships, work absences, continued drinking despite physical problems, and emotional insecurity. If unrecognized or untreated, it can cause long-term complications for the sufferer, such as increasing the risk of diseases, including heart disease and alcohol-related liver disease. This obviously adds pressure to an already overburdened national health service. More evident social problems caused by heavy drinkers include the ability to work. In the UK and Wales, about 17 million working days are lost to alcohol in one year. This places a significant financial burden on the economy and on small to medium enterprises. In conclusion, Professor Gilvarry states that "alcoholism is a major social problem posing a widespread challenge not only to the medical profession but also to other caring and policymaking agencies."

2. Causes of alcoholism

Alcoholism can be attributed to several genetic and environmental factors. Genetic research has shown that genes play a pivotal role in the development of alcoholism. People who have family members with alcoholism are more prone to develop alcoholism than people who do not. Studies have shown a strong genetic link in people suffering from alcohol dependence. Research has identified chromosome 1 as a strong indicator of the threshold at which a person feels the effects of alcohol. Furthermore, this chromosome has also been linked with an increased likelihood of being diagnosed with antisocial personality disorder - a condition in which a person shows no regard for societal norms or the rights of others. There are also a number of environmental factors that can contribute to the risk of alcoholism. These include socioeconomic status, culture, and peer pressure. For example, people in lower income groups are more likely to engage in heavy drinking in the UK. It is thought that the ready availability of cheap alcohol in supermarkets and the significant discounts offered by some off-licenses and clubs may further contribute to alcohol abuse among those with lower incomes. The difference in levels of alcohol consumption between different income groups has steadily increased over the past decade. For some people, increased levels of alcohol use are primarily psychological. They show a mental reliance on alcohol that can be damaging, relaxing, and generating confidence. This may be because they are genetically predisposed to develop the addiction or they may have a history of a dangerous drinking pattern. However, there are a number of psychological factors that can contribute to the development of alcoholism. One such reason is reliance. The person drinks and becomes alcohol dependent because they rely on the substance to either block out certain emotions in their life or to generate positive emotions. Alcohol can bring about a surrogate confidence in the person. When a person suffers from alcohol dependence, they may face a large range of health complications. These arise because alcohol has a significant impact on the body, not only physically but mentally as well.

2.1. Genetic factors

Now that we have an understanding of what the term alcoholism means, the definition of alcoholism can now be complete without mentioning the causes of alcoholism. The causes of alcoholism, according to biological or genetic theories, are handed down through the generations in families. These theories say that certain gene(s) that a person inherits is the cause of alcoholism. For example, many daughters of alcoholics are known to have the gene which makes it harder for them to stop drinking and increases the possibility of developing alcoholism. On the other hand, some sons of alcoholics are known to tolerate alcohol better than others because they do not inherit the gene. This biological theory is criticized by the fact that it is hard to determine whether people are drinking because of the assumed genetic link to alcoholism or they are actually influenced by the environment. Also, one would say that a behavioral effect of alcohol drives some individuals to depend on alcohol over time. However, the key word to biological theories is that they assume that addiction is an inherited disease and individuals who have it cannot help but become alcoholics when they start drinking. But a leading psychologist, Professor Dr. Stanton Samenow, a psychology professor at Mary Washington University in Fredericksburg, Virginia in the United States, argues that "alcoholism remains the only disease that patients and experts vigorously deny having" and people keep looking for any explanation for it, including genetic ones. He claims that it is wrong to think the focus on research into the genetic causes of alcoholism and addiction and there is no evidence that addiction is inherited. He says patients start with a history of bad choices and the choices amount to a history of not accepting responsibilities for their actions. Such patients look for people, places, substances, atmospheres, and many other variables to blame. And he says that patients turn to considering the idea that addiction is inside them and they feel so much better because it is not their fault that they are addicted, it is something inside them. But he insists, "it is no matter what is inside somebody, it is no matter what kind of disease they have been dealt with—ultimately the individual has the ability to make choices."

2.2. Environmental influences

Environmental influences also play a significant role in the development of alcoholism. Research has shown that a person is more likely to develop alcoholism if one or both of their parents are alcoholics, suggesting that it is a genetically influenced condition. However, in some cases, children of alcoholics never become alcoholics themselves. Social learning theorists believe that children learn to drink by observing the behaviors of the parent who drinks more and of the one who drinks less. If a child observes the daily consumption of alcohol by their parents, they may learn that alcohol is the way to cope with stress. Other environmental factors, such as stress, physical abuse, and low self-esteem, can also contribute to alcoholism. When a person is stressed over a long period of time, their body continually produces adrenaline and high levels of corticosteroids, which can weaken the immune system and cause gastrointestinal disorders and depression. In an attempt to eliminate these aversive feelings, chronic stress may lead people to use alcohol as a coping mechanism. Also, persons who are physically, emotionally, or sexually abused are much more likely to develop alcoholism. Alcohol can temporarily diffuse the physiological and psychological sense of pain and enhance feelings of power and self-worth, and therefore a person may turn to alcohol as a way of trying to escape the painful memories and feelings associated with abuse.

2.3. Psychological factors

There are different psychological factors that could lead to alcohol use disorders. For some people, the main focus is to numb the feelings of physical or emotional distress. Some people also drink because the effects of alcohol can temporarily relieve the symptoms of a mental health condition, making the drinker feel as though they are mentally healthy. Self-medication can take two forms: physical and emotional. Physical self-medication is where the alcoholic drinks in response to physical conditions. For example, a hangover is a form of physical distress leading a person to drink more. Also, withdrawal symptoms can be alleviated by drinking. Drinking alcohol causes a person to feel calm because alcohol affects the brain in that way. However, if the alcoholic is under stress when they are not drinking, this suggests that the stress is contributing to their drinking habits. Engagement in excessive drinking is likely to increase the chances of developing other mental health problems. This might be because alcohol alters the levels of serotonin in our brain, which is a chemical produced by nerve cells. Serotonin is affected by alcohol and it is believed this is what works in the brain to generate feelings of happiness and contentment. However, overuse of alcohol can actually change the levels of this chemical in our brain and lead us to become more prone to depression. Also, by drinking alcohol over the allowed amounts, a person is likely to become unbalanced and clumsy in their movements. It is believed that the disruption of the neurotransmitters in the brain from continued excessive drinking can lead to brain shrinkage. This can lead to an alcoholic developing issues with learning and memory, as well as having problems with their mental health. This could lead to a further cycle of depression and dependence on alcohol as the affected individual will find their ability to function daily greatly impaired.

3. Consequences of alcoholism

As a result, excessive use of alcohol has some serious effects on an individual's health and it is important that those who engage in alcohol consumption weigh the risks of the health consequences. Although the body has mechanisms to rid itself of the toxins that drinking alcohol produces, over time a person's body can suffer significant damage. In addition, mental illness such as depression can trigger the problem, and the individual may start to drink heavily as a form of escapism. Additionally, the cumulative effect of multiple instances of intoxication can produce long-term effects such as brain damage that in the most severe cases can produce a disorder known as alcohol dementia. Gradual damage to the nervous system and internal organs can occur, and these can become permanent problems over time. For instance, liver damage may occur and inevitably present the individual's body physiology with significant problems for the duration of that person's life. The pancreas can become inflamed, leading to a condition known as pancreatitis, and this is also a risk factor for the development of pancreatic cancer, another life-threatening condition. It is a matter of fact that health professionals rank this risk as one of the most serious health consequences of excessive drinking. Diabetes is also a risk factor, as alcohol has the effect of speeding up the body's absorption of glucose, which over time can result in the onset of Type 2 diabetes. Apart from the physical health, when an individual drinks alcohol beyond the body's ability to process it, that person's blood alcohol level (BAL) continues to rise. The higher the BAL, the more unsteady, overemotional, and mentally disoriented the person is, and it is said that the individual will begin to show symptoms at different levels of intoxication. For instance, a BAL of 0.05% is identified by impairments to judgment, and this can lower to 0. This level of intoxication will bring about significant emotional changes such as loss of affection, mood fluctuation, and potentially aggression. Regardless of the effects of a particular level of alcohol on one's health, three in ten hospital beds in the UK are occupied by someone with an alcohol-related illness. Of significant concern is that the Health and Social Care Information Centre points out that in 2011/12 there were 200,900 admissions where the primary diagnosis or the underlying cause of the admission was linked to alcohol consumption. This is a 1% increase on the number of such admissions in 2010/11. However, these are 'gross' figures, but there is evidence to suggest that there has been a year on year upward trend in the intensity of alcohol-related admissions to hospitals. Therefore, John French, Director of Marketing and Innovation of the Information Centre, stated that 'although the number of admissions has fallen slightly since 2010/11, it still equates to 1,000 alcohol-related admissions for every day in the year and it is clear that the rates of such admissions continue to spiral.' Social and economic consequences of alcohol misuse evince in various forms. Alcohol misuse is the biggest risk factor for death, ill-health and disability among 15-49 years old, and it is responsible for 4% of the global disease burden. In the UK, the cost of alcohol misuse in 2005 was estimated by the Cabinet Office Strategy Unit to be £17.7 billion, and this is projected to reach £21 billion by 2015, equivalent to....

3.1. Health effects of alcoholism

The health effects of alcoholism are largely determined by the length and severity of the alcohol addiction. Alcohol, when consumed excessively over time, can lead to degenerative health conditions, neurological impairment, and decreased life expectancy. For the purpose of this essay, the focus will be on the physical health effects. These begin with the body's most important organ, the brain. Due to damaged nerve cells and lessened communication between neurons, chronic heavy drinking takes a toll on cognitive and motor functions. For instance, in the later stages of alcohol addiction, an individual may have difficulty balancing and walking due to muscle atrophy and a lack of control over body movements. Alcohol also alters the function of white blood cells and can lead to an increased susceptibility to infections. It can cause damage to the liver, leading to a build-up of fat, inflammation, and eventually scarring of the liver tissue, known as cirrhosis. This is a serious condition that can destroy the liver. A particularly severe health disorder that can result from long-term heavy drinking is Wernicke-Korsakoff syndrome. This is actually two separate conditions that can occur together, although they are caused by a thiamine deficiency, which is often brought on by alcohol misuse. It affects memory formation due to chronic and damaging vitamin deficiencies attributable to alcohol intervention in nutrient absorption in the body. This would seem to be highlighted in a recent large-scale study, co-authored by University of Cambridge specialists, which determined that "alcohol is a major cause of dementia: individuals with an alcohol dependence diagnosis were found to be at a threefold increase in risk of developing dementia". Dementia is a group of diseases that harm the brain, and as a result, it therefore has a significant impact on memory, focus, language skills, judgment, and the ability to complete everyday activities. In conclusion, the health effects of excess alcohol use are significant. Regular excessive consumption can have a physical, psychological, and social impact on the individual. Brain and heart damage, liver failure, and a shorter life expectancy seem a heavy price to pay just for the enjoyment of drinking. Crick et al. (2013) emphasizes the long-term effects of alcohol addiction and specifically brain damage, noting that "alcohol addiction reduces mental and cognitive capacity and is of significance in the cause and progression of other conditions such as Alzheimer's and Parkinson's diseases." These findings suggest that chronic alcohol abuse not only has an impact on day-to-day brain function but also has the ability to change the structure and function of the brain over the lifetime of addiction. It seems that the authors here are implying that reducing alcohol intake, particularly for those in middle age, can help to limit the extent of brain injury and slow down the onset of further aging-related cognitive and motor dysfunction.

