To Drink or Not to Drink? Not to Be or to Be?
Low quality evidence suggests low to moderate intake is beneficial, but coincident harms may obviate the benefits, and there are indirect wide spread societal harms that aren't usually considered.
There is some benefit in alcohol but also much harm, even at the moderate doses that have been recommended by doctors for generations, and even at low doses if you take a broader societal perspective, where some will invariably imbibe more than recommended and because of it harm others who drink little or not at all in a number of ways.
Both the benefit and harm have direct and indirect aspects, i.e. some related to physiological effects of alcohol and others related to its immediate and wider social effects.
There is some low quality epidemiological evidence of personal benefit in small amounts of alcohol in those who can stick to drinking small amounts of alcohol, though there are many reasons to doubt this evidence, and other higher quality epidemiological studies that are contradictory when certain confounders are taken into account.
The strongest possible benefits are for heart and kidney disease reduction, a reduction of certain cancers, and possible reduction in all cause mortality, especially in hypertensives.
However there are offsetting increased risks for other chronic diseases, cancer and as mentioned the lowering of all cause mortality itself is likely limited to small subgroups, if not offset by painful comorbidities themselves stemming from alcohol use, including severe dementia which limits experiential lifespan.
What this all means is that a moderate drinker might miss developing heart disease or dying from a heart attack only to suffer attacks of cancer and a slow painful decline into dementia.
If there is any benefit to be had on an individual level it could be purely physiologically mediated, e.g. by hormesis, where a small to moderate stressor can strengthen the body. However this may no longer apply since most of us are already overly stressed by the burden of other environmental toxins, nnEMFs, social dysfunction, lack of sunlight, grounding, darkness at night and sleep. Adding any additional stress on top of all that can be the straw that breaks the camel’s back, or prevents it from mending.
Alcohol’s benefits could also be mediated via increases in personal intimacy and bonding, which can of course be had without alcohol, at least after some focused practice. And these social benefits can be offset, especially when alcohol is consumed in quantities that affect our experience of reality, by emotional and spiritual numbing that detracts from the reason people exist in the first place.
On the other hand indirect harm comes from alcoholics, especially affecting family members, but also the society at large via dysfunctional, abusive relationships and motor vehicle accidents.
The emotional damage becomes trans-generational because the affected children pass on the interpersonal dysfunction to their own children, so it spreads exponentially across time until there isn’t anyone in a society who isn’t somehow touched by it - either directly or due to such harm afflicting a loved one.
Those most indirectly harmed in this way may not even become alcoholic themselves but still find their lives are as chaotic and dysfunctional as those who are full blown alcoholics (there are 12 Step healing/support groups that cater to alcoholics and others that cater specifically to family members of alcoholics, who may or may not drink themselves).
This state of affairs is a general drag on civilization that could itself lead to a negative spiral into chaos over a long enough time span.
In a small, isolated, uniform community it might be possible to create strict social rules and policing around alcohol use and abuse and limit or even avoid the indirect harm it engenders, but in the modern interconnected, melting-pot world most of us inhabit this is functionally impossible.
Even if there were past societies that benefitted from alcohol use, nowadays alcohol seems manifestly harmful on net, but especially so if you consider a broader perspective including all the indirect effects that impact everyone, even those who can strictly limit their intake.
It’s a public health issue that negatively affects personal health both directly and indirectly since the dysfunction that spreads in society is itself a chronic stressor for every individual, whether they experience direct physiological harm from it or not.
