How Much Alcohol is Healthy?

The short answer for how much alcohol is healthy is: not much. 1-2 doses per day for men, 1 for women. “Bingeing,” weekends-only, for example, is much more harmful than moderate regular use.

Many studies suggest that up to 4 drinks per day for men, and up to 2 for women, provide an overall health benefit. Augusto Di Castelnuovo, ScD; Simona Costanzo, ScD; Vincenzo Bagnardi, ScD; Maria Benedetta Donati, MD, PhD; Licia Iacoviello, MD, PhD; Giovanni de Gaetano, MD, PhD, “Alcohol Dosing and Total Mortality in Men and Women: An Updated Meta-analysis of 34 Prospective Studies,” JAMA Internal Medicine (Dec 2006), available here. However, the CDC reports lower numbers — up to 2 drinks for men and 1 for women. Why?

The CDC considers a man to have transitioned from moderate to excessive drinking when he consumes more than 4 drinks in a day or 14 drinks in a week (3 and 7 for women). That’s the same daily drinking conclusions from the collection of studies above. The difference is the weekly drinking standards.

In a Study published in Alcohol, Japan’s Hyogo College of Medicine researchers found that cholesterol, triglyceride and overall blood-borne fats tend to build up in heavy drinkers and — especially — occasional heavy drinkers. In other words, occasionally heavy drinkers have more blood-borne fat than regular heavy drinkers.

Triglyceride and cholesterol levels are regular parts of medical checkups as we age. Pay attention to those levels. If you see elevated levels, consider either changing your drinking habits or ceasing drinking. At some point, we have to weigh the (substantial, non-trivial) benefits of regular moderate alcohol use — longer life, less risk of heart disease, less chance of ischemic stroke and diabetes — against our actual blood test results. Objective, individual evidence wins against trends in health among large populations.

Incidentally, I should point out that road deaths significantly decline when a state adopts legal marijuana access (an average of 15% reduction in traffic fatalities). If alcohol might be a problem in your life, consider a switch to cannabis as your go-to stress relief. It comes with far less side-effects, including hangover, is a natural powerful anti-inflammatory, and offers a growing list of health benefits. When I see clients make the switch to cannabis from alcohol (or opiates), it has always inured to a net public good. Better for them, better for those around them, all-around better.

Is there another reason CDC might suggest the lower levels of alcohol use? It could be because the CDC is worried about people developing alcohol use disorder, which the CDC describes as, “a pattern of drinking that results in harm to one’s health, interpersonal relationships, or ability to work.” In plain English: if your drinking is causing problems.

The CDC might also understate healthy alcohol use out of our country’s particular strain of Puritanism. The same energy that fueled the Puritans fueled Prohibition and resulted in the passage of the 18th Amendment banning alcohol. That same energy fuels the Drug War, the War on Women. And it all comes back to: piety. Wanting to tell other adults what they can and cannot do with their own body. Denying people agency. Control. Or, as one colleague termed it, “Everybody on probation / Everybody in treatment” thinking. (Don’t get me started on kids — the CDC says that “binge drinking” is any underage drinking. So if your kid takes Communion, or has wine at Passover: binge drinking, according to the CDC.)

Finally, what is a dose? 12 oz. of 5% ABV beer. 5% ABV beer is: Deschutes Brewery Twilight Summer Ale, Rainier, etc. Lighter beers. If you order a pint — 16 oz. — of Ninkasi IPA, consider that about 2 doses. A dose is also 5 oz. of wine — i.e., not a restaurant pour. Or 1.5 oz. of distilled spirits. You cannot “bank” your doses — in other words, having 14 doses on the weekend, but abstaining during the week, isn’t healthy. In conclusion, be careful out there, be thoughtful and honest about alcohol use, but don’t think abstinence is the healthiest thing for everyone.

The Wars on Drugs / DUII / Prostitution are Wars on Real People

When the government wants to over-criminalize an area, its favored tool is scare-mongering, or “worst-case-scenario syndrome.” Thus, in a run-of-the-mill .09% DUII trial with no bad driving, and a pull-over for a license plate light out, you’re guaranteed to hear talk about carnage on our highways. In a routine drug possession case, you’ll hear stories of addiction and loss that simply don’t match the facts. Lately, in prostitution cases you won’t hear that word as much as “human trafficking” — because it’s easier to get convictions if you call it that. In the March, 2015, Oregon State Bar Bulletin, the following discipline was reported (last name shortened to “R” because this poor guy has had his name dragged through the mud enough):

OSB #73xxxx
Lake Oswego
Public reprimand

By order dated Dec. 30, 2014, the disciplinary board publicly reprimanded Robert R. for violating RPC 8.4(a)(2) (committing a criminal act that reflects adversely upon fitness as a lawyer).

Over a period of several years, R. paid an adult prostitute to engage in sexual conduct or sexual contact. In April 2014, R. pleaded guilty to five counts of patronizing a prostitute in violation of ORS 167.008, a Class A misdemeanor.

R. and the bar stipulated to several aggravating circumstances, including substantial experience in the practice of law and a pattern of misconduct. In mitigation, the stipulation noted an absence of prior discipline, full and free disclosure (R. cooperated with law enforcement and reported his conviction to the bar) and the imposition of other penalties (18 months probation in the criminal proceeding).

My question: why was this lawyer disciplined at all? His bar number is from the year of my birth — meaning he’s at least in his 60’s. He was lonely, and he had an honest, long-term relationship with an adult with full agency. He didn’t breach or abuse their relationship. There was no force, coercion, or trafficking of an underage person.

His discipline comes down to the criminalization of adult conduct that we all know will happen. It’s called “the world’s oldest profession” for a reason. It’s not going anywhere. That prostitution is still illegal underscores the government’s discomfort with nuance: prostitution can be a violent system of exploit. It can also be a mature relationship between consenting adults. We should criminalize the former, and permit the latter. It seems like the most effective way to do so would be to legalize and regulate an industry that we know exists and will always exist. Instead, like drugs, the government chooses to create a unregulated black market. In so choosing, we knowingly put more kids and humans everywhere at risk — decriminalization of sex work would avert 33-46% of HIV infections in the next decade.

That statistic and many more are the result of years of studies that have led major human rights organizations to recommend decriminalization. Amnesty International; the United Nations; Human Rights Watch; and the World Health Organization all have adopted resolutions recognizing that the best way to protect the safety of sex-workers (and their clients and clients’ families) is to legalize the industry. By refusing to do so, we imperil our own citizens. Our government becomes an assistant to actual human traffickers — because they work in the dark, in an unregulated, illegal industry, rather than working in the light, in an industry with health and safety protections.

We have hope that the recent legalization of marijuana — without the sky falling — will help humanity evolve to decriminalize other forms of human conduct, like prostitution for a mature, lonely lawyer in his 60’s who wants to contribute to an adult sex-worker’s business of choice. The government has no business being in their bedrooms. Hopefully, in a few years I can look on this man’s disciplinary reprimand as an anachronism — the same way I would look at a lawyer’s old discipline for marijuana possession now. In both situations, it’s not the lawyer who erred — it’s us.