Thinking About Drinking

When I was in high school, a speaker from Alcoholics Anonymous offered my class some advice about drinking that stuck in my mind because it was so obviously false. "If alcohol causes you problems," he said, "alcohol is your problem. If alcohol is your problem, you're an alcoholic."

According to this syllogism, anyone who has ever had a hangover, consumed beer until he vomited, or lost a contact lens while intoxicated is a lifelong drunk who should never touch another drop. This account leaves no room for the possibility that people could learn from their mistakes and thereby become responsible drinkers, which is in fact what the vast majority of drinkers do.

I thought of the A.A. speaker's slogan while reading "Keeping Score on Alcohol," a recent report from Drug Strategies, a Washington, D.C.-based organization that aims to promote "more effective approaches to the nation's drug problems." Instead of talking about the difference between use and abuse, the report implies that alcohol is inherently bad. It advocates measures aimed at reducing alcohol consumption across the board, regardless of its context or consequences.

"With a cost as low as $4," the authors complain, "the average teenager can easily afford to buy a six pack of beer." Their answer is to raise excise taxes, presumably to the point where teenagers could no longer afford to buy beer.

But that approach would penalize all drinkers, more than 90 percent of whom are adults and most of whom drink responsibly. It is telling that the report pushes such a sweeping solution to a problem that could be managed through better enforcement of laws against alcohol sales to minors.

The report's response to the problem of Fetal Alcohol Syndrome also overreaches. FAS, which involves facial abnormalities, stunted growth, and mental retardation, has been observed only in the children of mothers who drank heavily during pregnancy; there is no evidence that light to moderate drinking causes birth defects.

Yet the authors insist that "health care providers must reinforce the message of abstinence during pregnancy," and they scold those who "portray moderate drinking during pregnancy as benign." They warn there is "no proof that small amounts of alcohol are safe." One wonders what sort of proof, aside from the absence of observed harm, would satisfy them.

On the other side of the ledger, the report grudgingly concedes the evidence that moderate drinking reduces the risk of heart disease, while emphasizing that heavy drinking is unhealthy. It says "the message can be confusing: drink moderately to protect your health but not enough to endanger it."

This message is confusing only to people who cannot grasp the idea of moderation. At times, the concept seems to elude the report's authors.

They worry, for example, that in one survey "eight in ten teens said there is nothing wrong with underage drinking as long as teens are responsible about the amount they consume." They are also aghast at the fact that one-quarter of parents in another survey said they would definitely or probably allow their teenagers to attend a New Year's party "where you suspected that alcohol was going to be served, but you knew that everyone would be required to give their keys to the host and that no one would be able to drive themselves home afterward."

Rather than promoting responsibility, the authors insist on zero tolerance, even though about three-quarters of teenagers are drinking by their senior year. The impracticality of this approach is magnified when these students go to college, where drinking is taken for granted.

Because most college students are not legally allowed to drink (even though they are officially adults), universities cannot inculcate an ethic of moderation--say, through courses in responsible drinking or faculty-supervised parties. The results can be seen in recent surveys, which show binge drinking and abstinence increasing simultaneously on college campuses.

The addiction psychologist Stanton Peele, who has long decried the all-or-nothing attitude reflected in such statistics, cites cross-cultural evidence indicating that people who are gradually introduced to alcohol under family supervision are less likely to have drinking problems as adults. The people at Drug Strategies would benefit from a visit to his Web site (www.peele.net), where he observes, "American public health does not do well at conveying the idea that drinking is a double-edged activity, one with potential benefits as well as real dangers, and that moderation is the distinguishing feature between the two."