Evidence for Moderate Alcohol’s Physiological Benefits
A substantial body of research – mostly epidemiological – has reported associations between light-to-moderate alcohol intake and certain health benefits, particularly for the cardiovascular system. Numerous large observational studies and meta-analyses have found that people who drink moderately (often defined as up to ~1 drink per day for women or 1–2 for men) have lower rates of coronary heart disease (CHD) and all-cause mortality compared to non-drinkers (here and here). For example, a 2011 BMJ meta-analysis of 84 cohort studies found a 25–30% reduced risk of heart disease in light/moderate drinkers versus abstainers (here). These epidemiologic findings led to the well-known “J-shaped” curve hypothesis, where low doses of alcohol appear protective against cardiovascular events, while heavy drinking is harmful. Proposed mechanisms from clinical and preclinical studies may help explain these associations: moderate ethanol intake can raise HDL (“good”) cholesterol levels, including raising apolipoprotein A1 (here and here), reduce blood clotting tendency (by lowering fibrinogen and increasing fibrinolysis) (here), and dampen chronic inflammation (usually misinterpreted as always positive, but inflammation is your own immune system fighting for good reason, either against extra or intracellular pathogens or to remove toxins). Light alcohol intake has also been linked to better insulin sensitivity and a lower incidence of type 2 diabetes in some populations (here), potentially via improved adiponectin levels and insulin signaling.
Beyond the heart and metabolism, some studies have observed cognitive or neurological benefits of low-dose alcohol. Certain longitudinal studies reported that moderate drinkers had equal or lower rates of dementia and cognitive decline compared to abstainers (here), though findings have been mixed. On a neurobiological level, recent research offers insight into stress-related mechanisms: A 2023 Massachusetts General Hospital study found that light/moderate drinkers showed reduced stress signaling in the amygdala (brain’s stress center) on PET scans, which correlated with fewer heart attacks and strokes (here and here). This suggests moderate alcohol might confer some cardiovascular benefit by blunting chronic stress pathways. In animal models, low doses of ethanol have shown hormetic effects – for instance, improving endothelial function and reducing atherosclerotic plaque development in some rodent studies (here and here). Such preclinical findings align with the idea that small amounts of alcohol might induce mild adaptive stress responses (e.g. upregulating cellular antioxidative defenses) that could be beneficial, while larger doses overwhelm these systems.
Study Quality and Ioannidis’s Reliability Rubric: It is important to note that most “benefit” data come from observational studies, which have inherent limitations. John Ioannidis is famous for noting decades ago that most academic research findings are false, and that most study designs in most situations are likely to return false results, essentially mirroring the mainstream consensus. His criteria for robust, reliable research emphasize factors like large sample sizes, minimal bias, pre-registration, and consistent replication. Many alcohol studies supporting benefits fall short on these counts. They are typically non-randomized cohorts with self-reported alcohol intake, leaving ample room for confounding and measurement error. The effect sizes observed (e.g. ~0.8 relative risk for moderate drinkers) are relatively small, and Ioannidis has cautioned that modest associations in nutritional epidemiology are often non-reproducible false positives if biases aren’t rigorously controlled (e.g. here). Indeed, the literature on moderate drinking has produced conflicting results across different populations and health outcomes – a warning sign under Ioannidis’s rubric. There is also multiplicity of analyses (varied health endpoints, subgroup definitions, etc.): Ioannidis’s team notes that testing many hypotheses without proper adjustments greatly increases the likelihood of spurious “significant” findings (see here). In short, while a considerable number of studies suggest physiological benefits from moderate alcohol, their observational nature and methodological weaknesses mean we must interpret the findings with caution when judged by rigorous standards of evidence quality.
More on Weaknesses and Biases in Studies Claiming Benefits
Despite the suggestive findings above, many other researchers have identified multiple specific major limitations and biases in studies that claim alcohol is beneficial. These issues cast doubt on whether moderate drinking truly causes better health or if other factors explain the correlation. Importantly many of these biases can only skew study results towards overestimating the benefits of alcohol and underestimating its harms.
