The day after drinking provides a reminder that alcohol is bad, however, this sentiment has never been established long-term in societies or governments. Consequently, policy regarding alcoholism has historically been rather passive. Photo credit: Adam Wilson via Unsplash
The idea that alcohol is bad for you is not revolutionary — just ask anyone who has ever had a hangover. However, alcohol is considered to be bad for you in the same way as watching TV: maybe it is not the best use of your time, but everyone does it, so it must be fine.
The government’s strategy towards alcohol has compounded this attitude. The lack of policies to counter the harms that alcohol causes to both the individual and society leads the public to believe that alcohol is not a significant problem. In the UK, alcohol is the leading cause of death and disability for those aged 15 to 49 and the cost of alcohol misuse is estimated to be between £21 and £52 billion a year. With that said, this view of alcohol must change.
To see why, first consider the physical harms of alcohol to the drinker. Alcohol is broken down in the liver into energy and acetaldehyde — the more you drink the more acetaldehyde is produced. Acetaldehyde can permeate the liver tissues and freeze metabolic activity, gradually solidifying the liver, a process called liver cirrhosis. Furthermore, acetaldehyde is toxic – the carbon-oxygen double bond in the molecule can react with proteins, lipids, and DNA, interfering with their functionality. The damage that sustained heavy drinking does to DNA may lead to abnormal cell growth and the formation of a cancer tumour.
From 1970 to 2010, in the UK, deaths due to liver disease increased five-fold. This contrasts with the decreasing mortality rates of almost every other disease. Given that 80% of deaths from liver disease are attributed to alcohol, this trend shows that increased levels of drinking are significantly harming public health.
…were alcohol introduced to the market today, the acceptable level of consumption (by the standards of the European Food Standard Authority) would be two units a year…
Alcohol does not only cause liver cancer: it has been linked to at least six other types of cancer, including breast, oesophageal, lip and nasal, and is suspected to be a risk factor for many more. In fact, ethanol, the main ingredient in alcohol, is classified as a Group 1 carcinogen. This means that the level of certainty that alcohol causes cancer is the same as the level of certainty that tobacco, radiation, and asbestos cause cancer. Based on this carcinogenic property, were alcohol introduced to the market today, the acceptable level of consumption (by the standards of the European Food Standard Authority) would be two units a year. That is one glass of wine a year.
Alcohol does not only cause liver cancer: it has been linked to at least six other types of cancer, including breast, oesophageal, lip and nasal, and is suspected to be a risk factor for many more.
As well as the physical harms of alcohol (which, on top of what has already been discussed, include negative effects on the heart, gut, brain, and more), one should consider the effects of alcohol on mental health. Very frequently people use alcohol to self-medicate pre-existing mental illnesses, such as anxiety, depression, bipolar disorder, and PTSD. This makes it difficult to evaluate the effect of the alcohol consumption. There is clearly a correlation, however: 70% of people entering treatment for alcohol dependency also suffer from a mental illness. This can often hinder them from receiving effective treatment as experts are unsure whether to treat the alcoholism or the mental illness first.
Furthermore, there is evidence that continued, heavy use of alcohol, changes brain chemistry at the level of gene-expression. For example, chronic alcohol consumption can hinder DNA methylation, which affects gene expression in multiple types of brain cells. This changes brain pathology and plasticity, leading to a higher alcohol tolerance (and so a greater risk of developing an alcohol dependency) and a greater susceptibility to mental illness.
Alcohol dependency both destroys the mental well-being of a person and massively increases their risk of severe physical harm, as alcoholics will generally be drinking far above the low-risk guidelines of 14 units a week. Any effective government alcohol strategy should, therefore, include effective measures for treating alcohol-dependency.
This, however, was not a priority in the last government alcohol strategy, which was published under the Cameron-Clegg coalition government in 2012. This government did not believe that alcohol dependency was an illness and so addiction care was moved from the NHS to social services. This move was accompanied by the treatment budget being halved and the number of training posts for addiction psychiatrists also being halved. As of 2023, 82% of dependent drinkers are not in treatment. Clearly the government strategy is not effectively treating people who suffer from alcohol dependency, nor is it helping to prevent the development of alcohol dependency.
The Cameron-Clegg coalition government did set up a committee to find strategies that would encourage drinking within the guidelines. However, the committee was formed of 50% health experts and 50% representatives of the drinks’ industry. This was an unworkable set-up: when any compulsory policies that could reduce drinking were suggested, the drinks’ industry would veto them as, inevitably, such policies would reduce their profits. Eventually, the health experts resigned, and the committee was disbanded.
One policy that was rejected in the committee was the introduction of minimum unit pricing (MUP). MUP is a law that states the minimum price per unit of alcohol must be 50p. In 2018, this policy was introduced in Scotland and its success there perhaps provides a model for England. MUP in Scotland is thought to have been responsible for a 13.4% reduction in alcohol-related deaths since it was introduced, with the greatest improvements being found in the most socioeconomically deprived areas. This data indicates that the policy is helping most those who need it most.
Another country who has managed to implement successful strategies to reduce the harms of drinking is France. In 1970, the death rates from liver cirrhosis in France was five times that of the UK . The government then introduced a series of policies to encourage moderate drinking, whilst also trying to minimise harm to the economy. These policies included banning alcohol adverts from TV, adding health warnings on all alcohol labels, and reducing the legal driving limit from 80mg of alcohol per 100ml of blood (which is still the limit in the UK) to 50mg per 100ml. With these policies in place, death rates from liver disease in France halved, while those in the UK have more than doubled in the same period.
The current UK government is making some moves in a positive direction on alcohol policy. As of August 1st 2023, the Sunak government changed how alcohol duty is calculated. In the previous system, the duty was calculated based on the type of alcohol. In the new system, the duty only depends on alcohol strength. This will lead to stronger drinks getting more expensive whilst weaker drinks get cheaper — an effective way to get drinkers to cut back on their weekly units.
The production of alcohol may stretch back as far as 40,000 years, and has occurred spontaneously all around the globe and in most cultures. It is therefore highly unlikely that there will ever be a time when drinking is not part of our society. Whilst this may have harmful consequences, alcohol can also have social benefits; lubricating interactions and bringing together communities. It is only possible, however, for the benefits to outweigh the harms when people are drinking moderately and understand the risks involved.
The laissez-faire attitude the government has thus far taken — making drinking a matter of personal responsibility and will-power — ignores the fact that alcohol is an addictive substance.
The type of policies that should be introduced would have little effect on those who drink moderately. They would, however, help curb the drinking of the heaviest drinkers in society. The laissez-faire attitude the government has thus far taken — making drinking a matter of personal responsibility and will-power — ignores the fact that alcohol is an addictive substance. In the same way that government restrictions on tobacco are widely accepted, stronger restrictions on alcohol should, and one hopes, would be accepted.
For further reading on this topic, I would strongly recommend ‘Drink? The New Science of Alcohol and Your Health’ by Professor David Nutt, who is neuropsychopharmacologist and was a government advisor on drug and alcohol policies.