Wanted to be clear, in your Appendix A, are you suggesting categorically that people not use alcohol, regardless of whether they have reason to believe they are/would be an alcoholic?
I would certainly agree with you that this advice would be prudently taken by alcoholics.
However, many (most?) people can enjoy alcohol occasionally and in moderations for pleasant experience without this usage causing problems in their lives. If you are someone who occasionally drinks, enjoys it, and this usage isn’t causing problems in your life, I think it is advisable to continue occasional, responsible drinking.
I mean, people aren’t given “future alcoholic” cards. I think there are circumstances under which you can be sure drinking is especially risky, such as being a recovering alcoholic or having history with a different addiction or having a decent amount of recent family history with addiction, but I’m not aware of a ton of factors you can reference to be confident you won’t be one.
I don’t think your odds are more than half, but I do think they’re around one in ten if you’re an average American (if you’re drinking enough that cutting alcohol is a significant sacrifice, then I would guess your odds are worse than that). Those are very bad odds considering how badly this disorder fucks up your life and how small the upside is by comparison.
There’s also a risk of contributing to a drinking culture in which casual drinking is normalized or even expected in many contexts, hurting others who casually stumble into drinking because they didn’t realize how dangerous it was/just want to fit in (and drinking alone makes your odds even worse). I think we should treat alcohol a bit more like we tend to treat tobacco, so…the short answer is yes, I think almost no one should drink.
I wonder if the target audience for the advice could be a crux here.
From the perspective of a teenager who is deciding whether to start drinking, I am skeptical that doing so would be a net positive. Their odds of developing alcohol use disorder (AUD), experiencing significant problems due to problem drinking, alcohol-related disability or early death, etc. are ~average—and those risks are considerable as Devin points out.
On the other hand, suppose you’re a 40-year old who has consumed alcohol for the last 20-25 years, but has never experienced significant problems due to their drinking. For the past decade, your drinking has (with rare exceptions) been consistent with the guidance for low-risk drinking.[1] Significant reliance on base rates in the general population wouldn’t be appropriate in this hypothetical; the question is how often people with a similar history end up developing problematic drinking habits.
Of course, there are many points of gradation between these two hypotheticals. My hot take is that choosing or continuing to drink is generally going to be net negative in expectation for anyone in a community/subculture/friend group that pressures its members—even indirectly—to drink immoderately. Social conformity is a powerful drug, and people routinely overestimate their resistance to that drug.
UK guidelines here, but note that the UK “unit” is smaller than the US “standard drink.” I’m skeptical of the degree of difference for women & men in the US guidance, but in light of UK guidance that may be because the US guidance for men is too permissive.
Worth adding though that alcoholism can get gradually worse over long periods, and many alcoholics spend decades in denial, so if you are trying to rule yourself into this class, you really should look at this much more objective criteria rather than sorta vibing “I’ve done this forever and I’m not an alcoholic”.
Wanted to be clear, in your Appendix A, are you suggesting categorically that people not use alcohol, regardless of whether they have reason to believe they are/would be an alcoholic?
I would certainly agree with you that this advice would be prudently taken by alcoholics.
However, many (most?) people can enjoy alcohol occasionally and in moderations for pleasant experience without this usage causing problems in their lives. If you are someone who occasionally drinks, enjoys it, and this usage isn’t causing problems in your life, I think it is advisable to continue occasional, responsible drinking.
I mean, people aren’t given “future alcoholic” cards. I think there are circumstances under which you can be sure drinking is especially risky, such as being a recovering alcoholic or having history with a different addiction or having a decent amount of recent family history with addiction, but I’m not aware of a ton of factors you can reference to be confident you won’t be one.
I don’t think your odds are more than half, but I do think they’re around one in ten if you’re an average American (if you’re drinking enough that cutting alcohol is a significant sacrifice, then I would guess your odds are worse than that). Those are very bad odds considering how badly this disorder fucks up your life and how small the upside is by comparison.
There’s also a risk of contributing to a drinking culture in which casual drinking is normalized or even expected in many contexts, hurting others who casually stumble into drinking because they didn’t realize how dangerous it was/just want to fit in (and drinking alone makes your odds even worse). I think we should treat alcohol a bit more like we tend to treat tobacco, so…the short answer is yes, I think almost no one should drink.
I wonder if the target audience for the advice could be a crux here.
From the perspective of a teenager who is deciding whether to start drinking, I am skeptical that doing so would be a net positive. Their odds of developing alcohol use disorder (AUD), experiencing significant problems due to problem drinking, alcohol-related disability or early death, etc. are ~average—and those risks are considerable as Devin points out.
On the other hand, suppose you’re a 40-year old who has consumed alcohol for the last 20-25 years, but has never experienced significant problems due to their drinking. For the past decade, your drinking has (with rare exceptions) been consistent with the guidance for low-risk drinking.[1] Significant reliance on base rates in the general population wouldn’t be appropriate in this hypothetical; the question is how often people with a similar history end up developing problematic drinking habits.
Of course, there are many points of gradation between these two hypotheticals. My hot take is that choosing or continuing to drink is generally going to be net negative in expectation for anyone in a community/subculture/friend group that pressures its members—even indirectly—to drink immoderately. Social conformity is a powerful drug, and people routinely overestimate their resistance to that drug.
UK guidelines here, but note that the UK “unit” is smaller than the US “standard drink.” I’m skeptical of the degree of difference for women & men in the US guidance, but in light of UK guidance that may be because the US guidance for men is too permissive.
This seems right to me.
Worth adding though that alcoholism can get gradually worse over long periods, and many alcoholics spend decades in denial, so if you are trying to rule yourself into this class, you really should look at this much more objective criteria rather than sorta vibing “I’ve done this forever and I’m not an alcoholic”.