“Grey-area drinkers” aren’t falling-over drunks, but nor is their relationship with booze healthy. In recent times, many have been giving up or cutting back – being sober is the new black.
Few would fit the cliched profile of an alcoholic. Most are closer to what American nutritionist and TEDx talker Jolene Park has dubbed "grey-area drinkers", people who have come to live somewhere between "an end-stage, lose-everything drunk" and someone who, as she says, drinks "a glass of champagne at a wedding and never drinks again for weeks". A wellbeing expert and one of the first people Kristen Allan found online when she gave up, Park has said of her own pattern of drinking, where a glass of wine tended to turn into a bottle: "What people didn't know was how much I loved the 'off' switch that wine provided to my 'on' – and often-anxious – brain."
Significantly more teenagers abstained in 2016 than in 2013 (82 per cent compared to 72 per cent), while the average age among 14- to 24-year-olds trying alcohol for the first time increased (from 15.7 to just over 16 years of age). Of course, that trend is neither uniform nor universal – young people are more likely to binge-drink, for instance. At the opposite end of the spectrum, those aged 70 or more are the most likely to drink daily.
As for what lies between: "In 2001, the peak age for long-term risky drinking (more than two drinks per day) was 18 to 24. That has now moved to 40 to 49," says Matthew James, deputy director of the Australian Institute of Health and Welfare, which releases the NDSHS report. "There is evidence of an increase in lifetime risky drinking among people in their 40s and 50s, and the peak age for men is their 40s and for women is their 50s."
"I do feel a sense of freedom from not drinking anymore, because it took up so much brain space," said Laura Willoughby at London's Mindful Drinking Festival, an event founded to suggest that you don't need to be paralytic to have a good time. "It's been the best decision of my life."
Check every alcohol statistic from the last couple of years and you'll see I'm not alone: lots of people seem to believe that regularly poisoning yourself for fun isn't such a good idea. In a survey by Drink Monitor, almost a fifth of respondents said they were changing their drinking behaviours, while at least two-fifths have utilised planning methods to cut down, with older drinkers sticking to old-fashioned restraint and millennials being more likely to avoid alcohol altogether.
In fact, there's been a sharp rise in teetotallers generally. According to the Office of National Statistics, there are over 2 million teetotal adults in London – 30 percent of the adult population – while nationwide it's 20.9 percent. This trend only seems to be catching on, as you'll know from the endless reports of Gen-Z (16 to 24-year-olds) supposedly swapping Stella for sobriety
A decade ago, an event like the Mindful Drinking Festival (MDF) might have been derided as some kind of puritanical love-in. But today, in this climate, in makes perfect sense. Run by Club Soda – which describes itself as a "mindful drinking movement" – the festival at Spitalfields Market this past weekend was busy with people trying the various alcohol-free drinks on offer.
Pressure to drink from friends is the number one influencing factor in drinking alcohol in the UK, a survey has revealed.
From the 1,697 men and women questioned, a startling 85% had experienced bullying from friends to consume alcohol.
The study was done by One Year No Beer (OYNB), in collaboration with Stirling University.
“I know from personal experience how difficult it is to say no when you are being badgered into have a drink. And it’s easy to cave in under peer pressure when everyone around you is having a great time getting stuck in. It’s expected of you to drink; it goes against the grain if you don’t…why is it that it’s the people we call our friends who find it hardest of any of our relationships to accept when we say no? The One Year No Beer community aims to destroy the peer pressure around going alcohol free, and empowering people to say no, whether it’s with friends on a night out or deciding to quit alcohol for a longer period.”
– RUARI FAIRBAIRNS, OYNB CO-FOUNDER
In the Calendar region, men felt 26% more peer pressure than the UK average, with family being the biggest pressure point.
The survey also found:
What the research actually says
So, what are we to make of this research? In studies such as this, one of the many pitfalls of exploring the association between an exposure variable (alcohol) and the outcome variable (dementia) is the presence of confounders. Confounders are a statistician’s worse nightmare – they are variables that may justifiably be associated with both the exposure and outcome variable.