Confounding Lifestyle Factors: Moderate drinkers may differ systematically from abstainers in ways that affect health. They often have higher socioeconomic status, better diets, more exercise, and stronger social networks – all of which improve health independent of alcohol - and they may specifically start drinking or moderate preexisting drinking because they have been told that it is beneficial to do so. This artificially inflates the group of moderate drinkers with people who are particularly health conscious. Conversely, the “non-drinker” group can include people who abstain due to underlying poor health or former heavy drinkers who quit (see below). Such differences can mask the true impact of alcohol. Although many studies try to adjust for confounders, no statistical model can perfectly equalize groups on all unmeasured healthy lifestyle factors. Thus, moderate drinking might merely be a marker of a healthier or more social lifestyle, rather than the cause of the benefit.
Misattribution of Benefit to Alcohol Itself: Although some research suggests any cardioprotective effect in studies is not specific to wine vs beer vs liquor (here), it remains possible that there are one or more beneficial elements other than alcohol present in some or all of them. However, to date, attempts to isolate causal factors aside from alcohol (like the resveratrol in red wine hypothesis) have largely failed to show significant effects in controlled trials. If such a component does exist it’s possible the beneficial effect is only manifest in its un-isolated form, i.e. not separable from the harms of the alcohol.
“Healthy Drinker” or “Sick Quitter” Bias: A well-recognized bias is that some studies misclassify people who previously drank heavily and damaged their health (“sick quitters”) as “abstainers” as long as they did not drink during the study period. This tends to inflate the risk in the non-drinker study group, making current moderate drinkers (who are relatively healthier, perhaps less predisposed to damage, or just earlier in their drinking career) look good by comparison (here and here). Recent analyses that specifically addressed this bias found that the supposed protective effect disappears. Importantly, when researchers separate lifelong moderate drinkers from those who only later reduced their intake, the lifelong moderate group shows no longevity or heart benefit relative to true abstainers (here and here). One study reclassifying “former” and “reducing” (previously heavier) drinkers demonstrated that mixed populations had created a false J-curve: higher cardiac risk in the abstainers/reducers who had been improperly grouped into the low or no alcohol use category artificially produced the lower risk seen in moderate drinkers (here). In other words, properly designed studies find moderate drinkers are not significantly healthier than genuinely abstinent people, undermining the claims of benefit (here). A 2016 meta-analysis by Stockwell et al., which controlled for abstainer bias and study quality across ~4 million people, concluded that low-volume alcohol consumption has no net mortality benefit compared to lifetime abstention (here). The initial mortality risk ratio of ~0.86 (14% benefit) for light drinkers became ~0.97 (statistically neutral) after correcting for biases (here). This demonstrates how pivotal methodological refinements can wipe out the appearance of protection.
Self-Report and Measurement Error: Almost all population studies rely on self-reported alcohol intake (questionnaires, interviews), which is famously prone to underreporting and misclassification. People may not accurately recall or truthfully report how much they drink. “Moderate” drinkers in surveys might actually be heavier drinkers who underestimate their intake, diluting the observed risks of alcohol. Conversely, occasional drinkers might be miscategorized as abstainers. Such measurement errors generally bias results toward suggesting safer effects of alcohol than truly exist (here and here). Without objective biomarkers or prospective randomization and controls, it’s hard to ensure that “moderate drinking” is measured consistently across studies.
Selection Bias and Survival Bias: Epidemiological cohorts often “select” for people healthy enough to remain in the study. Those who can sustain moderate drinking over many years may be a robust subset with genetic or health advantages; less healthy drinkers might drop out (or die) earlier. This survivorship bias can make moderate drinking look protective when in fact the cohort had a healthier constitution to begin with. Additionally, some large studies (like the famous Nurses’ Health Study) showed moderate drinkers had lower mortality, but critics note that participants were primarily health-conscious individuals to start with. Thus, moderate alcohol could piggyback on other selection effects.
