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Alcohol dependency: what pastors should know

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Alcohol dependency: what pastors should know

Brian Bull
Brian Bull, M.D., is Chair of Pathology and Human Anatomy at the Loma Linda University School of Medicine, Loma Linda, California, United States.

 

This problem every pastor faces and often cringes at the thought—a member of the congregation has an alcohol problem, and friends and family look to the pastor for help.

What should be done?

We hope that this article (part one) and the one to follow (part two) will help. Part one provides statistics on the prevalence of alcohol dependency. It also addresses the widespread perception that, while alcoholism may well be a national scourge, wine drinking is sophisticated and enhances the health and longevity of wine drinkers. The second part (May 2007 issue) will provide some assistance for those pastors who, at times, are expected to assume the role of counselor.

Alcohol dependency: the facts

In any congregation with more than 50 members, there will almost certainly be at least one person (and more likely two or three) who is alcohol dependent—for 1 out of 12 Caucasians in the United States has been identified as such.1 For most other ethnic groups the figure stands at least as high, and for some ethnic groups it is considerably higher. One-third of patients in large urban hospitals were admitted because of illnesses caused or made worse by drinking.2 Fifty percent of those admitted to a trauma service of a city hospital will find themselves victims of trauma because of alcohol.3

More than one possible reason exists, of course, as to why people who are dependent upon alcohol show up with greater frequency in places where illness is common—such as hospital wards and trauma services. Perhaps going to such places drives people to drink! Those who have “cooled their heels” for hours in an emergency room just waiting to be seen by a physician can readily identify with this possibility.

That, however, cannot be considered the explanation. Alcohol abuse counts as the third leading cause of preventable death in the United States,4 exceeded only by deaths attributable to smoking and obesity. Even in third place, it now accounts for over 85,000 deaths annually and indirectly increases the death rate from other major diseases including breast cancer.5 Alcohol also figures in 40 percent of highway fatalities.6

As already noted, in the general United States population 1 out of 12 Caucasians contends with alcohol dependency on a daily basis, but the risks for certain groups in the population register far higher. Among children of alcoholics, a group well acquainted with the devastation that alcohol brings, 1 out of 3 will become an alcoholic.7 Two out of every 5 who get drunk before the age of 14—often on alcohol present in the home—will succumb to alcoholism.8For these reasons it will be the rare pastor who does not have to interact creatively and redemptively with parishioners who wrestle with alcohol themselves or whose lives are being ruined by someone who does.

The wine assumption

These statistics, however, are just that—statistics. They will be useful for underscoring the extent of the alcohol problem generally and for warning the youth of the church about the hazards of alcohol, but they are useless to those already addicted.

However, statistics may be of use to pastors who are confronting a relatively recent phenomenon— the widespread perception that drinking wine is both enjoyable and good for one’s health even though addiction to alcohol has been clearly identified as an unmitigated evil. Essentially all of those who are college educated, as well as the vast majority of those with a high school education, now believe that drinking red wine in moderation will protect from a premature death due to heart disease or stroke. It proves no such thing because there is an additional, hidden, assumption—an assumption that is known to be false.9 The assumption is—those who drink red wine and those who do not are matched groups; they are similar in all other characteristics that might affect their chances of dying from cardiovascular disease.

In what ways are the groups not matched? What are the differences between the group that drinks and the group that does not?

Education—those who drink in moderation are, on average, better educated than are teetotalers.

Income—moderate drinkers, on average, earn more than those who abstain.

Health knowledge—those who drink in moderation are more knowledgeable about health matters (including, one can assume, that red wine is supposed to be good for the health!).

Diet—drinkers, particularly wine drinkers, eat more healthful foods.10

Hobbies—those who drink have more leisure time.

The list of differences between those who drink alcohol in moderation and those who abstain completely goes on. In 2004, in a massive study involving almost a quarter of a million people, these characteristics (education, income, health knowledge, diet, and leisure time—as well as 22 additional characteristics) were measured in a large group of moderate drinkers and a similar-sized group of nondrinkers. The two groups differed significantly in 29 out of 31 of the measured characteristics.11 It is likely that they differed in many more ways that were not measured.