3.2. Social and economic consequences

Another significant impact of alcoholism as a social problem is its devastating effect on the economy. The use and abuse of alcohol can have substantial negative effects on an individual's economy and the economy of the society. Abusers and addicts of alcohol may fail to fulfill their responsibilities at work, home or school. This may result in loss of job, poor grades or neglect of family responsibilities. They may also ignore home and work duties as a result of engaging in drinking habits. The World Health Organization reports that drinking and driving is responsible for 20% to 30% of fatal accidents, leading to economic and social consequences. Every year, 1.6 million people die and 20 to 50 million people are injured as a result of alcohol, with most victims being of young age. The economic and social effects of alcohol abuse can be split into two categories: the effects of drinking alcohol and the effects of paying for alcohol. The first category accounts for the physical and health risks. Drunkenness may lead to modern diseases and life problems. The second category accounts for the fact that someone has to pay for the drink – and if there are no effective principles in place to control the consumption of alcohol, the state frequently will have to cough up in one way or another as a result. In these circumstances, the taxpayer may end up paying twice: once to pay for the alcohol and once to pay for the resources and staffing necessary to cope with the effects. The use, abuse, and dependence on alcohol have serious effects on a person's strength of mind and persuasive power. Employment issues are mainly important when it comes to effects of alcohol on the body. However, many dissimilar things will also come into play such as depression and family connections – all of which can be disturbed detrimentally by alcohol-related illnesses or states of drunkenness. Children often suffer the most, and this is because poverty and domestic abuse often combine with alcoholism to create a harmful atmosphere in which to bring up children. Every child has the right to a safe and caring environment, but when drink is added into the equation, many of the baseline requirements for care and effective parenting fall away. The government and a number of welfare organizations are cognizant of this fact and usually offer support to those families whom it is believed can be saved from a life of neglect and abuse through the medium of alcohol advice and support. Children in families where a person has an addiction face the possibility of neglect, physical and/or emotional abuse, and other serious health and behavioral problems. These children often mimic the same behaviors of neglect, abuse, violence, and drug and alcohol addiction when they become adults. This cycle of addictive and abusive behaviors is a multi-generational issue. As children of addicts see and learn negative coping mechanisms through their parents, the likelihood of them being addicted to drugs or alcohol themselves is very high.

3.3. Impact on family dynamics

Alcoholism has a major impact on the dynamics of a family. When someone in the family is suffering from alcoholism, the other family members must carry a heavier load, and this creates a lot of stress for everyone. The love that most children feel for their parents is so strong that they do not want to believe that either of their parents has a medical problem. Children are dependent on parents and in most cases they take their words as the last statement. Consequences of this disease process are terrible for the alcoholic, the spouse, and the children. Many children often blame themselves for the drinking just as the alcoholic does. The child gets mixed messages. On the one hand they see the bottle and parent's drinking and know that the situation is bad. On the other hand, they know that the alcoholic keeps saying that the problem is his or her's fault and that the child should not tell anyone about what goes on in the home. As a result of all this madness, no one in the family is getting what he or she wants or needs. The stress on a family caused by alcohol is never completely repaired. For the non-alcoholic spouse the worry and stress can lead to problems such as depression, rage, severe anxiety and a poor ability to focus. In most of the cases, the children as well as the parents are completely unaware of the children abuse and maltreatment till they are not reported to the authorities. This further increases the level of stress and worries in the family system. When a parent is an alcoholic, it can take a heavy toll on the family. Spouses may think about leaving the alcoholic and become concern about child support and custody. The children begin to turn against the abusing parent and start believing that fighting back to stop the abuse will cause the violence to end. However when they realise that the abuse is still happening regardless of their actions and start feeling powerlessness again. The dysfunction and trauma that children experience in an alcoholic family have been clinically found to mirror the emotional pain of those diagnosed with the post-traumatic stress disorder. Also, most of the families that have been destroyed by the disease of alcoholism are so focused on the alcoholic that the children's ability to trust and build close and lasting friendships is cut short.

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Importance of Olympic Games

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Alcohol and Your Brain: The Latest Scientific Insights

Want to protect your brain here's what you need to know about alcohol consumption..

Posted March 18, 2024 | Reviewed by Devon Frye

• What Is Alcoholism?
• Find counselling to overcome addiction
• Transient memory loss, “blackouts,” and hangovers related to alcohol consumption are brain health risks.
• Alcohol use disorder (alcoholism) is a risk factor for developing dementia.
• Heavy or excessive alcohol consumption is dangerous to the brain for a number of reasons.
• The impact of mild to moderate alcohol consumption (1-3 drinks a day) on brain function is less clear.

Depending on who you ask, you might be told to drink a few glasses of red wine a day or to avoid alcohol altogether. The reasons for such recommendations are many, but, by and large, they tend to stem from a study someone read about or saw reported in the news.

So why is it so hard to know whether alcohol is good or bad for us—especially for our brains? In this post, we’ll explore the current science and some practical ideas on how to approach the topic.

What Is Alcohol Anyway?

When people talk about drinking “alcohol,” they’re almost always referring to the consumption of ethanol. Ethanol is a natural product that is formed from the fermentation of grains, fruits, and other sources of sugar. It’s found in a wide range of alcoholic beverages including beer, wine, and spirits like vodka, whiskey, rum, and gin.

Evidence for human consumption of alcohol dates back over 10,000 years. Consumption of alcohol has and continues to serve major roles in religious and cultural ceremonies around the world. But unlike most food products, in the last century, alcohol has been wrapped up in nearly perpetual controversy over its moral effects and health implications.

How Does Alcohol Impact the Brain?

As anyone who’s consumed alcohol knows, ethanol can directly influence brain function. Ethanol is classified as a “depressant” because it has a generally slowing effect on brain activity through activation of γ-aminobutyric acid (GABA) pathways.

In an acute sense, consumption of alcohol can lead to uninhibited behavior, sedation, lapses in judgment, and impairments in motor function. At higher levels, the effects can progress to coma and even death.

The Known Brain-Damaging Effects of Excess Alcohol

There is no debate here: Excessively high levels of alcohol consumption over short periods of time are toxic and potentially deadly, specifically because of its effects on the brain.

One critical fact to understand about the overall and brain-specific effects of alcohol is that the entirety of the debate around the risk/benefit ratio concerns mild to moderate alcohol consumption. As it relates to the effects of high amounts of alcohol on the body and brain, the research is consistent: It’s a very bad choice.

High amounts of alcohol use are causal risk factors in the development of disease in the heart, liver, pancreas, and brain (including the brains of children in utero). In fact, 1 in 8 deaths in Americans aged 20-64 is attributable to alcohol use. When it comes to adults, excessive alcohol use can cause multiple well-defined brain issues ranging from short-term confusion to dementia .

What Is “Excessive” or “High” Alcohol Use?

Key to the nuance in the conversation about alcohol use are definitions. Across the board, “excessive” or “high” alcohol use is linked to worse overall and brain health outcomes. So what does that mean?

While definitions can be variable, one way to look at this is the consumption of 4 or more drinks on an occasion (for women) and 5 or more for men. Additionally, excess alcohol is defined as drinking more than 8 drinks a week (women) and 15 a week (men), or consuming alcohol if you are pregnant or younger than age 21.

Beyond this, by definition, consuming enough alcohol to cause a “brownout,” “blackout,” hangover, or other overt brain symptomatology is evidence that the alcohol you’ve consumed is creating problems in your brain. Alcohol use disorder (or alcoholism ) is also a clear issue for the brain. It has been linked to a higher risk for dementia, especially early-onset dementia in a study of 262,000 adults, as well as to smaller brain size .

Is There a “Safe” Amount of Alcohol for the Brain?

In a highly publicized article from Nature Communications , researchers looked at brain imaging data from nearly 37,000 middle-aged to older adults and cross-referenced their brain scans with their reported alcohol consumption. The findings were profound: People who drank more alcohol had smaller brains, even in people drinking only one or two alcoholic beverages a day.

Conversely, other recent data suggest a lower risk for dementia in people consuming a few alcoholic beverages a day. This includes a 2022 study showing that in around 27,000 people, consuming up to 40 grams of alcohol (around 2.5 drinks) a day was linked to a lower risk for dementia versus abstinence in adults over age 60. A much larger study of almost 4 million people in Korea noted that mild to moderate alcohol consumption was linked to a lower risk for dementia compared to non-drinking.

How Do We Make Sense of This Data?

When it comes to the bottom line as it relates to alcohol consumption and brain health, the data are rather solid on some fronts, and a bit less so on others. There’s also the potential for confounding variables, including the fact that many people like to drink alcohol to enjoy and enhance social bonds (which we know are beneficial for the brain). Here’s a summary of what the most recent research is telling us.

• Experiencing transient memory loss, “blackouts,” or hangovers related to alcohol consumption is overt evidence of threats to brain health.
• The impact of mild to moderate alcohol consumption (1-3 drinks a day) on brain function is less clear, but it seems unreasonable to start alcohol use for brain health.

Austin Perlmutter, M.D. , is a board-certified internal medicine physician and the co-author of Brain Wash .

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Alcohol is a chemical substance derived from the fermentation or distillation of various fruits, grains, or other natural sources. It is commonly consumed in the form of alcoholic beverages and is known for its psychoactive effects. Alcohol, specifically ethanol, acts as a central nervous system depressant, affecting brain function and altering behavior.

The origin and history of alcohol can be traced back to ancient civilizations. The earliest evidence of alcohol production dates back to around 7000 to 6600 BCE in China, where fermented beverages made from rice, honey, and fruit were consumed. Similarly, in the Middle East, evidence of alcoholic beverages made from barley dates back to around 5400 to 5000 BCE. Throughout history, alcohol has played a significant role in various cultures and societies. It was often associated with religious rituals, social gatherings, and medicinal purposes. The Ancient Egyptians, Greeks, and Romans had a wide variety of alcoholic beverages, and the art of brewing and distillation spread through trade routes. During the Middle Ages, monasteries in Europe became centers of brewing and distillation, and the production of alcoholic beverages became more organized. In the 18th and 19th centuries, the Industrial Revolution led to the mass production of alcohol, contributing to social issues related to alcohol abuse.

Alcohol has both short-term and long-term effects on the body and mind. In the short term, alcohol acts as a depressant, slowing down the central nervous system and affecting coordination, judgment, and reaction time. It can cause relaxation, euphoria, and lowered inhibitions. However, excessive consumption can lead to negative effects such as impaired judgment, blurred vision, slurred speech, and increased risk-taking behavior. Long-term alcohol use can have detrimental effects on various organs and systems. Prolonged heavy drinking can damage the liver, leading to conditions such as cirrhosis and alcoholic hepatitis. It can also weaken the immune system, increase the risk of cardiovascular diseases, and contribute to the development of certain types of cancer. Alcohol misuse and addiction can have profound social and psychological consequences. It can strain relationships, lead to financial difficulties, and contribute to mental health disorders such as depression and anxiety. Additionally, excessive alcohol consumption is associated with an increased risk of accidents, injuries, and even fatalities. It is important to note that moderate alcohol consumption can have some potential health benefits, such as a reduced risk of heart disease. However, these potential benefits must be balanced with the risks and individual circumstances, and it is always advisable to consume alcohol responsibly and in moderation.