Industry Funding and Influence: The alcohol industry has a vested interest in promoting the idea that moderate drinking is healthy, which can subtly or overtly influence research. Many studies on alcohol and health have received industry funding or have investigators with industry ties. While funding alone doesn’t invalidate results, it raises concern about design biases – similar to how pharmaceutical industry–sponsored trials tend to favor the sponsor’s drug. Documents revealed that the NIH’s 2018 MACH trial (a $100M randomized trial on moderate alcohol and heart health) was shaped behind the scenes by alcohol industry input, with industry partners explicitly seeking to “show the J-curve in all its glory” (here). Investigators and NIH staff were found to have improperly courted industry funding and designed the trial to focus on benefits while downplaying risks, leading to cancellation of the trial for ethics violations (here). This episode exemplifies how industry involvement can bias the research agenda – for instance, by excluding outcomes like cancer to favor a positive conclusion (here). A systematic analysis by Golder and McCambridge (2015) examined dozens of cohort studies and did not find broad evidence that industry-funded studies always showed more benefit, except in the case of stroke (where outcomes varied significantly by funding source) (here). Nonetheless, they cautioned that subtle “funding effects” could be at play and called for further scrutiny (here). In sum, one should ask: Are we seeing a true health effect or an echo of alcohol industry marketing? The heavy critique of the “moderate drinking is healthy” narrative in recent years suggests a lot of prior research may have overstated benefits due to systematic biases or conflicts of interest.
High-Quality Meta-Analyses on Alcohol and All-Cause Mortality
To clarify inconsistent findings especially for all cause mortality, which many consider the ultimate indicator of benefit, researchers have conducted rigorous meta-analyses and umbrella reviews across many populations. These analyses paint a bleak picture:
No Consistent Mortality Benefit After Bias Adjustment: The most recent high-quality meta-analyses suggest that any apparent longevity benefit from moderate drinking is likely not causal. A 2023 systematic review and meta-analysis (including 107 cohort studies, ~4.8 million people) found no significant reduction in all-cause mortality for drinkers consuming up to 25 g of alcohol per day when compared to lifetime abstainers, after adjusting for study design factors (here). In this analysis, low-volume drinkers (approximately 1 drink or less per day) had no statistically significant advantage in survival (relative risk ~0.93, 95% CI overlapping 1) relative to never-drinkers (here). By contrast, higher intake was associated with a clear increase in mortality risk – for example, women drinking ≥25 g/day and men ≥45 g/day had significantly elevated all-cause death rates (here). The authors concluded that “low-volume alcohol drinking was not associated with protection against death” and even modest drinking may slightly raise the risk for some individuals (here). These findings update and reinforce earlier meta-analyses (e.g. Stockwell et al. 2016) that questioned the so-called J-shaped curve when accounting for biases. In short, when the healthiest abstainers are properly identified and confounders are controlled, moderate drinkers no longer show a longevity advantage over true non-drinkers.
Umbrella Review and Specific Subgroups: An extensive 2022 umbrella review (covering dozens of meta-analyses of prospective studies) provides a broad overview of alcohol’s effects on various outcomes. Notably, this review found that the only subgroup with strong evidence of reduced all-cause mortality from alcohol was people with hypertension (here). In hypertensive individuals, low-to-moderate alcohol intake was associated with roughly a 19% reduction in overall mortality compared to abstainers (here). This specific benefit (moderate drinking helping those with high blood pressure) had a “high” quality of evidence rating in the umbrella review (here). The likely explanation is that in patients with hypertension – who are at elevated risk of heart attacks and strokes – a small amount of alcohol might reduce cardiovascular strain (via stress relief or modest vasodilation) and improve lipid profiles, thus slightly lowering their high baseline risk. Indeed, a prior meta-analysis focused on hypertensive patients (Huang et al. 2014) also reported that light drinkers with hypertension had significantly lower rates of heart disease and mortality than nondrinkers (here).
