Alcohol Awareness Month

Alcohol Awareness Month

What’s your relationship with alcohol? If you’re a drinker, you’ve almost certainly had good times, possibly some of your life's most memorable and joyful moments. You’ve probably also had times ranging from bad to horrible; maybe it’s even landed you in hospital. Do you not drink? It’s unlikely that you don’t have much of a reason for this. Perhaps you’ve seen enough of the bad times, never to drink again? Maybe it’s what you’ve seen in the drinking of others? Parents, siblings, friends. Maybe it’s generational; you have other, better options now. Perhaps you live in a country where alcohol is prohibited.  

Plenty of people don’t drink. In the US, it’s around 30%, and in the UK, 20%; but it’s hard to conceive of a person who has no relationship with alcohol at all. But wait, you say, what about the indigenous people on North Sentinel Island or tribes in the Amazon who have hardly any contact with the modern world? Well, if human history is any indication, they’ve almost certainly had some interaction with alcohol, a substance that hominids have been consuming regularly since long before we were humans. We share an enzyme with several of our great ape cousins—and a couple of species of Bush Baby—that allows us to metabolise ethanol more quickly and effectively than all other animal species. Humans, chimpanzees and a few other primates were able to sniff out volatile ethanol in rotting fruit. Taking advantage of the alcoholic bounty on forest floors was an evolutionary advantage; alcohol contains 75% more calories than an equivalent quantity of refined sugar. It also helps to guard against bacterial infections like tuberculosis. (Drink, Ian Gately 2008) We started consuming alcohol because it was useful. We kept at it because it felt good. You’ll struggle to cook up much of a hangover by eating fermenting fruit, but you can get tipsy. Getting a little bit drunk has its evolutionary advantages; it engenders trust, increases sociability, and relaxes. (Drunk Edward Slingerland 2021) It does this by activating receptors of the neurotransmitter GABA, and in its most ancient uses, that’s essentially where it stops. Alcohol is humanity’s first biotechnology; depending on how we define these things, it's certainly in the running for being our first technology full stop. But, like many human technological innovations, it’s something of a double-edged sword. As hominids became more advanced, we started to brew alcohol. Brewing means more alcohol per gulp. The more alcohol you ingest, the more other neurotransmitters get involved. It stimulates Serotonin, which promotes empathy but can also make you vomit. It promotes the release of dopamine, which accounts for its stimulating effect but can cause aggression. Then alcohol causes the brain to release endorphins, which create a high, but are also a key player in addiction.  Finally, if you drink enough, alcohol overstimulates your GABA system causing unconsciousness and, eventually, respiratory failure (Drink? David Nutt 2020).

We had this ambivalent liquid before we had bread, and some anthropologists now think that beer, not bread, is what kickstarted the agricultural revolution over 12,000 years ago (Alcohol and Humans: Reflections and Prospects,’ Kimberly Hockings & Robin Dunbar in Alcohol and Humans: A Long and Social Affair 2020).

Since then, alcohol has played a formative role in shaping our present civilization. It looks like the first large structures that hunter-gatherers built were paid for by the bottle, and the sites they built appear to be venues for the ritual consumption of alcohol.

The Suri tribe in present-day Ethiopia has a telling phrase: “Where there is no beer, there is no work.” (A Short History of Drunkenness, Mark Forsyth 2017) From the workers building the city walls of Ur in ancient Sumeria and the Pyramids of Giza to the soldiers fighting in the 30 Years War, the American Revolution and WWI, alcohol as payment for services rendered is as old as human civilization. There have been a number of situations in human history where alcohol was a de facto currency, and whoever controlled the flow of alcohol, like the Inca aristocracy in Peru, or the New South Wales Corps in colonial Australia, held the power.  

It’s a simple fact that alcohol confers benefits. People aren’t stupid; if alcohol was entirely detrimental to humans, we wouldn’t consume the stuff on such a grand scale. The historical record is littered with those extolling the benefits of alcohol. The ancient Greeks were so enamoured of wine that they considered “water drinkers” to be suspect individuals. The Roman poet Horace said that wine “unlocks secrets, bids hopes be fulfilled, thrusts the coward onto the battlefield”, and “takes the load from anxious hearts.” At the Jewish festival of Purim, Rabbis instructed the faithful to get so drunk they could no longer distinguish between the good and the bad. The first miracle ascribed to Jesus in the bible is turning water into wine. Islam eventually prohibited alcohol in this life, but in the hereafter, the righteous would be rewarded with “gardens and vineyards” and “rivers of wine.” Despite the religious prohibition in Islam, the Arabic world had an entire genre of poetry—Khamiryya—dedicated to wine, letting readers know they could “drink the wine, though forbidden. For God forgives even grave sins.” (Drink, Ian Gately 2008).