Public opinion about alcohol varies greatly depending on cultural, social, and individual factors. It is a complex and multifaceted topic that elicits diverse perspectives. Some individuals and societies view alcohol consumption as an acceptable and enjoyable part of social gatherings and celebrations. They may see it as a way to relax, socialize, and enhance the enjoyment of certain experiences. In these contexts, alcohol is often seen as a normal and integral aspect of everyday life. On the other hand, there are those who hold more cautious or negative views towards alcohol. They may emphasize the potential risks and harms associated with its use, such as addiction, health problems, and impaired judgment. Concerns about alcohol-related accidents, violence, and addiction can shape public opinion and lead to stricter regulations and policies. Public opinion on alcohol is also influenced by cultural and religious beliefs, as well as personal experiences and values. Some individuals may have witnessed the negative consequences of alcohol misuse and therefore hold more critical views. Others may have positive associations with alcohol and view it as a benign or enjoyable substance when consumed responsibly.

Alcohol is a frequently depicted substance in various forms of media, including movies, television shows, music, and advertising. Its portrayal in media can range from positive and glamorous to negative and cautionary, reflecting the diverse perspectives and attitudes towards alcohol. In some media representations, alcohol is shown as a symbol of sophistication, celebration, and socializing. It is often associated with luxury and enjoyment, depicted in glamorous settings where characters are seen drinking champagne, cocktails, or wine. This positive representation can be found in movies like "The Great Gatsby" and TV shows like "Mad Men," where characters are shown indulging in alcohol as a part of their lifestyle. However, media also portrays the negative consequences and risks associated with alcohol consumption. Films like "Leaving Las Vegas" and "Flight" depict the destructive effects of alcohol addiction, showcasing the devastating impact it can have on individuals and their relationships. Such portrayals serve as cautionary tales and highlight the potential dangers of excessive alcohol use. Furthermore, there are public service announcements and campaigns that aim to raise awareness about responsible drinking and the harmful effects of alcohol abuse. These messages often depict the negative consequences of alcohol-related accidents, impaired judgment, and addiction.

1. According to the World Health Organization (WHO), alcohol is responsible for more than 3 million deaths worldwide each year. This includes deaths from alcohol-related diseases, accidents, and violence. It is a significant public health concern that requires attention and prevention efforts. 2. A study published in the journal Addiction revealed that alcohol consumption is a leading risk factor for disease burden and premature death globally. It ranked as the seventh leading risk factor for both death and disability-adjusted life years (DALYs) in 2016, highlighting the significant impact of alcohol on population health. 3. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports that alcohol-related problems cost the United States economy an estimated $249 billion in 2010. These costs include healthcare expenses, lost productivity, and criminal justice costs associated with alcohol-related incidents. This statistic emphasizes the economic burden of alcohol misuse on society.

Alcohol is an important topic to explore in an essay due to its widespread use and the complex implications it has on individuals, society, and public health. Understanding the various aspects of alcohol, including its history, effects, public opinion, and representation in media, can provide valuable insights into its impact on individuals and communities. By delving into the history of alcohol, one can examine its cultural, social, and economic significance throughout different time periods and regions. Exploring the effects of alcohol on the human body and mind helps shed light on the risks and potential consequences associated with its consumption. Analyzing public opinion allows for an understanding of societal attitudes, perceptions, and debates surrounding alcohol use and abuse. Furthermore, the representation of alcohol in media and popular culture plays a significant role in shaping public perceptions and behaviors. Investigating how alcohol is portrayed in films, advertisements, and literature can reveal underlying messages and narratives about its consumption.

1. Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary care (2nd ed.). World Health Organization. 2. Dawson, D. A., Goldstein, R. B., Saha, T. D., & Grant, B. F. (2015). Changes in alcohol consumption: United States, 2001–2002 to 2012–2013. Drug and Alcohol Dependence, 148, 56–61. 3. Grant, B. F., & Dawson, D. A. (2017). Alcohol and drug use disorder: Diagnostic criteria for use in general health care settings. National Institute on Alcohol Abuse and Alcoholism. 4. Gual, A., Segura, L., Contel, M., & Heather, N. (2013). AUDIT-3 and AUDIT-4: Effectiveness of two short forms of the Alcohol Use Disorders Identification Test. Alcohol and Alcoholism, 48(5), 565–565. 5. Koob, G. F., & Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, 35(1), 217–238. 6. Rehm, J., Mathers, C., Popova, S., Thavorncharoensap, M., Teerawattananon, Y., & Patra, J. (2009). Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. The Lancet, 373(9682), 2223–2233. 7. Roerecke, M., & Rehm, J. (2010). Alcohol consumption, drinking patterns, and ischemic heart disease: A narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Medicine, 8(1), 1–23. 8. Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. The Lancet, 365(9458), 519–530. 9. Schuckit, M. A. (2014). Alcohol-use disorders. The Lancet, 383(9929), 988–998. 10. World Health Organization. (2018). Global status report on alcohol and health 2018. World Health Organization.

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More women are drinking themselves sick. The Biden administration is concerned.

By Lauren Sausser

March 21, 2024 / 5:00 AM EDT / KFF Health News

When Karla Adkins looked in the rearview mirror of her car one morning nearly 10 years ago, she noticed the whites of her eyes had turned yellow.

She was 36 at the time and working as a physician liaison for a hospital system on the South Carolina coast, where she helped build relationships among doctors. Privately, she had struggled with heavy drinking since her early 20s, long believing that alcohol helped calm her anxieties. She understood that the yellowing of her eyes was evidence of jaundice. Even so, the prospect of being diagnosed with alcohol-related liver disease wasn't her first concern.

"Honestly, the No. 1 fear for me was someone telling me I could never drink again," said Adkins, who lives in Pawleys Island, a coastal town about 30 miles south of Myrtle Beach.

But the drinking had caught up with her: Within 48 hours of that moment in front of the rearview mirror, she was hospitalized, facing liver failure. "It was super fast," Adkins said.

Historically, alcohol use disorder has disproportionately affected men. But recent data from the Centers for Disease Control and Prevention on deaths from excessive drinking shows that rates among women are climbing faster than they are among men. The Biden administration considers this trend alarming, with one new estimate predicting women will account for close to half of alcohol-associated liver disease costs in the U.S. by 2040, a $66 billion total price tag.

It's a high-priority topic for the Department of Health and Human Services and the Department of Agriculture, which together will release updated national dietary guidelines next year. But with marketing for alcoholic beverages increasingly geared toward women, and social drinking already a huge part of American culture, change isn't something everyone may be ready to raise a glass to.

"This is a touchy topic," said Rachel Sayko Adams, a research associate professor at the Boston University School of Public Health. "There is no safe level of alcohol use," she said. "That's, like, new information that people didn't want to know."

Over the past 50 years, women have increasingly entered the workforce and delayed motherhood, which likely has contributed to the problem as women historically drank less when they became mothers.

"Parenthood tended to be this protective factor," but that's not always the case anymore, said Adams, who studies addiction.

More than 600,000 people in the U.S. died from causes related to alcohol from 1999 to 2020, according to research published in JAMA Network Open last year , positioning alcohol among the leading causes of preventable death in this country behind tobacco, poor diet and physical inactivity and illegal drugs.

The World Health Organization and various studies have found that no amount of alcohol is safe for human health. Even light drinking has been linked to health concerns, like hypertension and coronary artery disease and an increased risk of breast and other cancers .

More recently, the COVID-19 pandemic "significantly exacerbated" binge-drinking, said George Koob, director of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, as people used alcohol to cope with stress. That is particularly true of women, who are more likely to drink alcohol because of stress than men, he said.

But women are also frequently the focus of gender-targeted advertising for alcoholic beverages. The growth of rosé sales and low-calorie wines , for example, has exploded in recent years. New research published by the International Journal of Drug Policy in February found that the "pinking of products is a tactic commonly used by the alcohol industry to target the female market."

Also at play is the emergence of a phenomenon largely perpetuated by women on social media that makes light of drinking to deal with the difficulties of motherhood. The misperception of "mommy wine culture," said Adams, is that "if you can drink in a normal way, a moderate way, if you can handle your alcohol, you're fine."

And while it's unclear to what extent memes and online videos influence women's drinking habits, the topic merits further study, said Adams, who with colleagues last year found that women without children at age 35 are still at the highest risk for binge-drinking and alcohol use disorder symptoms among all age groups of women. But over the past two decades, the research concluded, the risk is escalating for both childless women and mothers.

These factors at play, coupled with the pressure to fit in, can make excessive drinking a difficult conversation to broach. "It's a very taboo topic," Adams said.

And when it does come up, said Stephanie Garbarino, a transplant hepatologist at Duke Health, it's often surprising how many patients are unaware how their drinking affects their health.

"Often, they didn't know there was anything wrong with what they're doing," she said. She is more frequently seeing younger patients with liver disease, including men and women in their 20s and 30s.

And public health and addiction experts fear that alcohol-related liver disease among women will become a costly issue for the nation to address. Women accounted for 29% of all costs associated with the disease in the U.S. in 2022 and are expected to account for 43% by 2040, estimated a new analysis published in the American Journal of Gastroenterology in February.

National dietary guidelines advise women to drink no more than one alcoholic drink a day. Those guidelines are up for a five-year review next year by the USDA and HHS, which has called a special committee to examine, among other questions, the relationship between alcohol consumption and cancer risks. The report will be made public in 2025.

When Canada published guidance in 2023 advising that drinking any more than two alcoholic beverages a week carried health risks, Koob sparked backlash when his comments to the Daily Mail suggested that U.S. guidelines might move in the same direction. The CDC report published in February suggested that an increase in alcohol taxes could help reduce excessive alcohol use and deaths. Koob's office would not comment on such policies.

It's a topic close to Adkins' heart. She now works as a coach to help others — mostly women — stop drinking, and said the pandemic prompted her to publish a book about her near-death experience from liver failure. And while Adkins lives with cirrhosis, this September will mark 10 years since her last drink.

"The amazing thing is, you can't get much worse from where I got," said Adkins. "My hope is really to change the narrative."

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.

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Alcohol Exclusion Laws and Its Drawbacks

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INTRODUCTION

Since the repeal of the 18 th Amendment in 1933, alcohol consumption has become prevalent among many Americans. Alcohol intoxication is an increasing contributor to emergency room visits wherein individuals present to the emergency department (ED) in an inebriated state,  often with secondary injuries or severe medical co-morbidities related to alcohol poisoning. The ED is a stressful environment with providers working under taxing conditions while triaging difficult cases. Alcohol related visits contribute to this added stress for staff given that intoxicated individuals increase wait times for the ED, use up valuable resources, and have the capacity to act violently towards providers. As one nurse puts it, some intoxicated individuals  present with “an aggressive state, perhaps have been in a fight, blood everywhere, careening  around the place – it can make things very difficult.” [1] To combat these circumstances, thirty-four States including the District of Columbia have implemented a countermeasure recognized as Alcohol Exclusion Laws (AELs). 