Outside of that hypertension subgroup, the umbrella review did not find robust evidence of all-cause mortality benefit in the general population. Some associations that appeared favorable (e.g. moderate drinking and lower overall cancer mortality or non-hypertensive cardiovascular mortality) were graded as “weak” or “moderate” evidence, meaning they could be due to chance or bias (here). In fact, the umbrella review confirmed protective effects of moderate alcohol on only a few outcomes with high confidence – notably, reduced risk of renal cell carcinoma, dementia, and colorectal cancer mortality, and again all-cause mortality in hypertensive patients (here). Meanwhile, it found strong evidence of harm for multiple outcomes even at moderate doses, such as increased risk of several cancers (breast, colorectal, esophageal, skin cancers) (here) and higher risk of hemorrhagic stroke (here). This underscores that any potential benefit is highly context-dependent and outweighed by risks for most people.
Consistency Across Populations: The question of whether alcohol’s effects vary by population (e.g. by age, sex, or region) has also been explored. Some earlier studies suggested that older adults might experience more benefit (since their baseline heart risk is higher), or that benefits were more evident in European cohorts than U.S. cohorts (here). For instance, the 2006 meta-analysis noted the mortality benefit for men was smaller in the U.S. than in Europe (here), possibly due to lifestyle differences. However, contemporary meta-analyses that stratify by age and sex find that no group truly gains in mortality from drinking. The 2023 analysis by Zhao et al. noted female drinkers actually face higher relative mortality risk than males at a given consumption level (women have increased risk even at ~25 g/day, whereas men’s risk climbs more notably beyond ~45 g/day) (here). This sex difference aligns with clinical data showing women are more vulnerable to alcohol’s toxic effects on the liver, heart, and cancer risk. By age: younger people (<40) generally do not experience health benefits from alcohol, as their baseline disease risk is low but alcohol-related risks (injuries, violence, etc.) are relatively high. Any potential cardioprotective effect becomes more relevant in middle-age and older adults; yet even in these groups, rigorous analyses (and genetic studies, see below) find little net mortality benefit outside of specific high-risk conditions like hypertension (here).
Confirmations and Refutations: The emerging scientific consensus leans toward refuting broad health benefits of moderate drinking. Additional support for this comes from Mendelian randomization studies, which use genetic variants as unbiased proxies for alcohol intake. One such study found that individuals with genetic traits predisposing them to drink less had a linear reduction in cardiovascular and mortality risk, with no J-shaped protection at low doses (here). This genetic evidence suggests that lower alcohol consumption causally improves health, refuting the idea that moderate intake is inherently protective. Moreover, global analyses like the 2018 Global Burden of Disease study concluded that “the safest level of drinking is none,” given that any slight reductions in heart disease are offset by increased risks of cancer, injuries, and other conditions on a population level (here). That said, moderate drinkers in past studies did often have lower heart disease incidence, and a minority of special populations (e.g. people with established heart disease or risk factors) may derive a small benefit. Overall, however, high-quality evidence now challenges the notion of a widespread health benefit from alcohol. The consensus of recent meta-analyses is that any benefit is at best small, non-generalizable, and likely confounded, whereas the harms of alcohol are suspected even at moderate doses and indisputable at high doses.
Direct, Indirect and Societal Harms of Alcohol Consumption
When evaluating alcohol’s impact, it’s critical to look both at individual harms as well as considering broader public health and social consequences. Even if moderate drinking has a health benefit for some, alcohol does harm others, and it’s not possible to know into which category you will fall, and in general the overall footprint on society is overwhelmingly negative.
Direct Physical Health Risks (Cancers, Organ Damage) at Moderate Doses: Alcohol is a known carcinogen and even moderate consumption measurably increases the risk of several cancers. For instance, breast cancer risk rises by about 7–10% per 10g of alcohol/day – meaning even one drink daily can raise a woman’s breast cancer risk significantly over time (here). A recent National Academies review confirmed that moderate drinking is associated with higher incidence of breast and colorectal cancers (here). Alcohol also contributes to liver disease (e.g. fibrosis and cirrhosis can develop in some “moderate” drinkers who are especially susceptible), as well as hypertension and atrial fibrillation risk, which increase roughly linearly with dose (here and here). It’s notable that no organ system is truly spared – even low levels of alcohol produce acetaldehyde and reactive oxygen species (toxic metabolites), causing cellular stress and engaging often already overburdened detox pathways. A 2018 comprehensive analysis in The Lancet (Global Burden of Disease study) concluded that “no amount of alcohol is safe”, as any potential cardiovascular benefits are outweighed by increased risks of cancer and other diseases (here). The researchers found that the optimal level of drinking for health is zero, from a population standpoint, given alcohol was responsible for ~3 million deaths worldwide in 2016 (here). Thus, even moderate drinkers may pay a price in terms of long-term disease risk that isn’t immediately obvious.