Of course, we’ve never been entirely oblivious to the harm alcohol can cause. The great Islamic surgeon Al Zahrawi identified the relationship between alcohol and cirrhosis, gout, and dementia in the tenth century, and by the 1800s, doctors were beginning to understand what we now call foetal alcohol syndrome and withdrawal (Drink, Ian Gately 2008).

Interestingly, whilst in the ancient world, immediate harms from too much alcohol are well documented, nothing in the historical record describes the symptoms and behaviours we see in addiction. Anthropologists speculate that there are several reasons for this. Much of the beers and meads consumed in the ancient world were relatively low strength by today’s standards. Wine contained more alcohol, but wine drinking had a heightened cultural value and was consumed in keeping with specific rules and social rituals. “Strong drink,” in the ancient world, was usually a beer, wine, or a kind of alcoholic porridge mixed with other psychoactive substances. These drinks were confined to specific individuals who engaged in religious rituals. Context, it seems, was key to staving off the long-term effects of excessive alcohol consumption (Alcohol: Social Drinking in Cultural Context, Janet Chrzan 2013).

Economics and politics play a large role in the health harms of alcohol too. Economic and political expedience led William of Orange, the new King of England, to liberalise the production of a novel and exciting drink called Geneva, or gin, in the early 18th century. The “gin craze” and the subsequent chaos that ensued were also largely economic problems. The English gentry was kicking the peasantry out of the countryside at a rate never before seen in European history to gobble up the land they lived on and establish large-scale farming. A stream of Welsh, English, and Scottish peasants ended up in city slums with little money and less work. Combine a large destitute population and a cheap, easy-to-make and storable high-strength alcoholic drink, and you have a recipe for binge drinking and all its subsequent health and social problems.

The English government repeatedly tried to counter the gin epidemic with legislation, taxes, and even a network of Gestapo-like informants to limit gin production. None of it worked. The gin epidemic ended only when urban workers' quality of life improved (Drink, Ian Gately 2008). In almost all its guises, prohibition comprehensively fails unless tied to ritual or religious significance—and even then, a lot of alcohol drinking goes on behind closed doors.  

Sometimes alcohol is necessary for survival. The first settlers in the Americas could not drink the local water, and boiled water would get quickly contaminated. The solution was beer and cider. The same was true in Australia (Drink, Ian Gately 2008). For most of European history, water supplies around human settlements were breeding grounds for cholera and typhus. It's no coincidence that the European peasantry—men, women, and children—got almost a third of their daily calories from beer. Beer kills toxic bacteria in water and supplies necessary calories. It kept people alive.  

All this is to say, we drink for a reason. Alcohol is far and away the most popular psychoactive substance on the planet. Almost everyone on earth has some relationship with alcohol, good, bad, or ugly. There have been a number of periods in history where another psychoactive substance has turned up that looked like it might supplant alcohol as the king of drinks. Coffee and Tea were heralded as the death of alcohol. The majority of this caffeine boosting was written in the language of intoxication. Tea and Coffee were initially marketed as alternatives to alcohol, which got you something like drunk (Drink, Ian Gately 2008). They didn’t, of course, but found their own place in our culture.  

To paraphrase a modern Homer, alcohol is “the cause and solution to all of life’s problems.” We drink for a reason. It feels good; it helps us relax and unwind; it’s played a crucial role in human bonding that might even have kickstarted large-scale human civilization. This isn’t a moral question. There is nothing wrong with wanting to get a buzz on, despite what the puritanically minded might have you think. The trouble is alcohol does come with a host of side effects. After the first tickling of your GABA system with alcohol, things can go wrong pretty easily. These health problems compound exponentially when they run into economics and society. Annually, the total costs of alcohol harm is staggering: they account for around 2.5% of world GDP. Fortunately, the maths is pretty easy: in 2022, world GDP was just over $100 trillion, so the global cost of alcohol consumption that year was around $2.5 trillion.  

But the root desire behind our perennial consumption of alcohol is a positive one. If we have the technology to get what we want from alcohol without what we don’t want, we will make the leap. We’ve seen how quickly a tobacco alternative has taken off in the rise of e-cigarettes. When people find there’s a safer alternative to a so-called vice, they take advantage of it. Functional alcohol alternatives are just a matter of when and what obstacles must be overcome. Businesses and politicians can block this—and probably will, for a while—but we know what happens then: enterprising chemists come up with untested analogues, and a dangerous black market emerges; just look at ‘spice’ for a recent example of the perils of prohibition. The simple fact is: people like to drink, and they will continue to drink. Yoga, mindfulness, self-reflection and alcohol-free beer will never take the place of a pint. If this is true, denying consumers a safer way to practice one of the most ancient social behaviours seems immoral.