The moderate drinkers were better educated, had more leisure time, earned more money, had lower blood pressure and cholesterol, and were more likely to have health insurance than did the nondrinkers. Furthermore, even among those who had no known cardiovascular illnesses, three times as many of the drinkers were in the lowest risk category for developing cardiovascular disease in the future.

To put it simply: They were healthier in almost every attribute that was measured.

Yet the attributes of more education, more leisure time, higher incomes, and more health knowledge cannot reasonably be attributed to alcohol consumption. Drinking alcohol in moderation cannot be the cause of such good fortune! It seems simply that those who are health-conscious, well-educated, and relatively wealthy (and hence in a low-risk category for heart disease and stroke) are choosing to drink. They learn about the supposed benefits of moderate alcohol consumption and choose to drink (often red wine) because they believe it will further enhance their already healthy lifestyle. Moderate consumption of alcohol is, in this case, not the cause of their health—and certainly not the cause of their good fortune.

These statistics on confounders (differences other than alcohol consumption between those who drink and those who don’t) are a warning against the all-tooeasy assumption that alcohol protects from cardiovascular disease. Quite likely, moderate alcohol consumption is merely a marker of a lifestyle already at a reduced risk for heart disease and stroke.

Another flaw The studies linking alcohol to protection from cardiovascular disease suffer from another major flaw—a flaw that erroneously increases the apparent healthiness of the moderate drinkers by making the nondrinkers appear sicker than they really are. Almost all of these studies have placed former drinkers, including those who have had to stop drinking for health reasons, into the category of nondrinkers.

All studies on the health benefits of drinking come from studies on the health benefits of moderate drinking. No one would think of claiming that alcoholics, still drinking heavily and slowly dying from fibrosis of the liver, have enhanced their health by drinking! Reasonably enough, such people are excluded from analysis because they no longer qualify as moderate drinkers. These study subjects are not a problem to the statisticians because they can easily be identified and excluded.

If, however, heavy drinkers become so ill from alcohol consumption that they have to stop drinking, where in the statistical groupings do they go? Unfortunately, in most studies of the risks and benefits of moderate alcohol consumption, these former heavy drinkers get lumped in with the nondrinkers because at the time of the study they are, in fact, nondrinkers!

Former drinkers are former drinkers for a variety of reasons. Some have stopped on doctor’s orders. Others have damaged their health to the point where further drinking would likely be lethal.

Still others have with age lost their taste for alcohol. Whatever the reason, in most of the studies on the effects of moderate alcohol consumption, these former drinkers with ruined health have been categorized as teetotalers. They were so categorized because, when the study was performed, they were “on the wagon.”

The result? The illnesses of those whose health has been ruined by excessive alcohol consumption—ruined to the point that they can no longer drink—are considered to be health problems of nondrinkers! Not surprisingly, this makes the teetotalers look unhealthy simply because the study authors fail to exclude former drinkers entirely. They eliminate them from the category of the moderate drinkers but, typically (and inadvertently), allow them to contaminate the category of the nondrinkers.

How often has this happened? Out of 54 studies analyzed by Fillmore et al., 47 of those studies had failed to exclude former drinkers.12 And here’s the important point: None of the remaining seven studies confirmed the widely held opinion that drinking alcohol in moderation benefits one’s health.

Not surprisingly, nondrinkers can be made to look unhealthy if all of the illnesses of former heavy drinkers (now too sick or too old to continue abusing alcohol) are added into health statistics of the nondrinkers.

“As people age they both abstain and cut down to very occasional drinking for health reasons, disability, frailty and/or medication use. If they are included as ‘abstainers’ in these studies then these ‘abstainers’ will appear to be less healthy than light drinkers and at increased risk of premature death. In other words, regular light drinking may be a marker for good health among middle aged and older people, not a cause of it. As a consequence, estimates of the extent of the impact of cardiac benefits from light alcohol consumption on mortality risk may have been greatly over-estimated.”7

Conclusion

In summary, it is likely that drinking in moderation carries with it no health benefits whatsoever in light of the following two facts:

1. The drinking populations that have been studied are healthier to start with (are wealthier, are better educated, have more access to medical care, and are better insured) than the nondrinking populations with whom they have been compared.