AELs reduce or cut insurance coverage of certain visits to the ED if the cause of the visit is due to alcohol intoxication. [2] The vast implementation of this law is derived from the idea of individual decision making, that it is an individual’s choice to consume alcohol, and therefore they hold a personal responsibility for their intoxication. By using insurance coverage as a leverage, the law aims at reducing the number of ED visits relating to alcohol intoxication, saving resources, and deterring irresponsible drinking. While the intention behind AELs aims for positive change, it is unethical to use AELs, a form of financial leverage, to address certain problems within emergency medicine. 

Stigma is prominent in almost all substance abuse cases including those seen with alcohol intoxication. Many patients feel embarrassment or shame when seeking medical attention for a condition that was brought on by alcohol misuse. A personal account by Jonathan Hunt Glassman, a former alcoholic and NBC contributor, emphasizes on this negative bias. He knows firsthand how unsettling an ED visit can be. He felt demoralized from a superficial prognosis  made by a nurse on his complex alcohol abuse condition, in which the nurse said, “You need to  stop drinking.” [3]

Whether it be from shame or insecurities about an individual’s condition, the stigma behind substance abuse cases in the emergency department and the daunting task of asking for help can turn a lot of patients away from seeking and receiving medical treatment. The implementation of Alcohol Exclusion Laws can amplify this already present stigma. A study conducted by the National Institute of Health (NIH) analyzed States that implemented and continued to enforce Alcohol Exclusion Laws and the stigma in those states surrounding alcohol-related ED visits. The result from the study showed that AELs correlated with an increase in stigmatization regarding medical attention for alcohol-related incidents, and that AELs “negatively impact people’s willingness to seek medical care after alcohol-related injuries or  illnesses.” [4] Both the NIH study and the personal account by Hunt-Glassman go on to show that  AELs have the adverse effect of reinforcing the stigma surrounding alcohol cases in the ED.  While the idea behind AELs is in good faith, it contributes to the stigma. This contribution ethically challenges the idea that the emergency room is a space where the treatment of injuries is carried out without biases infringing on such medical care. The mission of EDs is to provide medical care to anyone in need. AELs have the effect of discouraging these patients from seeking help with the unintended consequence of doing them harm. 

A point of argument for the implementation of AELs is that it is the individual’s choice to be intoxicated and therefore justifiable that an individual receives less insurance coverage for medical expenses from a preventable intoxication. The idea of it being an individual choice to become intoxicated is one of the strongest supports for these exclusion laws. However, it is unjust to assume that all alcohol intoxications come by choice. Instances that disprove this assumption include both the college party scene and bar scene. Spiked drinks significantly increase alcohol concentration and can cause any responsible drinker to become intoxicated without intention or against their will. Additionally, alcoholic beverages served in various social gatherings like those in or around college campuses may not have a clear percentage of alcohol determination. Liquor containing high percentages of alcohol, such as Everclear which contains up to 190 proofs, are often masked by sweeteners and flavorings. Cocktails like these can cause a person to become dangerously intoxicated without their realization or intention. Some may argue that consuming an alcoholic beverage still holds accountability, that the person should be aware of the potential for a tampered drink, and therefore AELs should remain in use to deter this. However, like any law, AELs needs to have defined restrictions and/or exemptions. If the individual choice argument is used in favor for AELs, then how far reaching can the laws be applied? An attorney who specializes in these exclusion laws believes that AELs often offer more ambiguity than clarification when it comes to insurance policy, which leads to further ways insurance claims can be denied. [5]

In summary, the idea behind the use of Alcohol Exclusion Laws aims to reduce intoxication cases in the ED, however, there are drawbacks and aspects of this law that challenge the ethics of seeking medical care from the emergency department. The present stigma surrounding going to the ED for alcohol-related emergencies is already prevalent in hospitals across the country. When applying AELs, the present stigma may be magnified and further push the idea that seeking help for alcohol-related emergencies is shameful and embarrassing for patients, and therefore should be punished via financial means. Secondly, one of the main justifications for AELs is the idea that it is a deliberate intention to become intoxicated. It isn’t always the intention of individuals to get drunk when they choose to consume alcohol. There are additional factors that may play a part to exonerate a person’s accountability. It is difficult for people to recall the specifics of a situation when they become intoxicated; in some cases, accountability cannot be determined and the used of AELs can become unjustified. Overall, Alcohol Exclusion  Laws try to solve the issue of alcohol incidents in a way that produces more detriment than progress. A method to combat the issue of irresponsible drinking and intoxication in the emergency room within the US should not use AELs and financial leverage as one of its forefronts. In fact, a study that based its findings obtained from the Behavioral Risk Factor  Surveillance System nationwide survey that spanned twenty-four years from 1993-2017,  showed no real impact on binge drinking or increased alcohol consumption. [6] Given the downsides to AELs and its proven non-significant effects, several States have already repealed their AELs. For all these reasons, it would be beneficial to find an alternate method to address alcohol related issues within healthcare.

[1] Gregory, A. (16 Jun 2014). Nurses say drunk patients should be banned from A&E as ‘waste of resources’ UK:  Mirror. https://www.mirror.co.uk/news/uk-news/nurses-say-drunk-patients-should-3706280 2 (Jan 2008).

[2] Alcohol Exclusion Laws. National Highway Traffic Safety Administration. https://www.nhtsa.gov/sites/nhtsa.gov/files/810885.pdf.

[3] Glassman, J.H. (28 Apr 2022). Why don’t alcoholics get prescribed the medication they need?. NBC.  https://www.nbcnews.com/think/opinion/alcohol-related-deaths-er-visits-rose-covid-solution-use- rcna26425.

[4] Azagba, S., Ebling, T., Hall, M., (2023). Health claims denial for alcohol intoxication: State laws and structural stigma. Wiley Online Library . https://onlinelibrary.wiley.com/doi/10.1111/acer.15153. 

[5] (7 Sep 2021). The Alcohol Exclusion Chart Denied Life Insurance Claim. https://www.lifeinsuranceattorney.com/blog/2021/september/the-alcohol-exclusion-state-chart-denied-life-in/.

[6] Azagba, S., Shan, L., Ebling, T., Wolfson, M., Hall, M., Chaloupka, F., (26 Nov 2022). Does state repeal of alcohol  exclusion laws increase problem drinking? National Institutes of Health . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10099925/.

William Ngo

Second place winner of Voices in Bioethics' 2023 persuasive essay contest. 

Disclaimer: These essays are submissions for the 2023 essay contest and have not undergone peer review or editing.

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Low social status increases risk of health problems from alcohol problems

People with low income or education levels may benefit from screening for alcohol-related conditions.

Men and women with lower income or education levels are more likely to develop medical conditions related to alcohol abuse compared to similar individuals with a higher socioeconomic status. Alexis Edwards of Virginia Commonwealth University, US, and colleagues report these findings in a new study published March 19 in the open access journal PLOS Medicine .

The World Health Organization estimates that harmful alcohol use accounts for 5.1% of the global burden of disease and injury worldwide, and results in three million deaths each year. Excessive alcohol consumption can also take an economic toll. Previous studies have identified links between a person's socioeconomic status and alcohol use, but currently it is unclear how an individual's social class impacts their future risk of acquiring alcohol-related medical conditions, like alcoholic liver disease.

In the new study, researchers used a model that follows people over time to estimate their risk of developing medical conditions from alcohol abuse using two indicators for socioeconomic status: income and education level. The researchers analyzed data from more than 2.3 million individuals in a Swedish database to show that both men and women with a lower income or education level were more likely to develop these conditions. The associations held true, even when researchers controlled for other relevant factors, such as marital status, history of psychiatric illness and having a genetic predisposition to abuse alcohol.

The new findings are important for understanding which populations are most likely to suffer from medical conditions resulting from alcohol abuse, and contribute to a growing body of literature on health disparities that stem from socioeconomic factors. The researchers recommend that individuals with lower income or education levels might warrant additional screening by clinicians to evaluate their alcohol consumption and identify related conditions.

The authors add, "Among individuals with an alcohol use disorder, those with lower levels of education or lower incomes are at higher risk for developing an alcohol-related medical condition, such as cirrhosis or alcoholic cardiomyopathy. Additional screening and prevention efforts may be warranted to reduce health disparities."

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• Alexis C. Edwards, Sara Larsson Lönn, Karen G. Chartier, Séverine Lannoy, Jan Sundquist, Kenneth S. Kendler, Kristina Sundquist. Socioeconomic position indicators and risk of alcohol-related medical conditions: A national cohort study from Sweden . PLOS Medicine , 2024; 21 (3): e1004359 DOI: 10.1371/journal.pmed.1004359

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Alcohol's Effects on Health

Research-based information on drinking and its impact.

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Harmful and underage college drinking.

Harmful and underage college drinking are significant public health problems, and they exact an enormous toll on the lives of students on campuses across the United States.

Drinking at college has become a ritual that students often see as an integral part of their higher education experience. Some students come to college with established drinking habits, and the college environment can lead to a problem. According to the 2022 National Survey on Drug Use and Health (NSDUH), of full-time college students ages 18 to 22, 49.0% drank alcohol and 28.9% engaged in binge drinking in the past month. 1  For the purposes of this survey, binge drinking was defined as consuming 5 drinks or more on one occasion for males and 4 drinks or more for females. However, some college students drink at least twice that amount, a behavior that is often called high-intensity drinking. 2

What Is Binge Drinking?

Many college alcohol problems are related to binge drinking. NIAAA defines binge drinking as a pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08%—or 0.08 grams of alcohol per deciliter—or more. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours. 11

Drinking this way can pose serious health and safety risks, including car crashes, drunk-driving arrests, sexual assaults, and injuries. Over the long term, frequent binge drinking can damage the liver and other organs.

Note: BAC of 0.08% corresponds to 0.08 grams per 100 milliliters.

Consequences of Harmful and Underage College Drinking

Drinking affects college students, their families, and college communities. 

The most recent statistics from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) estimate that about 1,519 college students ages 18 to 24 die from alcohol-related unintentional injuries, including motor vehicle crashes. 3

The most recent NIAAA statistics estimate that about 696,000 students ages 18 to 24 are assaulted by another student who has been drinking. 4

Sexual Assault

Although estimating the number of alcohol-related sexual assaults is exceptionally challenging—since sexual assault is typically underreported—researchers have confirmed a long-standing finding that 1 in 5 college women experience sexual assault during their time in college. 5 A majority of sexual assaults in college involve alcohol or other substances. 6,7 Research continues in order to better understand the relationships between alcohol and sexual assault among college students. Additional national survey data are needed to better estimate the number of alcohol-related assaults.

Academic Problems

About 1 in 4 college students report experiencing academic difficulties from drinking, such as missing class or getting behind in schoolwork. 8

In a national survey, college students who binge drank alcohol at least three times per week were roughly six times more likely to perform poorly on a test or project as a result of drinking (40% vs. 7%) than students who drank but never binged. The students who binge drank were also five times more likely to have missed a class (64% vs. 12%). 9

Alcohol Use Disorder 

Around 15% of full-time college students ages 18 to 22 meet the criteria for past-year alcohol use disorder (AUD), according to the 2022 NSDUH. 10

Other Consequences

Other consequences include suicide attempts, health problems, injuries, unsafe sexual behavior, and driving under the influence of alcohol, as well as vandalism, damage, and involvement with the police.

How Much Is a Drink?

To avoid binge drinking and its consequences, college students (and all people who drink) are advised to track the number of drinks they consume over a given period of time. That is why it is important to know exactly what counts as a drink.