In this study, abstainers with higher levels of illnesses such as heart disease, diabetes and obesity were those at highest risk of dementia. It may be that having a physical illness is the reason that these people abstained from alcohol. These same physical illnesses may also be the reason for developing dementia. In this way, physical illness unrelated to alcohol consumption could be a confounder for both abstinence and dementia. Drinking may just be a red herring…For those that do drink alcohol, people drinking above lower risk limits has, once again, been given a salutary warning. It is one that we should continue to heed – but we also need to get the message out there that alcohol-related dementia needs to be rediscovered and investigated again.
Last year, the National Institute on Alcohol Abuse and Alcoholism, part of the federal National Institutes of Health, laid out plans for what is a rarity in the realm of public health: a high quality clinical trial. The “Moderate Alcohol and Cardiovascular Health Trial,” known as MACH15, was to be randomized so that some subjects would be selected to drink and some would not. It would follow participants “prospectively,” over time, not retrospectively. And in the end, the results were to be adjudicated by evaluators blinded to which subjects had been instructed to drink and which to abstain. The goal was an assessment of the effect of alcohol consumption on cardiovascular health.
The methodologic problems of the MACH15 trial’s design are considerable. How the outcome measures ever passed muster defies logic.
But last month, the National Institutes of Health took the unusual step of shutting down one of its own clinical trials — a $100 million dollar experiment gone wrong. The announcement followed an internal investigation, prompted by a dogged New York Times report, that uncovered inappropriate interactions between the alcohol industry (Anheuser-Busch InBev, Heineken, and others) and the NIAAA in the execution of MACH15.
Here’s how it was supposed to have worked: Volunteers aged 50 or older with either substantial cardiac risk factors or existing heart disease were to have been randomly assigned to either abstain from alcohol completely or to consume precisely one alcoholic beverage per day. They were then to be monitored for cardiovascular health. Investigators were interested in whether the patients assigned one drink per day were more, less, or equally likely to experience a heart attack, stroke, or even die in just six years? This was primary goal of the MACH15 trial.
In essence, the NIH was making a $100 million gamble that volunteers would portray their alcohol consumption accurately.
That’s not where the problems ended. In their report, the NIH investigators said they had found that the trial was apparently set up to lean towards “demonstrating a beneficial health effect of moderate alcohol consumption,” and that it was exceedingly unlikely to find that alcohol was harmful, because the trial design ignored some of alcohol’s most notable long-term risks, including cancer and congestive heart failure — the latter of which is linked to alcohol consumption. The eventual study would have under-reported cancer risks simply because, at six years, the trial was too short for those dangers to have caught up to patients who drink. But neglecting to include heart failure as an outcome of interest in a trial assessing cardiovascular health of alcohol is a far more flagrant oversight — akin, perhaps, to a study assessing the health risks of sugar intake in which researchers failed to ask whether patients developed diabetes. How the outcome measures of MACH15 ever passed muster defies logic, but in a statement attributed to Dr. Kenneth Mukamal, the study’s principal investigator, and supplied by his hospital’s public affairs office, he said the protocol was approved by “three external scientific panels and by ten institutional review board.”
“Most trials undertaken today are destined to produce a certain conclusion through designs that are manipulated just enough to almost guarantee a result without losing their integrity.”
Perhaps what sets MACH15 apart is not what it did, but who did it. The alcohol industry, while powerful, is far less experienced in the realm of biomedical research than large pharmaceutical companies who perhaps, by now, know just how to expertly game the research system without breaking the rules outright. Alternatively, it might be that alcohol itself is expected to play by a different set of rules than other would-be medicinal compounds. “Alcohol was never meant to necessarily benefit people, unlike medications,” wrote Florence Bourgeois, an assistant professor of pediatrics and emergency medicine at Harvard Medical School and a faculty member at Boston Children’s Hospital, in an email. “With drugs, pharma can justify their trials and marketing as an attempt to help people in need of medical breakthroughs. But alcohol is generally perceived as harmful to our society, so attempting to promote it on the false grounds of having health benefits doesn’t go over well in the lay media.”
For complete article cited 30/7/18