2. In addition, persons who have quit drinking or drink only occasionally due to disability or frailty or for health reasons have been included in the category of nondrinkers in the vast majority (47 out of 54) of the studies done to date. Of the seven correctly performed studies, none showed moderate drinking to be beneficial.

Statistics such as these may be helpful to pastors as they deal with those in the congregation who have not yet begun to drink. The statistics are inexorable. One out of every 12 of those who start to drink in moderation will become addicted, with Christians as no exception to the rule.

What should the pastor do then? The second of this two-part series will address this very challenging question.

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1 Bridget F. Grant, Deborah A. Dawson, Frederick S. Stinson, S. Patricia Chou, Mary C. Dufour, and Roger P. Pickering, “The 12-Month Prevalence and Trends in DSM-IV Alcohol Abuse and Dependence: United States, 1991–1992 and 2001–2002,” Drug
and Alcohol Dependence 74 (2004): 223–34.
2 10th Special Report to the U. S. Congress on Alcohol and Health, U.S. Dept. of Health and Human Services, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD.
3 O. Savola, O. Niemela, M. Hillbom, “Alcohol Intake and the Pattern of Trauma in Young Adults and Working Aged People Admitted After Trauma,” Alcohol and Alcoholism 40 (2005): 269–73.
4 Ali H. Mokdad, Ph.D.; James S. Marks, M.D., M.P.H.; Donna F. Stroup, Ph.D., M.Sc.; Julie L. Gerberding, M.D., M.P.H., “Actual Causes of Death in the United States, 2000,” Journal of the American Medical Association 291, no. 10 (March 10, 2004): 1238, 1241.
5 M. A. Stahre, R. D. Brewer, T. S. Naimi, J. W. Miller, L. T. Midanik, F. J. Chaloupka, R. Saitz, T. L. Toomey, J. L. Fellows, M. Defour, M. Landen, and P. J. Brounstein, “Alcohol-Attributable Deaths and Years of Potential Life Lost—United States, 2001,” U.S. Morbidity and Mortality Weekly Report 53 (Sept. 24, 2004): 866–70.
6 National Center for Statistics and Analysis, “Persons Killed, by State and Highest Blood Alcohol Concentration in Crashes (2003),” accessed 5-26- 2005 at http://www-fars.nhtsa.dot.gov/FinalReport.cfm?stateid=0&title=states&title2=alcohol&year=2003.
7 See column by Kevin Helliker, “Stop Before You Start,” (Wall Street Journal, Oct. 21, 22, 2006), R6.
8 B. F. Grant and D. A. Dawson, “Age at Onset of Alcohol Use and Its Association With DSM-IV Alcohol Abuse and Dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey,” Journal of Substance Abuse 9 (1997): 103–10.
9 B. Bull, “To Drink, or Not to Drink,” Adventist Review, (Jan. 12, 2006), 8–12.
10 J. D. Friis, K. E. Skovenborg, et al., “Food Buying Habits of People Who Buy Wine or Beer: Cross Sectional Study,” British Medical Journal (2006).
11 T. S. Naimi, D. W. Brown, R. D. Brewer, W. H. Giles, G. Mensah, M. K. Serdula, A. H. Mokdad, D. W. Hungerford, J. Lando, S. Naimi, D. E. Stroup, “Cardiovascular Risk Factors and Confounders Among Nondrinking and Moderate-drinking U.S. Adults,” American Journal of Preventative Medicine 28, no. 4 (2005): 369–73.
12 K. M. Fillmore, W. C. Kerr, T. Stockwell, T. Chikritzhs, A. Bostrom, “Moderate Alcohol Use and Reduced Mortality Risk: Systematic Error in Prospective Studies,” Addiction Research and Theory (2006): 1–31.

 

 

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