Dwindling Evidence for the Moderate Use of Alcohol

From the monthly pastor and health feature.

Fred Hardinge, DrPH, RD, is associate director of the General Conference Health Ministries Department, Silver Spring, Maryland, United States.

Your parishioners have undoubtedly asked you about the potential benefits of consuming moderate amounts of alcohol for their health. During the past 20 years, much scientific evidence has accumulated to suggest that people who drink moderately (usually defined as one drink per day for women and two drinks per day for men) have a lower rate of overall mortality and coronary heart disease when compared with heavy drinkers or nondrinkers.1

In spite of this promoting evidence in favor of moderate alcohol consumption, alcohol continues to be one of the leading causes of preventable death in the world. In the United States, alcohol is the third leading cause of preventable death.2 In 2010, the United Kingdom’s Independent Scientific Committee concluded that alcohol was the world’s most dangerous drug.3 Alcohol is associated with financial stress, domestic violence, child abuse, and all types of crime and violence. Alcohol remains a major factor in motor vehicle accidents.

A ten-year study of eight European countries on alcohol consumption and cancer led researchers to conclude “there is no sensible limit below which the risk of cancer is decreased. . . . Thus, alcohol consumption should not be recommended to prevent cardiovascular disease or all-cause mortality.”4

While the media has focused primarily on the apparent benefits for heart health, it has largely ignored other serious negative impacts. Peter Landless and David Williams5 indicate that moderate drinking is associated with a range of negative outcomes, which include the following:

1. Risk of progression. The National Institutes of Health suggests a “low estimate” is that 5 to 7 percent of abstainers will develop diagnosable problems if they begin using alcohol moderately.

2. Risk of Addiction. In the general population, 13 percent of people who regularly drink will become alcoholics. If a first-degree relative suffers from alcohol dependence the percentage doubles to 26 percent; and if alcohol use begins earlier than 14 years old, the percentage jumps to 40 percent or more.

3. Binge drinking. Evidence reveals that binge drinking once a week is more harmful than spreading out the consumption over the whole week. Yet, both moderate and heavy drinkers experience the same rate of binge drinking.

Research also demonstrates a strong association between light alcohol use and deviant behavior. Alcohol impairs the quality of decisions people make in almost every type of situation, often leading to life-destroying moral choices. Even small amounts of alcohol lower the likelihood that a person will utilize religious or cultural norms in making their decisions.

Accumulating evidence demonstrates that the purported benefits of light alcohol consumption do not apply across all age, ethnic, and gender variations. In fact, there is growing evidence that there have been serious methodological limitations to many of the earlier studies. Landless and Williams6 outlined these limitations as the following:

1. Failure to record variations in alcohol intake over time. Almost all prospective studies used a singlebaseline alcohol-consumption measure to predict health outcomes years later, thus overestimating the benefits of moderate drinking.

2. Duration of follow-up. The apparent benefit of moderate alcohol intake diminishes with prolonged follow-up.

3. Potential confounding issues. Confounding occurs when the apparent benefits of some exposure (alcohol) on health are distorted by other factors (such as genetics, context of use, psychological variables). Randomization in studies tends to eliminate confounders, but because of the addictive nature of alcohol, it is unethical to conduct randomized studies. As a result, human studies are all observational, leading to high levels of residual confounding due to socioeconomic status, levels of exercise, dietary practices, or other unmeasured factors.

4. Misclassifications of drinking categories. In many studies, both former high-risk drinkers and people who drink infrequently were classified as nondrinkers. These biases tend to inflate the health risks of those who abstain from alcohol.

A recent longitudinal study from a large sample in Great Britain overcame some of these methodological issues by removing former drinkers from comparison groups. When all the appropriate statistical controls were applied, there was no health benefit from drinking alcohol. 7 These results showed a small cardio-protective benefit to women over 65, but none for men of any age or for women under 65. The authors noted that selection bias may have influenced the slight benefits for older women and are actually skeptical there is any benefit. For those who have never used alcohol, the evidence says: Don’t begin.

For those who currently drink alcohol, the same evidence says, Stop drinking now! God’s help is available to empower both.

 

References:

1 Joseph A. Hill, “In Vino Veritas: Alcohol and Heart Disease,” American Journal of the Medical Sciences 329, no. 3 (March 2005): 124–135.

2 Centers for Disease Control and Prevention, “Excessive Alcohol Use: Addressing a Leading Risk for Death, Chronic Disease, and Injury,” Chronic Disease Prevention and Health Promotion, www.cdc .gov/chronicdisease/resources/publications/aag/alcohol.htm.

3 David J. Nutt, Leslie A. King, and Lawrence D. Phillips, “Drug Harms in the UK: A Multicriteria Decision Analysis,” Lancet 376, no. 9752 (November 6, 2010): 1558–1565.

4 Madlen Schütze et al., “Alcohol Attributable Burden of Incidence of Cancer in Eight European Countries Based on Results From Prospective Cohort Study,” British Medical Journal 342 (April 7, 2011), doi: http://dx.doi.org/10.1136/bmj.d1584.

5 Peter N. Landless and David R. Williams, “Alcohol and Health— Sorting Through the Myths, the Dangers, and the Facts,” Journal of Adventist Education 76, no. 2 (December 2013/January 2014), 25–32.

6 Ibid.

7 Craig Knott et al., “All Cause Mortality and the Case for Age Specific Alcohol Consumption Guidelines: Pooled Analyses of up to 10 Population Cohorts,” British Medical Journal 350 (February 2015), doi: http://dx.doi.org/10.1136/bmj.h384.

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Fred Hardinge, DrPH, RD, is associate director of the General Conference Health Ministries Department, Silver Spring, Maryland, United States.

May 2015

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