I've been discussing alcohol with a friend for months. He likes to drink a lot. Last summer he brought his tolerance to a maximum after drinking at least half a litre of wine every day. Ironically, he despises all people who consume tobacco, marijuana or other 'harmful' substances. "You know alcohol is just as bad as the other substances, right?" - "Yes, but it's not illegal. Besides, come on, everybody drinks alcohol."
Alcohol, the Everyman's Drug
With the accumulation of scenarios like the one mentioned above, my amazement at the ignorance of the average citizen about drugs increases.
How is it that such few people in my environment deal with it, although it seems to represent an important, for some even a central, part in our lives. A nice get-together with colleagues or friends would suddenly be not so nice without alcohol.
And why would you celebrate your birthday, New Years Eve or even Christmas, if not to have a reason to drink to oblivion and to break the monotony of everyday life.
Are there any other reasons for alcohol consumption?
Alcohol is fun and helps you socialize.
For our society these reasons for drinking alcohol are completely legitimate. But if you take the exact same arguments and try to justify the consumption of another substance, people ask you if you´re nuts.
"Why am I nuts?" - "Well, X is totally harmful and dangerous for your body. That cannot be justified by the socialisation or fun factor. It isn´t for nothing that X is illegal." - "But alcohol is more harmful than X and is still legal. The fun factor seems to be enough for alcohol."
Alcohol is an integral element of our society and an essential part of our culture. With the blessing of the authorities, Austrians consume on average of around 11 litres of pure alcohol per year (statistics: 15-99 year-old Austrians, year 2016) and around 40,000 Austrians suffer an alcohol-related death each year in favour of alcohol producers. According to the Austrian Federal Ministry of Health, a total of around 1,000,000 Austrians consume alcohol "on a problematic scale".
And I wonder why politicians don't mind.
Could it be that our drug policy is determined by hypocritical alcoholics?
After all, alcoholism is nothing new among politicians. An amusing example: Austrian politician Hubert Gorbach is said to have been caught driving with 1.9 per mille which resulted in him losing his driver´s licence in 2011. Funnily, Hubert Gorbach had been minister for transport in 2005 and had been running campaigns against drink-driving, with the slogan "Driving drunk - can YOU live with it? [1]
But it could also be that the politicians are strawmen in their area and do not even know the hard facts, because there are so many different human studies on the effects of alcohol that diverge in their results and conclusions, such that one no longer knows what is right and what is wrong.
Or maybe politicians are aware of the hard facts, but do not know how to react to this information. Criminalisation, regulation or education?
Perhaps a hybrid of these three scenarios is also the reason why our drug policy makes no sense.
With this post I want to debunk the most meaningless myth on which so many people swear:
"Legal = Good"
I don't understand why almost no one around me is interested in knowing why alcohol is legal while other - safer- substances aren´t. And I have often tried to talk to other people about this issue over the past year (I´m fun at parties) and it seems that the reasons behind some laws don't interest anyone. The good thing is, they listen to me because they know that I myself drink alcohol. So I can't be anti-alcohol. And I can assure you, I´m not. I just like to ask questions and my question is:
How does a substance qualify for legalization?
Former British government drug commissioner David Nutt conducted a drug risk assessment study in 2007. In this study, the risk potential of legal and illegal drugs was divided into three main categories:
1. The physical damage. 2. The potential for dependency. 3. The social damage.
Let's quickly examine our alcohol one category at a time with the help of science:
1
The ethanol content in alcoholic beverages enters the blood immediately after ingestion and is distributed over the entire (!) body. 20% is absorbed by the stomach and intestine and some of it is then passed on to the liver so that it can break down the alcohol. There the alcohol is first converted into acetaldehyde (evil!) by the enzyme ADH. This substance is responsible for nausea when you consume too much alcohol and it also changes the cells of the liver so that they produce more collagen. This so-called 'fibrosis' disrupts the architecture of the liver and thus promotes liver cirrhosis.[2]
Meanwhile, researchers at Cambridge University have also discovered mutations of the stem cell genome (in vivo) that are triggered by acetaldehyde.[3] Mutations like these increase, e.g. the risk of tumour formation. Normally, however, acetaldehyde is rapidly broken down with the help of the enzyme ALDH2, unless alcohol consumption is excessive or an amino acid is reversed in ALDH2 (Asian Flush). The acetaldehyde is converted into acetic acid, which is no longer toxic to the body, and further processed into water and carbon dioxide, which is exhaled or excreted.
