The Antidote to Alcohol Abuse: Sensible Drinking Messages

Written by Stanton Peele

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Stanton and Archie Brodsky, of Harvard Medical School, detail the remarkable differences in amount, style, and outcomes from drinking in Temperance and non-Temperance cultures (there is a strong negative correlation between volume of alcohol consumed in a country and AA membership in that country!). They derive from these stark data and similar information healthy and unhealthy group and cultural dimensions to the drinking experience and how these should be communicated in public health messages.

In Wine in Context: Nutrition, Physiology, Policy, Davis, CA: American Society for Enology and Viticulture, 1996, pp. 66-70

Morristown, NJ

Archie Brodsky
Program in Psychiatry and the Law
Harvard Medical School
Boston, MA

Cross-cultural research (medical as well as behavioral) shows that a no-misuse message about alcohol has sustained advantages over a no-use (abstinence) message. Cultures that accept responsible social drinking as a normal part of life have less alcohol abuse than cultures that fear and condemn alcohol. Moreover, moderate-drinking cultures benefit more from the well-documented cardioprotective effects of alcohol. Positive socialization of children begins with parental models of responsible drinking, but such modeling is often undermined by prohibitionist messages in school. Indeed, alcohol phobia in the US is so extreme that physicians are afraid to advise patients about safe levels of drinking.

The beneficial effect of alcohol, and especially of wine, in reducing the risk of coronary artery disease has been characterized in the American Journal of Public Health as "close to irrefutable" (30) and "robustly supported by the data" (20)—conclusions supported by editorials in this country's two leading medical journals (9,27). This thoroughly documented benefit of moderate wine consumption should now be made known to Americans as part of an accurate and balanced presentation of information about the effects of alcohol.

Some in the public-health and alcoholism fields worry that replacing the current "no-use" (abstinence-oriented) message with a "no-misuse" (moderation-oriented) message would lead to increased alcohol abuse. Yet worldwide experience shows that the adoption of the "sensible drinking" outlook would reduce alcohol abuse and its damaging effects on our health and well-being. To understand why, we need only compare the drinking patterns found in countries that fear and condemn alcohol with those of countries that accept moderate, responsible drinking as a normal part of life. This comparison makes clear that, if we really want to improve public health and reduce the damage resulting from alcohol abuse, we should convey constructive attitudes toward alcohol, especially in the physician's office and at home.

**Table 1**. Temperance, alcohol consumption, and cardiac mortality
Alcohol Consumption (1990)	Temperance Nations^a	Non-Temperance Nations^b
total consumption^c	6.6	10.8
percent wine	17.7	43.7
percent beer	53.1	40.4
percent spirits	29.2	15.9
AA groups/million population	170	25
coronary mortality^d (50-64 males)	421	272
^a Norway, Sweden, U.S., U.K., Ireland, Australia, New Zealand, Canada, Finland, Iceland ^b Italy, France, Spain, Portugal, Switzerland, Germany, Denmark, Austria, Belgium, Luxembourg, Netherlands ^c Liters consumed per capita per annum ^d Deaths per 100,000 population Source: Peele S. Culture, alcohol, and health: The consequences of alcohol consumption among western nations. December 1, 1995. Morristown, NJ.

Temperance vs. Nontemperance Cultures

National comparisons: Table 1 is based on an analysis by Stanton Peele (30) that makes use of historian Harry Gene Levine's distinction between "temperance cultures" and "nontemperance cultures" (24). The temperance cultures listed in the table are nine predominantly Protestant countries, either English-speaking or Scandinavian/Nordic, that had widespread, sustained temperance movements in the 19th or 20th centuries, plus Ireland, which has had similar attitudes toward alcohol. The eleven nontemperance countries cover much of the rest of Europe.

Table 1 reveals the following findings, which probably would surprise most Americans:

Temperance countries drink less per capita than non-temperance countries. It is not a high overall level of consumption that creates anti-alcohol movements.
Temperance countries drink more distilled spirits; nontemperance countries drink more wine. Wine lends itself to mild, regular consumption with meals, whereas "hard liquor" is often consumed more intensively, drunk on weekends and in bars.
Temperance countries have six to seven times as many Alcoholics Anonymous (A.A.) groups per capita as nontemperance countries. Temperance countries, despite having much lower overall alcohol consumption, have more people who feel they have lost control of their drinking. There are often phenomenal differences in A.A. membership which are exactly opposed to the amount of drinking in a country: the highest ratio of A.A. groups in 1991 was in Iceland (784 groups/million people), which has among the lowest levels of alcohol consumption in Europe, while the lowest A.A. group ratio in 1991 was in Portugal (.6 groups/million people), which has among the highest levels of consumption.
Temperance countries have a higher death rate from atherosclerotic heart disease among men in a high-risk age group. Cross-cultural comparisons of health outcomes must be interpreted with caution because of the many variables, environmental and genetic, that may influence any health measure. Nonetheless, the lower death rate from heart disease in nontemperance countries seems to be related to the "Mediterranean" diet and lifestyle, including wine consumed regularly and moderately (21).