Addiction and Progression to Heavy Use: Alcohol is an addictive substance, and what starts as “moderate” use can escalate. A portion of moderate drinkers will lose control over their intake over time. Epidemiologically, any regular alcohol use increases the lifetime risk of developing Alcohol Use Disorder (AUD). Data show an astounding ~29% lifetime prevalence of AUD in the U.S. (here), and risk is “dose-dependent” – the more one drinks, the higher the likelihood of eventual alcoholism. Genetic predispositions can make even “social drinking” a slippery slope. The simple presence of alcohol in one’s lifestyle (versus complete abstinence) opens the door to habituation, tolerance and increasing use over time to achieve the same pleasurable effects. From a public health view, encouraging the idea of moderate drinking as healthy could inadvertently lead some people to drink who otherwise wouldn’t, expanding the pool of those at risk for alcohol’s harms.
Family and Domestic Problems: Alcohol’s role in domestic and social dysfunction is well-documented. Domestic violence and abuse are frequently fueled by alcohol consumption. Estimates from the WHO indicate about 50–60% of intimate partner violence incidents involve alcohol use by the perpetrator (here and here). While these typically involve heavy episodic drinking, even habitual moderate drinking can set the stage for family conflict – for example, a person who has a few drinks every night may have impaired judgment or irritability that affects their spouse and children. Alcohol impairs inhibition and can exacerbate mental health issues (depression, anger) that play into family violence or neglect. Children raised in households with regular drinking may experience a less stable and nurturing environment, even if the drinking is “moderate” by clinical standards. Parental alcohol use is associated with a higher risk of behavioral problems and alcohol use in children (through both genetic predisposition and learned behavior) (here ). In fact, having a family history of alcoholism increases one’s own risk of AUD several-fold (here), illustrating how alcohol’s damage often propagates across generations. This intergenerational impact is not solely genetic – it’s also environmental. A culture of moderate drinking in the home may normalize alcohol for the next generation, potentially leading to earlier onset of drinking and higher lifetime consumption in descendants. In the worst cases, moderate drinking can progress to parental alcohol misuse, which is recognized as an Adverse Childhood Experience (ACE) linked to long-term trauma for children. Even in utero, alcohol can harm: drinking during pregnancy (even at “moderate” levels) can cause fetal alcohol spectrum disorders. Health authorities therefore urge zero alcohol during pregnancy, since no known safe threshold exists to avoid developmental damage. The presence of alcohol in a family often goes hand-in-hand with marital stress, divorce, child neglect, and financial problems – all societal dysfunctions that radiate outward from the individual drinker.
Accidents, Injuries, and Public Safety: Alcohol consumption – including moderate amounts – contributes to accidents and injuries that affect others. Even at blood alcohol levels corresponding to moderate intake (e.g. after 1–2 drinks), impairment can occur: slowed reaction time, reduced coordination, and altered judgment. This means moderate drinking can be enough to cause motor vehicle accidents or mistakes at work. Alcohol-related accidents are not limited to drunks; “buzzed driving” is dangerous too. Moreover, even a “moderate” drinker who occasionally binge drinks (e.g. social drinking that goes too far) puts others at risk. Alcohol is implicated in a large share of falls, fires, and other unintentional injuries in the home and community. On a population scale, these incidents translate to healthcare burdens and lost productivity. It’s estimated that alcohol-related workplace productivity losses and healthcare costs run in the hundreds of billions of dollars annually, amounting to at least 1% of GDP in high-income countries when factoring in all harms (here). These costs are borne by society at large (through insurance, medical costs, legal system, etc.), not just the drinkers themselves. In short, the externalities of alcohol use are massive, and even so-called moderate consumption contributes to that toll (since a large proportion of alcohol-related harm – like car crashes or violent altercations – occur at levels not far above the “moderate” range).
