Many public health experts adopt an extreme, “all-or-nothing,” prohibitionist approach to anything and everything that might potentially cause harm to some individuals.
They remain convinced that complete abstinence from alcohol is the only answer. And they insist on banning, condemning, regulating, and prohibiting it across the board for everyone.
But some modern experts now say that complete abstention may not be the right approach—even for “problem drinkers.” Instead, as I always recommend, they advocate moderation.
I’ll tell you more about that in a moment. But first, let’s set the stage…
Drinking is on a spectrum—like most behaviors
As I’ve reported before, 91 percent of people who consume alcohol do so safely and in moderation. Perhaps they share a bottle of wine with dinner (or with lunch, as in Europe) or engage in a short “happy hour” after work.
By doing so, these people enjoy the many science-backed health benefits of moderate alcohol consumption. Like significant protection against heart disease and dementia. In fact, as you may recall, moderate drinkers are far more likely to live to age 85 without developing dementia than are teetotalers.
On the other hand, only 9 percent of people who consume alcohol do it to excess.
But the truth is—drinking really falls on a spectrum (like other behaviors). At the one end are outright “teetotalers” who never drink. At the far other end are those who meet the clinical definition for an alcohol use disorder (AUD), including signs of physical dependence.
In the middle, there’s a wide range of drinkers—including those who rarely drink as well as those categorized as “risky drinkers” by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). (Interestingly, this broad, middle group is about three times larger than the groups at the far ends of the spectrum. In fact, from 2001 to 2013, the middle group increased by 30 percent.)
Risky drinkers in this middle group include:
- Men 21 to 64 years of age who routinely exceed the recommend outer limits of four drinks per day, or 14 drinks per week
- Women and men 65 and older who exceed three drinks per day
- Binge drinkers, defined as men who consume more than five drinks—and women who consume more than four drinks—on one occasion
For a long time, the medical community treated these risky drinkers in the same way as drinkers with a clear “alcohol use disorder”…by recommending complete abstinence.
But, as I mentioned earlier, many researchers now believe that’s the wrong approach…
Risky drinkers respond well to moderation
According to Keith Humphreys, Ph.D., a professor of psychiatry and behavioral sciences at Stanford University, so-called risky drinkers may NOT need to completely abstain from alcohol. Instead, physicians can help these patients implement strategies that encourage moderation.
The first step is to distinguish those with a true AUD from those with risky behaviors.
Physicians can use two, quick, one-minute screening tests, including the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and the Single Alcohol Screening Question (SASQ) recommended by NIAA. For those who show risky tendencies, physicians can follow up with a more thorough assessment, which typically takes less than five minutes.
Then, for those who need it, the U.S. Preventive Services Task Force (USPSTF) recommends brief, 30-minute counseling sessions. (Some are even available on the internet!)
According to Alex Krist, M.D., M.P.H., a professor of family medicine and population health at Virginia Commonwealth University, “On average, doing very basic counseling like that results in people drinking about 1.6 less drinks per week, and about 14 percent of people who are engaging in risky drinking stop doing so.”
And that’s from just one intervention!
Plus, it seems that people who are employed, have an education, and a good support system of family and friends benefit the most from this sensible approach of encouraging moderation.
So, doctors need to stop preaching abstinence and instead try moderation for those many people in the middle of the alcohol use spectrum.
But until this “innovative” approach catches on, I’ll continue exposing all of the truth behind alcohol consumption here in my Daily Dispatch and in my monthly Insiders’ Cures newsletter. In fact, if you want a closer look at how moderate alcohol consumption is beneficial to your health, check out the November 2018 issue (“The truth behind the latest anti-alcohol headlines: Raise a toast this holiday season to SAVE your heart, your brain… and your life”). Subscribers have access to this report and all of my past content in the archives, so if you haven’t already, consider signing up today!
“Everything in Moderation? Not All Problem Drinkers May Need Abstinence.” Medscape, 12/6/19. (medscape.com/viewarticle/922276)