A medical case for teetotalism

Alcohol is icky – so much so that not drinking at all seems like the best idea.

Professor David Nutt – the man sacked as chairman of the Advisory Council on the Misuse of Drugs for relying on statistics not sensationalism – argues that the safest approach to alcohol is to avoid it altogether:

The myth of a safe level of drinking is a powerful claim. It is one that many health professionals appear to believe in and that the alcohol industry uses to defend its strategy of making the drug readily available at low prices. However, the claim is wrong and the supporting evidence flawed.

There is no safe dose of alcohol for these reasons:

• Alcohol is a toxin that kills cells such as microorganisms, which is why we use it to preserve food and sterilise skin, needles etc. Alcohol kills humans too. A dose only four times as high as the amount that would make blood levels exceed drink-driving limits in the UK can kill. The toxicity of alcohol is worsened because in order for it to be cleared from the body it has to be metabolised to acetaldehyde, an even more toxic substance. Any food or drink contaminated with the amount of acetaldehyde that a unit of alcohol produces would be immediately banned as having an unacceptable health risk.

• Although most people do not become addicted to alcohol on their first drink, a small proportion do. As a clinical psychiatrist who has worked with alcoholics for more than 30 years, I have seen many people who have experienced a strong liking of alcohol from their very first exposure and then gone on to become addicted to it. We cannot at present predict who these people will be, so any exposure to alcohol runs the risk of producing addiction in some users.

• The supposed cardiovascular benefits of a low level of alcohol intake in some middle-aged men cannot be taken as proof that alcohol is beneficial. To do that one would need a randomised trial where part of this group drink no alcohol, others drink in small amounts and others more heavily. Until this experiment has been done we don’t have proof that alcohol has health benefits. A recent example of where an epidemiological association was found not to be true when tested properly was hormone replacement therapy. Population observations suggested that HRT was beneficial for post-menopausal women, but when controlled trials were conducted it was found to cause more harm than good.

• For all other diseases associated with alcohol there is no evidence of any benefit of low alcohol intake – the risks of accidents, cancer, ulcers etc rise inexorably with intake.

Surprisingly Responsible Teenagers

One of the best films of the year so far has been the Way Way Back. While the main reason to love it are the terrific performances, another attraction is the twist it provides on the coming of age story. As you would expect the teenage characters rebel against their parents. What is unusual is the assumption that the clash of generations is down to the younger generation’s irresponsibility. What it shows instead are parents whose hedonism wreaks a high emotional price on their children. The lead character, Duncan’s, rebellion is not drink and take drugs but to get a job that allows him to escape from the adults in his life.

This is arguably a cultural reflection of a real social phenomenon. The BBC Home Affairs correspondent Mark Easton:

Teenage rebels are not what they were. Adolescents are increasingly turning their noses up at drugs, booze and fags, with consumption by young people the lowest at almost any time since we started measuring these things.

Drugs: Last week, the Home Office published analysis which suggests the proportion of 16- to 24-year-olds that have ever taken illicit drugs has fallen from 54% in 1998 to 38% now. Among 11- to 15-year-olds the figure has fallen from 29% to 17% in a decade.

Tobacco: Last month, NHS analysis suggested the proportion of English 16- to 19-year-olds who have never smoked has risen from about two-thirds in 1998 to three-quarters now. And the data is just as striking among their younger brothers and sisters. In 1982 most 11- to 15-year-olds (53%) had had a sneaky cigarette at one time or another. Today, just a quarter has ever spluttered over a fag behind the bike sheds.

Alcohol: It is a similar story with booze. In 1998, 71% of 16- to 24-year-olds questioned said they’d had a drink that week. Today it is 48% – far lower than their parents (about 70%). Among 11- to 15-year-olds there are similar big falls. A decade ago, 26% reported they’d had alcohol in the previous week. Now the data suggests the figure is 13%.

A trend he attributes to new technologies providing more benign distractions and to the greater focus demanded by a tougher economy.