In the United States, a standard drink (or one alcoholic drink-equivalent) is one that contains 0.6 fl oz or 14 grams of pure alcohol (also known as an alcoholic drink-equivalent), which is found in the following:

• 12.0 oz of beer with about 5% alcohol content
• 5.0 oz of wine with about 12% alcohol content
• 1.5 oz of distilled spirits (e.g., gin, rum, tequila, vodka, and whiskey) with about 40% alcohol content

Unfortunately, although the standard drink (or alcoholic drink-equivalent) amounts are helpful for following health guidelines, they may not reflect customary serving sizes. A large cup of beer, an overpoured glass of wine, or a single mixed drink could contain much more alcohol than a standard drink. In addition, the percentage of pure alcohol varies within and across beverage types (e.g., beer, wine, and distilled spirits).

Factors Affecting Student Drinking

Although some students come to college already having some experience with alcohol, certain aspects of college life—such as unstructured time, widespread availability of alcohol, inconsistent enforcement of underage drinking laws, and limited interactions with parents and other adults—can lead to a problem. In fact, college students have higher binge-drinking rates and a higher incidence of driving under the influence of alcohol than their noncollege peers.

The first 6 weeks of freshman year are a vulnerable time for heavy drinking and alcohol-related consequences because of student expectations and social pressures at the start of the academic year.

Factors related to specific college environments also are significant. Students attending schools with strong Greek systems or prominent athletic programs tend to drink more than students at other types of schools. In terms of living arrangements, alcohol consumption is highest among students living in fraternities and sororities and lowest among commuting students who live with their families.

An often-overlooked preventive factor involves the continuing influence of parents. Research shows that students who choose not to drink often do so because their parents discussed alcohol use and its adverse consequences with them.

Addressing College Drinking

Ongoing research continues to improve our understanding of how to address the persistent and costly problem of harmful and underage student drinking. Successful efforts typically involve a mix of strategies that target individual students, the student body as a whole, and the broader college community.

Strategies Targeting Individual Students

Individual-level interventions target students, including those in higher risk groups such as first-year students, student athletes, members of Greek organizations, and mandated students. The interventions are designed to change student knowledge, attitudes, and behaviors related to alcohol so they drink less, take fewer risks, and experience fewer harmful consequences.

Categories of individual-level interventions include the following:

• Education and awareness programs
• Cognitive-behavioral skills-based approaches
• Motivation and feedback-related approaches
• Behavioral interventions by health professionals

Strategies Targeting the Campus and Surrounding Community

Environmental-level strategies target the campus community and student body as a whole. They are designed to change the campus and community environments where student drinking occurs. Often, a major goal is to reduce the availability of alcohol because research shows that reducing alcohol availability cuts consumption and harmful consequences on campuses as well as in the general population.

Alcohol Overdose and College Students

Thousands of college students are transported to the emergency room each year for alcohol overdose, which occurs when there is so much alcohol in the bloodstream that areas of the brain controlling basic life-support functions—such as breathing, heart rate, and temperature control—begin to shut down. Signs of this dangerous condition can include the following:

• Mental confusion, stupor
• Difficulty remaining conscious or inability to wake up
• Slow breathing (fewer than eight breaths per minute)
• Irregular breathing (10 seconds or more between breaths)
• Slow heart rate
• Clammy skin
• Dulled responses, such as no gag reflex (which prevents choking)
• Extremely low body temperature, bluish skin color, or paleness

Alcohol overdose can lead to permanent brain damage or death, so a person showing any of these signs requires immediate medical attention. Do not wait for the person to have all the symptoms, and be aware that a person who has passed out can die. Call 911 if you suspect alcohol overdose.

A Mix of Strategies Is Best

For more information on individual- and environmental-level strategies, visit NIAAA's CollegeAIM (which stands for College Alcohol Intervention Matrix) guide and interactive website. Revised and updated in 2020, CollegeAIM rates more than 60 alcohol interventions for effectiveness, cost, and other factors—and presents the information in a user-friendly and accessible way.

In general, the most effective interventions in CollegeAIM represent a range of counseling options and policies related to sales and access. After analyzing alcohol problems at their own schools, officials can use the CollegeAIM   ratings to find the best combination of interventions for their students and unique circumstances.

Research suggests that creating a safer campus and reducing harmful and underage student drinking will likely come from a combination of individual- and environmental-level interventions that work together to maximize positive effects. Strong leadership from a concerned college president in combination with engaged parents, an involved campus community, and a comprehensive program of evidence-based strategies can help address harmful student drinking.

For more information, please visit:  collegedrinkingprevention.gov/CollegeAIM

1  Past-month alcohol use: consuming a drink of a beverage containing alcohol (a can or bottle of beer, a glass of wine or a wine cooler, a shot of distilled spirits, or a mixed drink with distilled spirits in it), not counting a sip or two from a drink in the past 30 days. Population prevalence estimates (5) are weighted by the person-level analysis weight and derived from the Center for Behavioral Health Statistics and Quality 2022 National Survey on Drug Use and Health (NSDUH-2022-DS0001) public-use file. [cited 2024 Jan 12]. Available from: https://www.datafiles.samhsa.gov/dataset/national-survey-drug-use-and-health-2022-nsduh-2022-ds0001

2  Hingson RW, Zha W, White AM. Drinking beyond the binge threshold: predictors, consequences, and changes in the U.S. Am J Prev Med, 2017;52(6):717–27. PubMed PMID: 28526355

3  Methodology for arriving at estimates described in Hingson R, Zha W, and Smyth D. Magnitude and trends in heavy episodic drinking, alcohol-impaired driving, and alcohol-related mortality and overdose hospitalizations among emerging adults of college ages 18–24 in the United States, 1998–2014. J Stud Alcohol Drugs. 2017;78(4):540–48. PubMed PMID: 28728636  

4  Methodology for arriving at estimates described in Hingson R, Heeren T, Winter M, Wechsler H. Magnitude of alcohol-related mortality and morbidity among U.S. college students ages 18–24: changes from 1998 to 2001. Annu Rev Public Health. 2005;26:259–79. PubMed PMID: 15760289

5  Muehlenhard C, Peterson Z, Humphreys T, Jozkowski K. Evaluating the one-in-five statistic: women's risk of sexual assault while in college. J Sex Res . 2017;54(4-5):549–76. PubMed PMID: 28375675

6  Carey KB, Durney SE, Shepardson RL, Carey MP. Incapacitated and forcible rape of college women: prevalence across the first year. J Adolesc Health. 2015;56(6):678–80. PubMed PMID: 26003585

7  Lawyer S, Resnick H, Bakanic V, Burkett T, Kilpatrick D. Forcible, drug-facilitated, and incapacitated rape and sexual assault among undergraduate women. J Am Coll Health. 2010;58(5):453–60. PubMed PMID: 20304757

8 Wechsler H, Lee JE, Kuo M, Seibring M, Nelson TF, Lee H. Trends in college binge drinking during a period of increased prevention efforts. Findings from 4 Harvard School of Public Health College Alcohol Study Surveys: 1993-2001. J Am Coll Health. 2002;50(5):203–17. PubMed PMID: 11990979

9 Presley CA, Pimentel ER. The introduction of the heavy and frequent drinker: a proposed classification to increase accuracy of alcohol assessments in postsecondary educational settings. J Stud Alcohol. 2006;67(2):324–31. PubMed PMID: 16562416

10  SAMHSA, Center for Behavioral Statistics and Quality. 2022 National Survey on Drug Use and Health. Table 8.33B—Alcohol use disorder in past year: among people aged 18 to 22, by college enrollment status and demographic characteristics: percentages, 2021 and 2022 [cited Jan 27]. Available from:  https://www.samhsa.gov/data/sites/default/files/reports/rpt42728/NSDUHDetailedTabs2022/NSDUHDetailedTabs2022/NSDUHDetTabsSect8pe2022.htm#tab8.33b

11 National Institute on Alcohol Abuse and Alcoholism [Internet]. Defining binge drinking. In: What Colleges Need to Know Now: An Update on College Drinking Research. Bethesda (MD): National Institutes of Health; 2007 [cited 2021 Oct 22]. Available from:  https://www.collegedrinkingprevention.gov/media/1College_Bulleting-508_361C4E.pdf

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Military service and alcohol use: a systematic narrative review

A k osborne.

Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK

G Wilson-Menzfeld

M d kiernan.

Despite research highlighting the role of alcohol in military life, specifically in relation to mental health and certain combat experiences, there is no synthesised evidence looking at the relationship between military service and alcohol use.

To synthesize and examine evidence exploring the relationship between military service and alcohol use.

Six databases were examined across a 10-year period. Papers were included if they involved a military population and focused on alcohol use. From 4046 papers identified, 29 papers were included in the review.

Military characteristics and experience were linked to high levels of alcohol use across military populations. Societal and cultural factors also played a role in alcohol use in military populations. Predatory behaviour of alcohol establishments, pressures to conform, an acceptance of alcohol use, and the role of religious services and military affiliated social networks were all considered. Excessive drinking impacted physical and mental health. Those diagnosed with PTSD and associated symptoms appeared to have greater alcohol use.

Conclusions

This review identified certain characteristics and experiences of military service that are associated with higher levels of alcohol use. It is important to identify risk factors for alcohol misuse to develop appropriate policy, targeting prevention.

Key learning points

What is already known about this subject

• Historically alcohol has had an integral role in military life and has been seen as an acceptable behaviour in social bonding and comradeship.
• Alcohol misuse in military populations has been associated with a negative impact on social, physical, and psychological health.
• Literature reviews to date have focussed on comorbidity of PTSD and alcohol misuse, wider mental health and Gulf and Iraq/Afghanistan war veterans, no systematic reviews of literature have considered the wider experiences of alcohol use and military service.

What this study adds

• Military-specific traits and experiences such as, service type, rank and deployment status are linked to higher levels of alcohol use in military populations across multiple countries.
• There appears to be an over-reliance on self-report questionnaires for the assessment of alcohol use in a military population focussing on symptom severity, with a paucity of research considering personal experiences and meanings ascribed to alcohol use.
• The systematic narrative review has brought together a body of knowledge on alcohol use in a military population and the synthesis of this literature provides an evidence base to help inform future policy.

What impact this may have on practice, policy or procedure

• There are specific characteristics strongly associated with military service that impact alcohol use, it is important to identify these ‘risk factors’ to mitigate the impact on operational effectiveness and workplace cohesion by developing appropriate and targeted prevention policies.
• Mental ill health and harmful levels of alcohol use in military personnel co-exist and more specifically, this creates internal stigma making this population particularly reticent to seek help for both alcohol and mental health problems and therefore harder to identify.
• The systematic narrative review has highlighted a lack of consistency in the tools and measures used to assess alcohol use in a military population and suggests a need for a consensus of assessment measures in practice and wider research.

Introduction

Alcohol has played a prevalent, historic role in military life, where, internationally, it has been used as a means of mediating stress, both in theatre and in the aftermath of battle [ 1 ]. Used in social bonding and comradeship [ 1 ], drinking has become a common and accepted behaviour in military culture, surpassing alcohol use in the general population [ 2 , 3 ]. Beliefs on acceptable drinking norms can be influenced and reinforced when exposed to the military social environment [ 4 ].

