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Alcohol and Health: Controversy Continues

Abstinent countries have the biggest health problems.

We often hear how many people die of alcohol-related diseases. Such research considers the only pathology and ignores the possibility that alcohol has health benefits. Such benefits appear to be enjoyed mainly by the affluent.

In an earlier post, I argued that very damaging drug use is selected against. The best example of this is the phenomenon of genetic alcohol intolerance in Asian populations that had been bedeviled by excessive alcohol use thanks to the easy availability of homemade rice wine (1).

Learning also matters. Tobacco use declines via social learning once its adverse health effects become widely known (2). Why would so many people drink alcohol if it is so bad for health?

Alcohol Use and Adaptation

Alcohol is consumed in most countries and by over 40 percent of the population in countries around the world. Recent research, published in Lancet, found that any level of alcohol consumption increases morbidity and mortality from alcohol-related diseases.

Many scholars argue that this is another case of human behavior going badly off the rails in modern societies that are very different from ancestral environments to which we are supposedly adapted (2).

Yet, this picture of human limitations may be excessively bleak. Humans and other mammals are a great deal more adaptable to their current environments than this approach suggests. Moose growing up in locations where wolves are extinct loose all fear of their ancestral arch enemy.

Humans are more flexible than other species and quickly learn to avoid foods and drugs that are harmful, including highly addictive drugs such as tobacco (2).

Alcohol has complex health effects and there may not be a simple linear effect of increasing alcohol consumption undermining health as the Lancet study concludes.

The U-shaped Function

Research on cardiovascular disease found that there is a U-shaped relationship between illness and alcohol consumption (3). This means that people who drink unusually little have worse health than those who consume a moderate amount whereas heavy consumption is associated with a heavy health cost.

These findings are inconsistent with the conclusion that alcohol in any amount is harmful.

Yet, there is a way in which the contradiction could be resolved. Even if alcohol is always toxic, its use in moderate amounts could have beneficial effects for health if (a) it facilitates social interactions and thereby reduces isolation and increases bonding and social support and (b) the beneficial consequences outweigh the toxicity costs.

Hence wealthy people consume more alcohol than average but also enjoy much better health and longevity than poorer segments of the population.

The Wealth Paradox

How does one square the fact that wealthy people drink more alcohol and yet have better health, and longer lives, than other segments of the population? There are two broad avenues of explanation. One is to emphasize that money brings improved access to healthcare, better life-extending treatments, a greater sense of control over one's life, and a generally healthier lifestyle. If so, the adverse consequences of high alcohol consumption may be more than offset by the benefits of better healthcare and lifestyle. Hence the alcohol-swilling elite of this country can live for decades longer than the less privileged.

Is it possible that their consumption of alcohol is associated with positive health effects overall? This possibility is rarely addressed by researchers because many are motivated to prevent the ravages of problem drinking.

Perhaps the impact of alcohol on health is mediated by the context in which alcohol is consumed.

The affluent often drink in positive social settings. They are in the company of members of a large and cohesive social network that helps them to cope with stress. They are enjoying the food at a fancy restaurant. They are vacationing in a pleasant resort. Or they are renewing social ties at a cocktail party.

All these contexts can build social support, reduce stress, and improve health. Alcohol may facilitate the breaking down of barriers and formation of friendships.

Affluent people generally describe themselves as happy and confident about the future and this reflects the vitality of their social networks and the protective effect of wealth.

If wealthy individuals drink more and have better health, the same is true of wealthy countries.

The Wealth Paradox Across Countries

Happiness is not the exclusive preserve of the wealthy. In Europe's social democracies, residents enjoy financial security that has helped them to risk starting new businesses. European countries drink a lot of alcohol but enjoy good health and long life expectancy.

For example, Denmark has more drinkers than any other country (95.3% women, 97.1 % men).

Despite drinking a lot, Denmark has repeatedly come out at the top in surveys of happiness.

The Danes, like the Irish, spend time in pubs that play a central role in social networks in these countries. Danes enjoy a good quality of life thanks to their affluence and their well-developed social democracy that minimizes inequality and alienation (5).

This is exactly the opposite of what would be predicted if the Lancet study - finding that any level of alcohol use is unsafe – represents the complete picture.

Alcohol Use May be Beneficial after all

If one restricts the focus to alcohol-related illnesses, it makes sense that any level of alcohol consumed increases the rate of these illnesses. Even if alcohol always increases the risk of alcohol-related diseases, it may still be associated with a boost in overall health.

This would explain why wealthy individuals, and affluent countries, both consume more alcohol and have a longer life expectancy.

In my own unpublished analysis of the connection between alcohol and life expectancy at birth, I found no evidence that countries with a higher proportion of drinkers, or with higher alcohol consumption per person, paid a price in lost life expectancy.

When the analysis was restricted to the wealthier half of countries - that drink more - I found that those countries that consumed more alcohol had a significantly higher life expectancy (even with national wealth, and religion, statistically controlled). Residents of countries where more of the people drank alcohol also lived significantly longer.

These data help explain why the majority of people drink alcohol in many developed countries. Their behavior cannot be maladaptive if it improves their health. If it does, then abstinence is the bigger health threat.


1 Henrich, J. (2015). The secret of our success: How culture is driving human evolution domesticating our species and making us smarter. Princeton, NJ: Princeton university Press.

2 Barber, N. (2015). Why behavior matches ecology: Adaptive variation as a novel approach. Cross Cultural Research, 49, 57-89.

3 Emberson, J. R., and Bennett, D. A. (2006). Effect of alcohol on risk of coronary heart diseaseand stroke: Causality, bias, or a bit of both? Vascular Health Risk Management, 2, 239-249.

4 Wilkinson, R., & Pickett, K. (2010). The spirit level: Why greater equality makes societies stronger. New York: Bloomsbury Press.

5 Zuckerman, P. (2008). Society without God: What the least religious nations can tell us about contentment. New York: New York University Press.