In this monumental review of research showing substantial psychological benefits from consuming alcohol moderately, Stanton (with Archie Brodsky) shows how complex is the world of psychoactive substances. Those who drink moderately show improved feelings, better mental health, greater sociability and social integration, higher incomes, and particularly better long-term cognitive functioning. The latter has been demonstrated by prospective studies across a range of American and European populations, including with discordant (for drinking) identical twins. The public health enterprise of identifying the damages and costs due to alcohol consumption thus seems to require another column in its ledger.

Prepublication version of article appearing in Drug and Alcohol Dependence, 60: 221-247, 2000
© Copyright 2000 Stanton Peele. All rights reserved.

The Lindesmith Center
New York, NY

Archie Brodsky
Department of Psychiatry
Harvard Medical School
Boston, MA

Abstract

The aim of this paper is to identify positive psychological concomitants of moderate alcohol consumption. Current research and public-health perspectives on alcohol emphasize harms disproportionately relative to benefits. The major exception is research establishing beneficial effects of moderate drinking on cardiovascular health and overall mortality. In addition, much observational and experiential data suggest the widespread prevalence of positive drinking experiences. This paper is one of the first attempts since 1985 to codify such benefits in epidemiological terms. Methodological difficulties in accomplishing this include defining moderate drinking, controlling for confounding variables, and establishing causality. Nonetheless, evidence of psychological benefits has been found in experimental, observational, interview, self-report, correlational, and some prospective research. These positive findings are in the areas of subjective health, mood enhancement, stress reduction, sociability, social integration, mental health, long-term cognitive functioning, and work income/disability. Problem drinkers and alcoholics also seek mood and other benefits from alcohol, but are more likely to drink to counteract negative feelings and to support their egos than are social drinkers. It is as yet impossible to determine to what extent moderate alcohol consumption causes positive psychological outcomes and to what extent it is part of a complex pattern of mutually reinforcing variables.

Keywords: Moderate drinking; Psychosocial models; Mental health; Cognitive performance; Alcohol consumption; Alcohol abuse

1. Introduction

The detrimental effects of alcohol are real, evident, and large. There has been an emphasis in the public-health field towards identifying and attempting to reduce these effects. These efforts include campaigns to reduce overall alcohol consumption conducted by a number of prominent national and international public-health bodies and alcohol researchers (Edwards et al., 1994; World Health Organization, 1993). The question arises whether, given this emphasis, the range of styles and outcomes of drinking has been slighted so as to retard scientific and applied understanding of alcohol's effects.

For example, documented cardiovascular health benefits have yet to be incorporated into cost analyses of alcohol consumption over populations (National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, 1998; Single et al., 1998). At the same time, the psychological and social sequelae of alcohol abuse are often noted. Yet, parallel to the research on alcohol and cardiovascular health is a vast body of social and ethnographic research, as well as of individual report, indicating that drinking is often a positive experience for individuals and social groups. This perspective has barely begun to be incorporated into epidemiologic research and analyses.

1.1. Medical and mortality benefits

Evidence has now accumulated that moderate alcohol consumption exerts a protective effect against coronary artery disease (CAD), along with some other diseases (e.g., occlusive stroke, Sacco et al., 1999). Two meta-analyses (Holman et al., 1996; White, 1999), incorporating 15 and 20 longitudinal studies respectively, and a continuing flow of prospective studies, including two conducted recently by the NIAAA's epidemiology division (Dawson, 2000) and the NIAAA-funded national epidemiology research center (Greenfield et al., 1999), have found in addition that moderate consumption is associated with reduced risk of all-cause mortality. Studies such as Dawson and Greenfield et al. controlled for health behaviors and demographics (for Dawson, these included age, sex, ethnicity, marital status, education, income, working, body mass, and smoking), and employed more refined measures of consumption (type of beverage x number of drinking occasions x amount consumed per occasion, plus binge episodes) in response to a range of potential confounders and measurement weaknesses in earlier studies. The index group for comparison in these studies was lifetime abstainers, to counter the possibility that some abstainers have ceased drinking due to health problems. The largest potential mortality benefits from drinking are indicated for older individuals of both genders and those otherwise at risk for heart disease (Fuchs et al., 1995; Thun et al., 1997). Beyond mortality, improved overall health and a reduced incidence of chronic illnesses have been reported in prospective studies with younger populations (Power et al., 1998; San José et al., 1999). An important and interesting development has been that, since mortality and health benefits may be mediated by factors such as social isolation and depression (Andréasson, 1998), several recent prospective studies of mortality and drinking have controlled for these psychosocial variables as well (Greenfield et al., 1999; Murray et al., 1999; Roberts et al., 1995).