The Motivational Model of Alcohol Use indicates consumption of alcohol may be used to cope, and to ‘regulate the quality of their emotional experience’ [ 5 p. 990]. These reasons for alcohol misuse have also been evidenced in serving military and veteran populations [ 4 ]. However, regardless of the potential advantages of alcohol consumption socially, especially in enhancing positive emotional experiences, problems develop when alcohol is misused. For military service members, exposed to highly stressful situations, behaviour around long-term alcohol use can be affected by the accepted social norms around higher levels of alcohol use for recreation and coping [ 4 ].

Research has suggested that alcohol may serve as a coping mechanism after traumatic events, where deployment has been associated with increased rates of alcohol use or problem drinking [ 6 ]. Drinking to excess may have a negative impact on mental and physical health [ 7 ], functional impairment [ 8 ], troop readiness [ 9 ], suicidal ideation [ 10 ] and the perpetrator in military sexual assaults [ 11 ]. Furthermore, the UK Armed Forces have expressed concerns that ‘excessive drinking can undermine operational effectiveness, leave soldiers unfit for duty, and damage trust and respect within the team’ [12 p. 12 ].

Alcohol use and military service are of great importance and a public health issue. However, there are no systematic reviews of literature that focuses on the wider, overall experiences of alcohol use and military service. Existing systematic review evidence stresses the important role of alcohol in military life, particularly focussing on the comorbidity of PTSD and alcohol misuse [ 13 ], Gulf and Iraq/Afghanistan war veterans [ 14 ], or as part of systematic reviews with a wider mental health focus [ 15 ]. Therefore, this study employs a systematic narrative review that aims to explore the relationship between military service and alcohol use.

To appraise evidence from multiple sources including qualitative and quantitative research, and to ensure an inclusive systematic search without bias, a systematic narrative review strategy was employed [ 16 ]. Suitable databases were searched, identifying published peer-reviewed evidence ( Table 1 ).

Systematic search strategy

Research papers on alcohol use with a military sample published prior to March 2021 were considered. Since the Global War on Terrorism began in 2001, there has been an increase in combat deployments of military service personnel from many nations across the globe. During this period, warfare has evolved, and the world has seen a more complex form of modern warfare, adapting and modernising to become more technologically advanced. This has also resulted in a change in the nature of deployments, impacting the role of military service in the lives of serving personnel. Deployments are dangerous and stressful for military personnel and combat stress, specifically experienced in Iraq and Afghanistan, has been associated with alcohol misuse [ 14 ]. Consequently, only papers published after 2001 have been considered in this review to ensure an accurate representation of the role military service has on alcohol misuse.

The exclusion criteria included papers that were unavailable in English, focussed on treatments or interventions for alcohol problems, or the sample included veterans. Papers on substance use were included, only if they reported alcohol use. The PICO framework was used to develop the search terms ( Table 2 ). Truncation and wildcard search strategies were utilised.

PICO framework to develop search terms

Veterans and ex-service were included as search terms to ensure the maximum number of papers were returned. However, only papers with a serving military population were included in the review. The ex-service military population was excluded because of additional, non-military specific, factors that exist that may impact alcohol use such as their experience of transition out of the military. Following the search of the databases, 4046 papers were returned ( Figure 1 ).

PRISMA diagram of papers returned during systematic search.

A full-text search was carried out on 83 papers to determine the suitability for inclusion in the review. To appraise the quality of papers included in the review, the Critical Appraisal Skill Programme [ 17 ] tool was consulted. Fifty-four papers were excluded due to their focus on a veteran population or alcohol use not specific to military service. No further papers were identified through reference and citation searches. Consequently, 29 papers were included in this review.

Thematic analysis was used to analyse the papers and generate themes. The six steps of Braun and Clarke [ 18 ] were followed: familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the report.

Twenty-nine papers were included in this review ( Table 3 ). There were 22 studies represented across all 29 papers. Studies with multiple papers in this review included: the Health and Wellbeing of the UK Armed Forces Cohort Study [ 2 , 8 , 39 ]; Ohio National Guard (OHARNG) Mental Health Initiative [ 34 , 36 ]; Department of Defence Health Related Behaviours study [ 28 , 35 ] and the Prevalence, Incidence and Determinant of PTSD and Other Mental Disorders (PID-PTSD +3 ) study [ 40–42 ].

Characteristics of papers in review ( N = 29)

AUDIT, Alcohol Use Disorder Identification Test; PTSD, Post Traumatic Stress Disorder; N/S, not specified.

Seventeen papers had samples from the US [ 6 , 20 , 21 , 23 , 25 , 26 , 28 , 31–38 , 43 , 44 ], six from the UK [ 2 , 8 , 19 , 27 , 29 , 39 ], three from Germany [ 40–42 ], one from Norway [ 24 ], one from Nigeria [ 30 ] and one from Angola [ 22 ]. Six papers looked at alcohol in the military for male personnel only [ 19 , 26 , 27 , 41–43 ], whereas 21 papers considered male and female personnel [ 2 , 6 , 8 , 20 , 23–25 , 28–40 , 44 ]. Two papers did not specify the gender of their sample [ 21 , 22 ].

Eleven papers considered Active Duty/Regular personnel [ 2 , 6 , 8 , 19 , 24 , 28 , 30 , 35 , 39 ] including two looking at special operations [ 23 , 38 ]. Ten papers considered National Guard/Reserve personnel [ 21 , 25 , 26 , 31 , 32 , 34 , 36 , 37 , 43 ] and four papers considered all serving personnel [ 33 , 40–42 ]. Five papers did not specify the enlistment type of the military personnel in their sample [ 20 , 22 , 27 , 29 , 44 ]

Of the 29 papers, 28 were quantitative [ 2 , 8 , 19–44 ] and one paper was qualitative [ 6 ].

Four themes were identified in the literature: Military Characteristics and Alcohol Use, Consequences of Deployment on Alcohol Use, Implication of Mental Health on Alcohol Use and The Role of Cultural and Social Factors on Alcohol Use.

Fifteen papers considered military characteristics associated with alcohol use in their military samples [ 2 , 19 , 20 , 22–25 , 27 , 29 , 30 , 33–35 , 40 , 41 ]. Hooper et al. [ 29 ] surveyed 1382 military personnel and reported they had a higher number of units of alcohol consumed per week than the suggested ‘low risk’ drinking threshold. In comparison to the general population, Fear, Iversen [ 2 ] identified a greater percentage of hazardous drinkers in a military population than in the general population.

Only two papers considered the potential differences in alcohol consumption between men and women. Fear et al. [ 2 ] suggested a gender difference in hazardous drinking where there were a greater number of male hazardous drinkers (67% military, 38% general population) than female hazardous drinkers (49% military, 16% general population). However Fadum et al. [ 24 ] noted that high alcohol consumption did not differ much between military women and men. Furthermore, no significant difference in high alcohol consumption between military and civilian women was found [ 24 ].

Papers in this review also considered the consequences of heavy drinking whilst serving in the military. For personnel that had deployed on operational service, a greater volume of drinking was linked to difficulties at home during and post-operational deployment [ 19 , 41 ]. In addition to demonstrating a high incidence of alcohol use in the military, the papers reported evidence of associations between alcohol use and factors such as age, service type, active deployment, combat exposure, mental health, and relationship status. In UK, US and German military populations, heavy drinking has been associated with holding a lower rank, being younger, being single, being in the Naval service or Army, being deployed to Iraq, not having children, being a smoker, having a combat role and having a parent with a drink or drug problem [ 2 , 19 , 23 , 25 , 35 , 41 ]. Most papers examined such risk factors in soldiers from US or UK military populations, potentially providing limited applicability to military populations in developing nations [ 22 ]. Interestingly, in contrast to US and UK findings, Cheng et al. [ 22 ] identified older age rather than younger age as a significant risk factor for alcohol use in Angola.

Literature suggests that, in the UK, levels of drinking are higher in the Army than other branches of the military [ 2 ]. Different subcultures of drinking within individual branches have been attributed to these variations across the military, especially under circumstances that involve personnel taking part in team activities where there may be pressure from peers to drink alcohol to relax and debrief [ 2 ]. These situations that involve socialising and alcohol use are a common feature of Armed Forces life and particularly in the Royal Navy. In this regard, Henderson, Langston [ 27 ] reported significant degrees of harmful drinking among personnel serving in the Royal Navy in comparison to the civilian population.

In addition to heavy and hazardous drinking, substantial levels of binge drinking have also been found in military populations across UK, US, German, Angolan and Nigerian military populations [ 2 , 20 , 22 , 25 , 30 , 33 , 40 ]. Binge drinking in the UK, has been associated with being younger, being in the Army, being single and being a smoker [ 2 ]. Furthermore, there appears to be a difference in the prevalence of binge drinking between Active Duty/Regular soldiers and National Guard/Reserves. Larson, Adams [ 33 ] identified that there was a marked difference between those personnel in Active Duty who reported frequent binge patterns of alcohol use than those in the National Guard/Reserves.

The issue of problematic alcohol use among the Armed Forces population, related to active service, was considered by 19 papers [ 6 , 19–21 , 23 , 29–31 , 33 , 34 , 36–44 ], including a focus on adverse combat experiences [ 19 , 21 , 29 , 37 , 38 , 44 ], pre-deployment preparedness [ 36 ] and differences between Active Duty/Regular soldiers and the National Guard/Reserves [ 31 , 33 ].

Rates of alcohol use have been perceived as the highest for those with combat specific jobs or those with a greater number and higher intensity deployments [ 6 ]. Furthermore, despite Special Operations Forces experiencing greater exposure to combat deployments than conventional forces, Dretsch et al. [ 23 ] determined that the prevalence of alcohol misuse in 16 284 Special Operations Forces soldiers was comparable or lower than reported by the wider military. This paper had the largest sample of the papers included in this review.

Research has indicated that heavy alcohol use often occurs during pre- and post- deployment with a significant association to the deployment period itself [ 6 , 20 , 30 , 37 , 43 ]. Most of the research primarily focuses on personnel with military service during the Iraq War (2003–2011), with and without deployment experience. More recent papers have begun to consider the impact of the War in Afghanistan (2001–2014).

Adverse combat experiences during deployment have been associated with heavy drinking in military personnel [ 19 , 21 , 38 ]. Hooper et al [ 29 ] discussed how the active involvement in theatre of war had strong links to problematic drinking habits among serving personnel who feared for their own mortality and who ‘experienced hostility from civilians’. Wilk, Bliese [ 44 ] also found that soldiers who had higher rates of exposure to the threat of death or injury were significantly more likely to screen positive for alcohol misuse. Exposure to atrocities similarly predicted misuse of alcohol with alcohol-related behavioural problems.

Although in Russell [ 37 ] all combat experiences were also positively correlated, only the combat experience of killing was significantly related to post-deployment alcohol use. Interestingly, alcohol use decreased amongst those who experienced killing during combat. The authors’ explanation for this was based on the suggestion that the ‘killing experience may activate the soldiers’ mortality salience and trigger a self-preservation focus that manifests itself in reduced risky alcohol consumption’ [ 37 ]. No other paper in the review considered this.