Transgenerational and Community-Wide Stress: Alcohol’s harms tend to cluster and amplify across generations and communities. In communities with prevalent drinking culture, one often sees a cycle of alcohol problems: youth observe adults using alcohol as a coping mechanism or social ritual, increasing the likelihood they’ll do the same. Over time this can perpetuate cycles of addiction and social ills. Researchers also talk about “transgenerational trauma” where the dysfunction from alcohol in one generation (e.g. an alcoholic parent) leads to emotional trauma in children, which in turn can manifest as substance abuse or mental illness in the next generation. Thus, alcohol’s damage isn’t contained to one person – it spreads especially through families in an exponential manner across time. From a societal viewpoint, alcohol (even in moderation) can erode the social fabric by contributing to violence, abuse, mental stress, and reduced economic productivity. Consider also the psychological stress on loved ones: the spouse of a moderate-to-heavy drinker may live in chronic stress or anxiety, which can degrade their own health. The children of a drinker may suffer academic and emotional consequences. These indirect effects are harder to quantify but are very real; many argue they make any level of alcohol use net harmful when viewed holistically. As one analysis succinctly stated: while moderate alcohol might protect some against heart disease, those potential benefits “do not outweigh the risks” of cancers, injury, and social damage (here). Public health experts therefore increasingly favor the message that alcohol is best avoided altogether, since even moderation can fuel a cycle of harm at the individual and population level.
Conclusion: Do the Benefits Outweigh the Harms?
Bringing together the evidence, the picture that emerges is that the purported health “benefits” of moderate alcohol are on shaky scientific ground, whereas the harms – both direct and indirect – are substantial and in many cases directly experienced and obvious to any unbiased observer. Early low-quality population studies suggested moderate drinking (especially wine) might extend lifespan and protect the heart, but more rigorous analyses controlling for bias have largely nullified those findings (here ). At best, a small cardioprotective effect might exist for certain individuals and certain subgroups might live slightly longer, but even this is strongly disputed and very likely a mirage of confounding (“healthy user” effects). On the other hand, even low-level drinking incrementally increases the risk of cancer, alcoholism, liver disease, and more. Alcohol also contributes to a wide swath of social ills – from family violence and dysfunctional relationships to accident fatalities – that no study has ever shown to be outweighed by health benefits. As Ioannidis and others would note, extraordinary claims require extraordinary evidence; the claim that daily consumption of a psychoactive toxin improves health has not met the burden of proof, despite millennia of widespread use. Instead, the most reliable current evidence (e.g. meta-analyses of high-quality studies and global disease burden data) indicates no net health benefit from drinking – and indeed a potential for net harm (here and here).
If a person doesn’t drink, there is no medical reason to start; and if one does drink moderately, it should be with the clear understanding that any minor possible benefits (such as a slight HDL boost or stress reduction) comes with real trade-offs including increased risks of cancer, dependency, and in the aggregate broader societal harm. And of course the aggregate includes each one of us, who contribute to the social acceptability of drinking.
Most think they are missing out by not drinking, but it’s exactly the opposite. The full range of human spiritual, emotional, intellectual and social experience is only available to those whose faculties are entirely intact and have been fine tuned and elevated by years of full contact living - the only kind of living that uncovers all our foibles and failures and allows us to correct them in a journey of gradual self-actualization.
Even though it’s often thought of in the opposite way, ultimately for most drinkers the question to drink or not to drink is like asking not to think, or to think?
Not to fully experience, or to fully experience?
Not to be, or to be?