Acetaldehyde is not the only villain in this story. Alcohol also has a direct negative effect on the mucosa of the small intestine, which among other things leads to harmful substances, such as endotoxins (bacterial toxins), entering the blood and lymph through the mucosa. Immune cells react to this "blood poisoning" by releasing inflammatory substances such as cytokines, which also have a bad effect on the liver and pancreas.[4][5]
Alcohol also has an effect on the brain: Studies have shown disproportionate deficits in grey and white matter volumes among alcoholics. Chronic alcohol consumption can even lead to the death of entire brain regions (Korsakow syndrome).[6]
"But Fishy! The dose makes the poison! Sugar in excess is also bad for humans. Shall we ban sugar too?" This is true, of course, since too much water consumption, for example, can cause water poisoning as well. Or vice versa, if we take for example the notorious murder poison arsenic and dilute it 10 000 times we suddenly receive a homeopathic remedy. But I digress from the subject and I prefer to leave pharmacy out of the game anyway, otherwise I could spend hours writing about the intoxicant Fentanyl, which last year was administered for months in an overdose in a Viennese hospital to pregnant women who were then impaired for a natural birth. Oops![7] (I just wanted to mention it.)
So with alcohol, as with all other substances, "moderation is key," right? It's not quite that simple. And it is not so simple that one can even claim that moderate alcohol consumption is healthy.
"A glass of day a wine is healthy!"
..doesn't even sound half as absurd as "A glass of wine a day is healthy!".
Rumours have been circulating for decades that a glass of wine is healthy in the evening and should prevent cardiovascular diseases.
A Swedish research team is said to have found out in a long-term study that moderate alcohol consumption reduces the risk of heart attacks in women (but increases the risk of cancer).[8]
Other old studies have also shown that there is a correlation between moderate alcohol consumption and increased HDL cholesterol.[9] HDL cholesterol has an important function in that it removes - roughly speaking - excess cholesterol from the body. This in turn has a positive influence on our cardiovascular system.
However, recent studies, such as the "In Vino-Veritas Study", have shown that HDL cholesterol levels do not change in any way as a result of wine consumption.[10] Scientists therefore disagree about HDL cholesterol. It cannot be denied that red wine contains the antioxidant resveratol, which is said to help kill cancer cells (in-vitro studies). However, the amount of Resveratol in wine is so low that one would have to drink 10-12 bottles a day for it to have an effect on health. Doesn't sound so healthy anymore, does it?
Ultimately, the dangers of alcohol outweigh the benefits by far and moderate alcohol consumption is not only 'healthy' but also unhealthy. Moderate drinking also increases the risk of damage to cerebral areas, as British researchers have found out.[11]
In the UK, new proposals for directives on alcohol have now been drafted which state that there is no safe dose for alcohol consumption. And the medical journal'The Lancet' has also taken up the cudgels for lowering the threshold values of'safe alcohol consumption'.
Establishing guidelines for safe consumption is a difficult matter anyway, as alcohol also correlates with poorer health in a complex and hidden way.[12]
The myth that alcohol brings health benefits is still spread today and when I look at sites like the German Wine Academy, which try to make it clear that moderate wine consumption is healthy and leads, for example, to a low risk of dementia, I can simply shake my head.
How biased do you have to be to propagate such an obviously harmful substance? Have you ever heard a cocaine addict say that cocaine is healthy because it promotes fat loss? "When your horse is dead, get off."
Facts: Over two hundred diseases are caused by alcohol. There is physical damage. First category done.
2
So we know now that alcohol is broken down by the enzymes ADH and ALDH2 and first converted into acetaldehyde and then into acetic acid. If we now start to consume alcohol regularly, a so-called MEOS system is switched on, which helps to break down the alcohol. The alcohol is broken down faster and our tolerance increases. And if our tolerance increases, so does our consumption. Alcohol also influences the production and transport of dopamine. Alcohol intake increases the release of dopamine. But: A German research team has investigated those areas of the brains of deceased alcoholics associated with the transport of dopamine and found that there is a lower number of dopamine receptors than in a 'healthy' brain.[13] This would mean that the brain reacts less to dopamine and more alcohol is needed for a balanced dopamine level. And boom, that's how an addiction starts.
3
Is there any social harm associated with alcohol consumption? In Austria, there are around 2,400 traffic accidents per year involving personal injury caused by alcohol.Is that enough proof? I do not think I need to elaborate on the fact that excessive alcohol consumption has a negative impact on relationships and work. You can also be sure that if alcohol changes your DNA, it also changes the DNA of your future children.
Now that we've gone through all categories of risk potential, it's time for a quiz!
QUIZ!!
If we look at this beautiful graph, we can see the dependency potential (Abhängigkeit) on the left side, the physical damage (physischer Schaden) at the bottom and the social damage (size of the dots) of various legal and illegal drugs:
A small, light yellow dot means less potential for dependence and less physical and social damage. Red is evil!
Question 1: Which dots are legal?
Question 2: Which dots are accepted by society?
Question 3: Which dots are glorified by society?