Alongside the available evidence that suggests that fighting the enemy in battle and witnessing the horrors of war predisposes serving personnel to the risk of problematic alcohol use, Skipper et al. [ 38 ] suggested that serving personnel who are part of ‘special forces’ are at an even higher risk of providing a positive alcohol test result due to problematic drinking if they are involved in hostile warfare. In line with adverse combat experiences, Browne, et al. [ 19 ] also argued that personnel who deployed with their parent unit, whose role in theatre was outside, above or below their training or experience and who experienced poor in-theatre unit leadership were more likely to be heavy drinkers.

Despite several papers in this review ( n = 13) identifying a significant link between deployment and subsequent alcohol use, regardless of country, Thandi et al. [ 39 ] demonstrated that levels of drinking were not related to deployment status. Marshall et al. [ 34 ] also found no effect of deployment on alcohol use, although this was for those who reported pre-deployment depression or PTSD. Three German papers support the suggestion that deployment has no effect on alcohol use [ 40–42 ]. Interestingly, the correlates of increased average daily alcohol use across two time points in these papers, were limited social support, greater sleeping difficulties and increased negative post-event cognitions following deployment [ 41 ]. Lower PTSD symptom severity pre-deployment and less childhood emotional neglect, predicted a decrease in average daily alcohol consumption [ 41 ]. It is possible to suggest that specific deployment experiences impact alcohol use in a military population rather than deployment in general. However, these German papers were all from the same Prevalence, Incidence and Determinant of PTSD and Other Mental Disorders (PID-PTSD +3 ) study. Additionally, Orr et al. [ 36 ] identified that only pre-deployment preparedness was associated with incident alcohol misuse when controlling for demographics, deployment related factors (e.g. exposure to warzone stressors), and the presence of psychopathology.

US research has identified further differences within a military population. Around 13–14% of National Guard/Reserve personnel exhibited high levels of drinking in association with deployment [ 31 , 33 ]. Whereas Larson et al. [ 33 ] discovered that an increase in alcohol use as a result of deployment was actually greater in Active-Duty personnel compared to the National Guard/Reserves. Regardless, alcohol use following deployment is thought to be uniquely predicted by higher levels of PTSD symptom severity, higher levels of avoidance-specific PTSD symptoms and lower levels of positive emotionality [ 31 ]. It is worth noting that although there appears to be an indication of differences in alcohol use with engagement type following deployment, more research is needed to further explore this.

Although not a focus of this review, eight papers focussing on alcohol use in a military population reported on the implication of mental health [ 8 , 25 , 28 , 31 , 32 , 34 , 39 , 40 ]. This included five papers looking at the role and impact of PTSD [ 25 , 31 , 32 , 34 , 39 ], one on wider mental health [ 40 ], one on suicide [ 28 ] and one on functional impairment [ 8 ].

Previous research has suggested military personnel with PTSD may use alcohol for self-medication as a coping mechanism for distress related to psychological symptoms [ 31 , 34 ]. Five papers indicated a significant association between PTSD symptom severity, heavy drinking behaviours and new-onset Alcohol Use Disorder [ 25 , 31 , 32 , 34 , 39 ]. However, once the influence of personality variables were accounted for, Ferrier-Auerbach et al. [ 25 ] found that mental ill health was not associated with any drinking variable.

Although baseline PTSD symptoms significantly increased the risk of screening positive for new onset alcohol dependence, Kline et al. [ 32 ] identified no effect of pre-deployment alcohol use on subsequent PTSD diagnoses post-deployment. Such findings indicate that it is possible that the specific psychological consequence of military deployment (e.g. PTSD) significantly impacts military personnel’s alcohol use rather than being in the military in general.

In support of the specific psychological impact of deployment on military personnel’s alcohol use, further differences have been identified between deployed and non-deployed military personnel. Trautmann et al. [ 40 ] identified among recently deployed soldiers, that heavy drinking was related to a higher risk of anxiety, affective and sleep disorders. Among soldiers never deployed, heavy drinking was linked with any mental disorders other than substance use disorder and was further associated with somatoform disorders. For those recently deployed, associations between heavy drinking and the presence of any mental disorder as well as anxiety disorders were significantly greater than those that had never deployed.

Beyond PTSD, Herberman et al. [ 28 ] identified that US soldiers who reported high levels of alcohol use were more likely to have seriously considered and/or attempted suicide. After adjusting for level of alcohol use, PTSD, and depression, drinking to avoid rejection/’fit in’ was associated with suicidality.

One paper considered the impact of alcohol use on functional impairment. Rona et al. [ 8 ] identified that a score on the Alcohol Use Disorder Identification Test (AUDIT) denoting potential alcohol dependence was consistently associated with functional impairment, whereas binge drinking was not. Interestingly, despite a known impairment, participants with hazardous drinking perceived their functioning to be better than those with lower AUDIT scores. The implications of this perception should be explored further. Furthermore, half of the participants presenting with potential alcohol dependence also had psychological comorbidities.

Five papers identified the role of social support and communities in the alcohol consumption of military personnel [ 6 , 22 , 26 , 30 , 39 ]. The communities within which military personnel reside can have a prominent role in their alcohol use. Besse et al. [ 6 ] conducted interviews and focus groups with 29 US Active-Duty soldiers to understand the context of alcohol establishments in communities near military installations in relation to alcohol use. Participants identified predatory behaviour by local alcohol establishments to encourage excessive drinking, placing the profit as a higher priority over the safety of the soldiers. Free or reduced admission fees and drink specials were often specifically designed with soldiers in mind, with some participants reporting that alcohol establishments gave soldiers ‘heavier pours’ or mixed drinks with a higher proportion of alcohol. These findings indicate that there is a perception that military personnel drink more, thus increasing the availability of alcohol and subsequent use.

Unsurprisingly, Besse et al. [ 6 ] also ascertained that drinking has been described as an accepted way to relax and cope with stress brought on by the daily stressors of military life. Drinking alcohol was perceived to be an accepted part of military culture. Pressure to engage in heavy drinking often came from peers as an obligation to prove oneself to the group. This was particularly common among young military personnel or those new to a unit. Socialising appears to play a role in military personnel’s alcohol use. Besse et al. [ 6 ] conducted the only qualitative paper in this review. The findings allow further insight into the reciprocal relationship between alcohol and military personnel by using interviews and focus groups to explore the reasons behind the relationship. Qualitative methods are highly appropriate for this paper, where the purpose was to learn how military personnel experiences the community within which they reside.

Unexpectedly, Cheng et al. [ 22 ] indicated that socialising with family and friends two to four times, but not five or more times, per month increased the risk for problematic drinking in military personnel. More specifically, Thandi et al. [ 39 ] identified that entering into a new relationship resulted in a decrease in alcohol use.

Only two papers considered the role of religion in alcohol consumption [ 22 , 30 ]. Cheng et al. [ 22 ] ascertained that attending religious services more than once a week appeared to protect against problematic drinking in Angolan soldiers. It is possible that the effect of religion on alcohol consumption is dependent on the soldiers’ culture as another paper determined that religion had no role in drinking in Nigerian soldiers [ 30 ].

The social networks of military members appear to be crucial in the likelihood of alcohol use. For Reserve and National Guard soldiers, one paper indicated that drinking-related social network characteristics such as drinking buddies were associated with increased alcohol problems [ 26 ]. However, for those deployed, military-affiliated social networks were a protective factor against alcohol problems [ 26 ].

This systematic narrative review explored the relationship between military service and alcohol use. From the 29 papers examined in this review, it is evident that there are military-specific traits and experiences which impact alcohol use, namely military characteristics, such as service type and rank, and military deployment. Mental health, cultural and social factors also play a role in alcohol use in a military population.

Throughout this review, there are associations drawn between military characteristics and alcohol use such as service type, rank and deployment status [ 2 , 19 , 23 , 25 , 35 , 41 ], that have been associated with higher levels of alcohol consumption in military populations in a number of countries [ 2 , 20 , 22 , 25 , 30 , 33 , 40 ]. Additionally, studies have pointed towards a difference between alcohol use in a military population and the civilian population [ 2 , 27 ]. Although, Fadum et al. [ 24 ] indicated no difference between military women and civilian women.

Most papers indicated that alcohol use was greatest in those with deployment experience, especially those with adverse combat experiences [ 6 , 19 , 21 , 38 ]. This is unsurprising, at least in a UK military population, where policy allows the continuation of alcohol use during military ‘decompression’, where those returning from combat receive a short duration of absence together with psychological support [ 45 ]. There was a suggestion that these findings were a result of using alcohol as a coping mechanism after traumatic events, however, further work is needed to explore this. Specific combat experiences were significantly related to screening positive for alcohol misuse for elite and non-elite military personnel including personal threats, fighting and atrocities [ 38 ]. Interestingly, an increase in alcohol use following deployment was greater for Active-Duty personnel compared to the National Guard and Reserves in a US cohort [ 33 ]. It is important to note that not all research found a significant link between deployment and subsequent alcohol use, regardless of country, a few papers argued that deployment had no effect on alcohol use in military populations [ 34 , 39–42 ].

Evidence in this review suggests that mental ill health and harmful levels of alcohol use in military personnel co-exist. But, more importantly, the evidence suggests that internal stigma makes this population particularly reticent to seek help for both alcohol and mental health problems. Kiernan et al. [ 46 ] identified that many veterans only present for help when they can no longer cope with the situation, they find themselves in. This study found that seeking help for alcohol misuse issues late, when problems have escalated significantly, invariably led to a co-morbid presentation, a significant decline in mental health and excessive drinking, usually exacerbated by a collapse of the individuals social support network. Once more, this strengthens existing evidence that excess drinking negatively affects physical, social, and mental health [ 7 , 46 ]. Specifically, PTSD symptom severity was significantly associated with greater alcohol use [ 25 , 31 , 32 , 34 , 39 ]. Heavy drinking was also related to a higher risk of anxiety, affective and sleep disorders, functional impairment, and suicide [ 8 , 28 , 40 ].

This review also suggests that culture and social factors can influence alcohol use in a military population. An interdependent relationship was identified between military personnel and local alcohol establishments near military installations [ 6 ]. It was suggested that establishments tailor their business, often in a predatory way that is perceived as detrimental to military personnel’s health, well-being, and career. The behaviour of alcohol establishments near military installations was felt to exacerbate this alcohol acceptance. However, only one US paper considered this, more international research should be conducted to consider if this is a common experience in a military population. Interestingly, there was a suggestion that attending religious services [ 22 ] and that having military affiliated social networks when deployed [ 26 ], protected against problematic drinking.

Drinking alcohol was noted as an accepted way to relax and cope with stress in the military with some feeling pressure to conform to drinking [ 6 ]. This acceptance of alcohol use and the social norms surrounding its use can have life-long, post-military service implications, as military veterans who normalise or excuse their drinking, delay their engagement in substance misuse services [ 46 ]. The historic social and cultural norms within the military [ 1 ], and even the ‘romanticising’ of this culture [ 12 ] are now being recognised, and the UK’s Ministry of Defence is trying to combat and encourage a sensible approach to alcohol use with initiatives to identify individuals’ alcohol use during regular oral examinations [ 47 ].

In almost all studies considered for this review, the Alcohol Use Disorder Identification Test (AUDIT) or the modified brief version, AUDIT-C was utilised. The AUDIT and AUDIT-C have been acknowledged as valid instruments for identifying alcohol misuse or dependence among US and Australian military populations [ 48 , 49 ]. However, the validity of such tests in other military populations does not appear to have been completed, despite the variability in populations. Regardless of the validity of such instruments, research has relied heavily on self-report questionnaires for assessment in a Military population. This can result in ascertaining large volumes of data; however, this can also give rise to participants answering in a more socially desirable way, rendering results inaccurate [ 50 ].

