Even Moderate Drinking Is Damaging Our Health, So Why Do We Do It?

During lockdown, Georgie Hodge* turned her front garden into a 'pub'. When it was allowed, neighbours would come with their own glasses and sit in spaced-out chairs in front of the house. "For those first six weeks, it was a lifeline," she says. "We’d get the music out, laugh and be silly while the world felt completely out of time." 

Georgie, 34, has always considered herself "middle of the road" with drinking, which she qualifies as drinking regularly but moderately, with both dry spells and binges. "I am a bit of a gannet with booze, so I try to be careful," she explains.

While on 'pub' duty one evening, Georgie drank five margaritas on an empty stomach. "I’d set out to drink one," she says, half laughing. "But clearly it was about abandon. I wanted a break from reality. My hangover the next day was biblical. I lay in bed until 3pm, unable to move my head." During this episode, her partner said, "I’m worried about you." Georgie winces as she recalls it. "Her saying that destroyed me. I don’t consider my overall drinking habits to be problematic but maybe they are. Clearly, feeling that terrible isn’t healthy." 

During the pandemic, researchers found one in five Australians increased their alcohol consumption — loneliness and emotional distress are likely drivers. It is understandable that loss of purpose and structure could lead to craving a break from reality. 

Bucking the trend of both my Scottish and French ancestry, I have a woeful constitution for alcohol. I love the headiness and creeping warmth of one negroni; two will blur my vision and probably leave me green-gilled the next day. But during lockdown, I drank every night: two canned G&Ts or two beers, usually. I live alone and, for eight weeks, it became a ceremonial coping mechanism; in those endless, stretchy afternoons, anticipating the buzz kept me going. Really, though, it was making me more anxious and my guts the site of warfare. I stopped. (My grandmother died of alcoholism in a terrible way and I have an irrational fear that finally ‘getting into’ booze will take me down the same path.) 

My concern is not misplaced. Colin Drummond, professor of addiction psychiatry at KCL, responded to the Ipsos MORI study: "There is extensive evidence that the population level of alcohol consumption is highly correlated with health harm. With a substantial increase in alcohol consumption during the COVID-19 pandemic, we can expect a surge in alcohol-related ill health including alcohol-related liver disease admissions and deaths. This will place an increased burden on our already overstretched [medical system]." 

This sounds alarming. So, too, does his warning that increased alcohol consumption is likely to increase mental distress and lead to an increased demand for mental health services. But maybe we should be alarmed. 

Along with modern rituals like Dry January and Sober October, the pandemic may have been an opportunity to properly observe our relationship with alcohol. Georgie suggested that Sober October encourages an "all-or-nothing attitude to booze, because it’s like a binge in itself — not that people would be comfortable admitting that." This stayed with me, because talking about our own or others’ drinking can be very thorny. [We're] stressed and exhausted, so picking at something that brings people happiness — or helps soften the edges of a fraught mind — means that, understandably, people become defensive. The historical ubiquity of alcohol is an argument in itself: we’ve always drunk, so why the fuss? Is now really a good time to examine our drinking? 

Some scientists would argue that now is the perfect time. A longitudinal study showed that moderate alcohol use is associated with decreased brain volume in early middle age. This is worth paying attention to: any notable loss of brain tissue will reduce the brain’s ability to function optimally. Former government drugs advisor Professor David Nutt has been researching the effects of alcohol for decades and memorably said that alcohol is more dangerous than crack cocaine. He is trying to invent a synthetic healthy alternative. "There is no level of alcohol consumption that is without risk," he writes in his recent book, Drink? The New Science of Alcohol and Your Health. Interestingly, Nutt says that in societies which revolve around alcohol, only a small percentage of people develop a damaging relationship with it. "Typically, in first-world Western countries, alcohol is consumed by over 80% of all adults — of that 80%, only about one-fifth get into problems with it."

Given how conflicting the information we receive about how harmful moderate drinking really is, the narrative of what is or isn’t 'right' is often written by the individual — particularly where stress is concerned. We may know, fundamentally, that bingeing regularly isn't good but drinking for stress relief is utterly normalised; as instinctive as putting on a coat to go out in the cold. The physical image of a cold beer or an immaculate martini can wield power in the mind as a bookend to a stressful day, a symbol of enjoying friends’ company or a gentle domestic ritual with a partner. Where’s the harm? Again, the answer is rationalised by the individual. But if one drink becomes six on a regular basis, there is a deeper emotional motivation.

