A new study by the US government’s health watchdog says that one in ten working-age Americans die annually from alcohol. That includes what the study calls ‘excessive drinking’, which translates into a couple of glasses of wine with dinner. The best way to cut drinking deaths, says the report by the Centers for Disease Control (CDC), is to cut consumption by increasing liquor taxes, halting deregulation of liquor sales, and limiting the number of liquor licenses granted by states and cities. The study, following a 2013 proposal by the US traffic safety agency to lower the blood alcohol level for drunk driving by more than one third, has put alcohol use under the government spotlight.
“Excessive alcohol use is a leading cause of preventable death that kills many Americans in the prime of their lives,” says Ursula E. Bauer, PhD, director of CDC’s National Center for Chronic Disease Prevention and Health Promotion. “We need to redouble our efforts to implement scientifically proven public health approaches to reduce this tragic loss of life and the huge economic costs that result.”
All this attention has elicited a variety of reaction from wine and alcohol officials in the US, although some prefer not to talk about it. A spokeswoman for The Wine Institute, the trade group that represents California winemakers, said, “We do not have medical or social science experts on staff and defer to the health care/medical community or Century Council for these questions.” A spokesman for the Wine & Spirits Wholesalers of America referred questions to the Distilled Spirits Council of the United States (DISCUS).
“There are an array of tools available to legislators and regulators to minimise irresponsible drinking,” says attorney Lou Bright with Martin, Frost and Hill in Austin, Texas, and the former general counsel for the Texas Alcoholic Beverage Commission. “But there is no iron-clad solution to those problems. Wise regulation is the artful balance of these and other tools, applied in the best way at the best time.”
The problem
The CDC study, which looked at statistics from 2006 to 2010, says alcohol-related deaths shortened the lives of those who died by about 30 years, including by breast cancer, liver disease, and heart disease. The health effects from drinking too much in too short a period of time include violence, alcohol poisoning, and auto accidents. It says that alcohol played a role in some 7,000 murders each year, about half of the US annual total. “It’s shocking to see the public health impact of excessive drinking on working-age adults,” says Robert Brewer, MD, who oversees CDC’s Alcohol Program and co-wrote the report. “CDC is working with partners to support the implementation of strategies for preventing excessive alcohol use that are recommended by the Community Preventive Services Task Force, which can help reduce the health and social cost of this dangerous risk behaviour.”
The most controversial part of the study? The definition of excessive drinking: Binging, which is four or more drinks at one time for women and five for men; and heavy drinking, eight or more drinks a week for women and 15 or more drinks a week for men. These standards come from a 2006 study in the American Journal of Preventive Medicine, and are based on the U.S. government’s dietary guidelines: “drink alcoholic beverages... in moderation, which is defined as no more than one drink per day for women and no more than two drinks per day for men.” It contrasts with the National Survey on Drug Use and Health’s definition of binge drinking as “five or more drinks on the same occasion, on each of five or more days in the past 30 days.” That’s almost double the limit in the CDC study.
In adapting the dietary guidelines the way it did, the CDC doesn’t seem to allow for the health benefits of moderate drinking, says Joseph Hill MD, PhD, the chief of cardiology and director of the Harry S. Moss Heart Center at UT Southwestern Medical Center in Dallas. “Certainly, there is no benefit from excessive drinking or binge consumption,” he says. “But there is a reasonable certainty, based on hundreds of studies over the past decade, that moderate drinking as part of the Mediterranean diet will benefit cardiac health. It’s the difference between partying and wine with a meal.”
It’s this apparent contradiction, says David Ozgo, the chief economist for DISCUS, that raises questions about the credibility of the study’s recommendations. “Beyond a shadow of a doubt, we should not drink to excess,” he says.
“We’ve known that for thousands of years. It’s not exactly news. What is news are these policy prescriptions. It’s treating drinking as if it was venereal disease or AIDs, which it isn’t. It’s looking for public health solutions to alcohol abuse, and that just doesn’t work.”
Bright says there are two problems with the regulatory recommendations in the CDC study. First, it’s one thing to say higher taxes and more regulation will cut consumption, but it’s another to see it happen in practice over time or large groups. In Texas, which has seen dozens of wet-dry elections over the past decade, per capita alcohol consumption was almost unchanged between 2010 and 2013. In addition, policy solutions are not one-size-fits-all; what works in a rural area may not be effective in a city, and vice versa. Second, the CDC study doesn’t differentiate between the social drinker and those who abuse alcohol. The latter, he says, are the real problem. “Yes, raising liquor taxes will probably stop the social drinker from drinking as much,” says Bright. “But the alcoholic, whose life revolves around drinking, is not going to be deterred by higher taxes.”