Answer:
One would think that an increased risk potential would mean that the sale and possession of a substance should be prohibited and disposed of by society.
However, this is not the case for alcohol and tobacco. And it doesn´t make any sense.
I do not assume that drug policy-makers are secretly alcoholics, but I assume that drug policy-makers do not know what measures they can and should take for a sensible drug policy. Worse, they may not even know that measures need to be taken at all.
And you're probably wondering what the goal of my uproar is. "Won't you even give us the booze! How else can we escape from the clutches of reality if the last legal drug is taken from us?"
The reason I am writing this post is because in my environment those who consume a beer every evening and get wasted every weekend have the biggest prejudices against users of illegal drugs. And that is the fault of the country, because when it criminalises a substance, it is clear that consumers of that substance will be discriminated. (It shouldn't be like that, but that's how society works at the moment.) So if other, more harmless drugs are illegal, alcohol should also become illegal. But is that even such a good idea? Let us look at the possible options for the development of a sensible drugs policy:
Criminalization
As long as humans feel the need to feel more euphoria, there will be drugs. Whether they are legal or illegal, they will exist. So if alcohol becomes illegal, it does not mean that alcohol will no longer exist. The black market will be opened and the criminals enjoy the situation because they can earn money with another substance.
Case Study: USA
From 1920 to 1933, the production, transport and sale of alcohol was banned nationwide in the USA. This prohibition failed completely because, although alcohol consumption has been proven to have decreased, crime increased by 24%: theft and burglaries increased by 9%, murders by 12.7%, assaults and assaults by 13%, drug addiction by 44.6% and police costs by 11.4%. Also the number of alcohol poisonings increased a lot, because the alcohol sold on the black market was partly more concentrated, thus stronger. Prohibition is said to have failed primarily because the majority of the population felt that the prohibition laws were "arbitrary and unnecessary" and were ready to break the law.[15]
All in all, it can be said that a country has more control over a drug when it is legal. It is therefore out of question that alcohol should be criminalised. It should even be out of question that any drug should be criminalised.
But if we don´t criminalize alcohol (or drug X), how else can we reduce alcohol consumption?
Regulation
One possibility, as with tobacco, would be to prevent any sponsorship and advertising by the alcohol industry, to introduce mandatory warnings, to limit availability and to make the price of alcohol less attractive.
Case Study: Sweden
After the Swedish temperance movement in the 19th century, strong regulations were introduced in Sweden. Today there is a state-owned company called "Systembolaget", which is the only one allowed to sell beverages with an alcohol content of more than 3.5%. Volume discounts are not granted and bundling such as six-packs is prohibited. And as an example of the high alcohol prices: Absolute vodka costs around 27 euros in Sweden, twice as much as in Austria. Currently there are around 3.5% alcohol addicts and researchers estimate that alcohol consumption would increase by 30% if the market were liberalised (to a similar level as in Austria and Germany).[16]
Education
The solution that sounds most attractive to me, but may be too utopian, is education. If media and the alcohol industries were less influenced by greed and presented the real hard facts about alcohol and alcoholism.
If education took place at school and at the doctors. And if society had a more open and critical attitude towards drugs of all kinds.
Then I could imagine that alcohol regulation is not necessary in the first place. And only then would I stop asking, "Why is alcohol legal?"
Sources: [1] Promille-Fahrt: Gorbachs Alkoholproblem [2] Hans-Konrad Biesalski, Olaf Adam: Ernährungsmedizin: Nach dem Curriculum Ernährungsmedizin der Bundesärztekammer. 3. Auflage, Georg Thieme Verlag, 2004 [3] Alcohol and endogenous aldehydes damage chromosomes and mutate stem cells. [4] Alcohol, Intestinal Bacterial Growth, Intestinal Permeability to Endotoxin, and Medical Consequences [5] Alkohol - Das unterschätzte Gift [6] Alcohol’s Effects on Brain and Behavior [7] Fehler in Spital: Schmerzmittel stark überdosiert [8] A 32-year longitudinal study of alcohol consumption in Swedish women: Reduced risk of myocardial infarction but increased risk of cancer [9] Alcohol consumption and high density lipoprotein cholesterol concentration among alcoholics. [10] A pilot randomized trial comparing long-term effects of red and white wines on biomarkers of atherosclerosis (in vino veritas: IVV trial) [11] Even moderate drinking may damage the brain [12] Thresholds for safer alcohol use might need lowering [13] Convergent evidence from alcohol-dependent humans and rats for a hyperdopaminergic state in protracted abstinence [14] Unfälle mit Personenschaden [15] Charles Hanson Towne (1923). The Rise and Fall of Prohibition: The Human Side of What the Eighteenth Amendment Has Done to the United States. [16] Die Schweden und der Alkohol
Pictures:
Diagrams are from Wikipedia, picture is PD