The story of human beings’ love affair with alcohol goes back to a time before humans and talk of emotion. Our fondness for booze is rooted in evolutionary hardwiring linked to our fruit-guzzling primate ancestors. Ethanol released from rotting fruit on the forest floor would have been appealing in many ways: the funky smell made the fruit easier to find, the fermented flesh was easier to digest (meaning more precious calories absorbed) and the antiseptic qualities of the microbes in it would boost the primates’ immune systems. In essence, we have evolved to consume alcohol. 

Of course, our relationship with booze goes far beyond these innate urges. Alcohol alters our minds: that’s why we like it. Ethanol causes the release of serotonin, dopamine and endorphins in the brain: compounds that make us feel happy and less anxious. As a species, we turned ourselves from hunter-gatherers into farmers — some 12,000 years ago — because we wanted to get pissed. In his book A Short History of Drunkenness, author Mark Forsyth writes: "We didn’t start farming because we wanted food — there was loads of food around. We started farming because we wanted to booze." 

Alcohol is an integral part of humanity; a cultural status symbol. From early human evolution, it has strengthened social bonds and tempered inhibitions. Gossiping and laughing with friends also trigger the production of endorphins in the brain, which, along with the alcohol itself, makes us feel great. But alcohol’s intoxicating power has always caused concern. Most societies have struggled to find a balance between drinking for pleasure and the often damaging effects of drinking too much. The social aspect of alcohol is very powerful, particularly for those who are introverted or socially anxious. Georgie feels she has "internalised a sense that I am more ‘fun’ if I am drinking; that people are more comfortable with the drinking, ‘fun’ Georgie."

Evidence that even moderate drinking can be harmful is mounting but Georgie's is a familiar rationale. Matthew Birke* is 32 and works in advertising. He has always been quite socially anxious. For him, drinking and socialising are inextricable. "Meeting new people makes me feel on edge and tired. Booze has always mitigated that a bit," he says. "But I had a shock when I started working in a media organisation at 23. The entrenched culture around drinking was new to me. It was a given that you’d be out most nights and hungover most days and I don’t think anyone really liked it. ‘The Sesh’ terrified me then and does now." I ask why he thinks people still booze, even if they aren't really enjoying it and find they struggle with the after-effects. His response will ring true for many. "The embarrassment of being called boring was a huge reason for taking part." 

I’ve lost count of the number of times I’ve been called ‘boring’ in pubs, restaurants or at people's dinner tables. Hearing the brayed phrase, "Oh, come on" was a reliable aspect of nights out for me for years and, of course, I internalised the idea that I am dull. But over time I realised that it wasn’t about my choices; rather, what they reflected back at people. At a dinner party last year, I felt a funny validation in replying to someone asking why I wasn’t drinking with, "Because I’m boring!"

I wonder how many people have felt like Matthew in his workplace. We talked more about shame, which underpins many conversations about alcohol. "I see friends of mine operating socially, in a freer and more fluid way than me, and judge myself negatively as a result." Again, booze helps. "The three-pint buzz is a very real thing," he says. "But I think a lot of men, including me, are so dependent on booze to feel okay socially that they make ‘liking beer’ a big part of their projected personality. Shame abounds, but men often turn drink into a status symbol to cover it up." 

This makes me think about how people talk about hangovers on social media. The common channelling of sweaty despair into memes and pithy one-liners is partly why I wanted to write this piece, because it sometimes seems like the dressing up of difficult emotions. Being catatonic on the sofa because you drank too much (two cans of Gordon’s ‘Pink and Tonic’ for me) the night before may, reasonably, make someone feel desperate to connect: with others feeling the same way so we don’t feel deviant, with feelings that eclipse the shame, with anything but our own thoughts. There can be camaraderie in hangovers, just as there is in getting pissed. There is no camaraderie if you’re alone. 

If we are to tackle harmful drinking behaviours in a meaningful way, public abstinence campaigns clearly start conversations. A collective call to pause and reflect is, broadly, a good thing, but it’s too binary. If we talk about behaviour we have to talk about emotion. Uncomfortable emotions – the urge to escape them, a difficulty in just ‘being’ — underpin many people’s relationship with alcohol and we have to think about why so many people are struggling to manage, or sit with, how they feel. It is a profoundly complex issue but the pandemic has shone a spotlight on what causes human beings the most distress — lack of money, ill health, lack of purpose, loneliness, the absence of community connections — and there is a live lesson here, at a private and public level, if we choose to listen. 

Looking at the potentially harmful, if understandable, things we use to help cushion distress is another step but an important one, because binge-shame-binge-shame cycles are emotionally corrosive. Perhaps the bigger question if we are assessing our relationship with alcohol is: what am I trying to escape? We might drink to forget that we’re anguished but, unlike the alcohol, the feelings won’t be flushed from our system. As Georgie reflects: "My therapist once said, ‘All the anxiety you feel before you drink is still there afterwards, but amplified.'"