This focus on quantitative research methods has made it difficult to draw any conclusions as to what the resulting impact of military service on alcohol use may have on the ability of service personnel to carry out their jobs. To mitigate this, future research must also consider a qualitative approach, considering personal experiences and meanings ascribed to alcohol use, rather than only symptom severity, to draw any conclusions.

This review has synthesised findings from existing literature, highlighting potential gaps in current research. Despite being a comprehensive, international systematic narrative literature review, it is important to acknowledge there are limitations. First, only papers written in English were considered for review and may have excluded inclusion of international findings. Only the relationship between military service and alcohol use of serving personnel was considered, with papers including veterans in their sample being excluded as it was outside of the aims of this review. Finally, only peer-reviewed research was included in this review and, whilst this was a purposeful decision, it is acknowledged that evidence from grey literature may illuminate further understanding of this issue.

This systematic narrative review aimed to critically evaluate existing literature to explore the relationship between military service and alcohol use. Findings indicated that there are specific characteristics strongly associated with military service that appear to have an impact on alcohol use. The subsequent effects of alcohol use in a military occupational context reinforces the validity of exploring the casual links in more depth. Further research is needed to identify specific ‘risk factors’ associated with serving in the military and problematic alcohol consumption. Exploring the attributable burden will be a crucial building block to developing appropriate and targeted prevention policies.

Contributor Information

A K Osborne, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

G Wilson-Menzfeld, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

G McGill, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

M D Kiernan, Northern Hub for Veterans and Military Families Research, Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-Upon-Tyne, UK.

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Guest Essay

It’s Not You: Dating Apps Are Getting Worse

By Magdalene J. Taylor

Ms. Taylor is a writer covering sex and culture.

“The golden age of dating apps is over,” a friend told me at a bar on Super Bowl Sunday. As we waited for our drinks, she and another friend swiped through Bumble and Hinge, hunting for new faces and likes. Across the bar were two young men: phones out, apps open, clearly doing the exact same thing. Never did the duos meet.

What’s lamentable here isn’t only that dating apps have become the de facto medium through which single people meet. Since 2019, three in 10 U.S. adults have reported using them, with that figure rising to roughly six in 10 for Americans under 50 who have never been married. Not only are people not meeting partners in bars or any of the once normal in-person venues — they’re barely meeting them on the apps, either.

Maybe most of us just aren’t as hot as we used to be. Maybe it’s time our inflated egos got knocked down a notch. Maybe the market of people still willing to put themselves out there in an attempt to date has gotten smaller. Or maybe the apps have functionally, intentionally gotten worse, as have our romantic prospects. The more they fail to help us form relationships, the more we’re forced to keep swiping — and paying.

The internet, where so many of us spend so much of our time, has not been spared from the decline in quality that seems to plague so much of consumer life. This phenomenon was described by the writer Cory Doctorow in a November 2022 blog post and is sometimes called “platform decay”: Tech platforms like Amazon, Reddit and X have declined in quality as they’ve expanded. These sites initially hooked consumers by being almost too good to be true, attempting to become essential one-stop shops within their respective spaces while often charging nothing, thanks to low interest rates and free-flowing venture capital funding . Now that we’re all locked in and that capital has dried up, those initial hooks have been walked back — and there’s nowhere else to go.

This is precisely what is happening with dating apps now, too, with much more urgent consequences. What’s worsening isn’t just the technological experience of online dating but also our ability to form meaningful, lasting connections offline.

The collapse of dating apps’ usability can be blamed on the paid subscription model and the near-monopoly these apps have over the dating world. While dozens of sites exist, most 20-something daters use the big three: Tinder, Hinge and Bumble. (Older people often gravitate toward Match.com or eHarmony.) All three sites offer a “premium” version users must pay for — according to a study conducted by Morgan Stanley , around a quarter of people on dating apps use these services, averaging out at under $20 a month. The purpose, many believe, is to keep them as paid users for as long as possible. Even if we hate it, even if it’s a cycle of diminishing returns, there is no real alternative.

In the early heyday of Tinder, the only limits on whom you could potentially match with were location, gender and age preferences. You might not have gotten a like back from someone you perceived to be out of your league, but at least you had the chance to swipe right. Today, however, many apps have pooled the people you’d most like to match with into a separate category (such as Hinge’s “Standouts” section), often only accessible to those who pay for premium features. And even if you do decide to sign up for them, many people find the idea of someone paying to match with them to be off-putting anyway.

“If I don’t pay, I don’t date,” a friend in his 30s told me. He spends around $50 a month on premium dating app subscriptions and digital “roses” to grab the attention of potential matches. He’s gone on 65 dates over the last year, he said. None have stuck, so he keeps paying. “Back in the day, I never would have imagined paying for OKCupid,” he said.

Yet shares (Bumble’s stock price has fallen from about $75 to about $11 since its I.P.O.) and user growth have fallen , so the apps have more aggressively rolled out new premium models. In September 2023, Tinder released a $500 per month plan. But the economics of dating apps may not add up .

On Valentine’s Day this year, Match Group — which owns Tinder, Hinge, Match.com, OKCupid and many other dating apps — was sued in a proposed class action lawsuit asserting that the company gamifies its platforms “to transform users into gamblers locked in a search for psychological rewards that Match makes elusive on purpose.” This is in contrast to one of the group’s ad slogans that promotes Hinge as “designed to be deleted.”

People are reporting similar complaints across the apps — even when they aren’t taking the companies to court. Pew Research shows that over the last several years, the percentage of dating app users across demographics who feel dissatisfied with the apps has risen . Just under half of all users report feeling somewhat to very negative about online dating, with the highest rates coming from women and those who don’t pay for premium features. Notably, there is a gender divide: Women feel overwhelmed by messages, while men are underwhelmed by the lack thereof.

With seemingly increasing frequency, people are going to sites like TikTok , Reddit and X to complain about what they perceive to be a dwindling group of eligible people to meet on apps. Commonly, complaints are targeted toward these monthly premium fees, in contrast to the original free experience. Dating has always cost money, but there’s something uniquely galling about the way apps now function. Not only does it feel like the apps are the only way to meet someone, just getting in the door can also comes with a surcharge.

Perhaps dating apps once seemed too good to be true because they were. We never should have been exposed to what the apps originally provided: the sense that the dating pool is some unlimited, ever-increasing-in-quality well of people. Even if the apps are not systematically getting worse but rather you’ve just spent the last few years as a five thinking you should be paired with eights, the apps have nonetheless fundamentally skewed the dating world and our perception of it. We’ve distorted our understanding of how we’d organically pair up — and forgotten how to actually meet people in the process.

Our romantic lives are not products. They should not be subjected to monthly subscription fees, whether we’re the ones paying or we’re the ones people are paying for. Algorithmic torture may be happening everywhere, but the consequences of feeling like we are technologically restricted from finding the right partner are much heavier than, say, being duped into buying the wrong direct-to-consumer mattress. Dating apps treat people like commodities, and encourage us to treat others the same. We are not online shopping. We are looking for people we may potentially spend our lives with.

There is, however, some push toward a return to the real that could save us from this pattern. New in-person dating meet-up opportunities and the return of speed dating events suggests app fatigue is spreading. Maybe we’ll start meeting at bars again — rather than simply swiping through the apps while holding a drink.

Have you ditched dating apps for a new way to meet people, or are you still swiping left?

Opinion wants to hear your story.

Magdalene J. Taylor (@ magdajtaylor ) is a writer covering sex and culture. She writes the newsletter “ Many Such Cases .”

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Drug and Alcohol Abuse Analytical Essay

Introduction, works cited.

For along time now, drug and alcohol abuse in the society has been a problem that affects the youth and the society at large. The youth in the society get engaged in abusing substances that they feel all help them forget their problems. This paper highlights the problems of drug abuse and alcohol drinking among the youth in the society.

Alcohol is a substance that contains some elements that are bring about physical and psychological changes to an individual. Being a depressant, alcohol affects the nervous system altering the emotions and perceptions of individuals. Many teenager abuse alcohol and other drug substances due to curiosity, the need to feel good and to fit in their different groups. Drinking alcohol should not be encouraged because it usually affects the health of the youth.

It puts their health at a risk. Drinking youth are more likely to engage in irresponsible sexual activities that may result in unexpected pregnancies and sexually transmitted diseases. Additionally, teenagers who drink are more likely to get fat while complicating further their health conditions. Moreover, the youth drinking are at a risk of engaging in criminal activities hence being arrested (Cartwright 133).

According to the Australian Psychological Society, a drug can be a substance that brings about physical or psychological changes to an individual (2). Youngsters in the in the community take stuffs to increase enjoyment or decrease the sensational or physical pain. Some of the abused drugs by the youth in the society include marijuana, alcohol, heroine and cocaine.

The dangers of drug abuse are the chronic intoxication of the youth that is detrimental to their societies. Much intake of drugs leads to addiction that is indicated by the desire to take the drugs that cannot be resisted.

The effect of alcohol and other hard drugs are direct on the central nervous system. Alcohol and drug abuse is linked to societal practices like, partying, societal events, entertainment, and spirituality. The Australian Psychological Society argues that the choice of a substance is influenced by the particular needs of the substance user (3).

However, the effects of drug abuse differ from one individual to another. The abuse of drugs becomes a social problem whenever the users fail to meet some social responsibilities at home, work, or school. This is usually the effect when the substances are used more than they are normally taken. Additionally, when the use of substances is addictive, it leads to social problems (Cartwright 135).

Drug and alcohol abuse among the youth in the society should be discouraged and voided at all costs. The youth are affected and the society is affected. The productive young men and women cannot perform their social duties. One way in which the abuse of drugs and alcohol can be avoided in the society is through engaging the youth in various productive activities. This will reduce their idle time while keeping them busy (Cartwright 134).

They will not have enough time for drinking. Additionally, they will have fewer problems to worry about. They should also be educated and warned about the dangers of drug and alcohol abuse both to their health and to the society. Since alcohol and substance abuse is related to increased crime in the society, its reduction will lead to reduced crime rates and economic growth.

The Australian Psychological Society. Alcohol, and Other Drugs . Australian Psychological society. Web.

Cartwright, William. Costs of Drug Abuse to the Society. The Journal of Mental Health Policy and Economics , 1999. 2, 133-134.

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IvyPanda. (2023, December 18). Drug and Alcohol Abuse. https://ivypanda.com/essays/drug-and-alcohol-abuse/

"Drug and Alcohol Abuse." IvyPanda , 18 Dec. 2023, ivypanda.com/essays/drug-and-alcohol-abuse/.

IvyPanda . (2023) 'Drug and Alcohol Abuse'. 18 December.

IvyPanda . 2023. "Drug and Alcohol Abuse." December 18, 2023. https://ivypanda.com/essays/drug-and-alcohol-abuse/.

1. IvyPanda . "Drug and Alcohol Abuse." December 18, 2023. https://ivypanda.com/essays/drug-and-alcohol-abuse/.

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IvyPanda . "Drug and Alcohol Abuse." December 18, 2023. https://ivypanda.com/essays/drug-and-alcohol-abuse/.

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