What’s The Truth About Alcohol’s Benefits And Risks? with Tim Stockwell
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If you've picked up a health magazine, watched the morning news, or listened to the radio lately,

You've probably heard something like this. A glass of wine, red wine in particular, is good for your heart. Researchers at Massachusetts General Hospital say they may be able to explain why light to moderate drinking can actually be good for your heart health. The pros of drinking any alcohol at all are that it is known to reduce the risk of heart disease, a number one killer of men and women. And also, moderate drinking

Wine drinkers in particular tend to be very healthy. But what if that research got it wrong? Health benefits have been, you know, at best exaggerated and are probably non-existent. That's Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research and a professor of psychology at the University of Victoria.

- We are very conflicted about alcohol in our society because we embrace it in so many celebrations and it's so much ingrained, at least in Western culture, in our way of life. - When scientific research started to show that alcohol was fine for our health, it was huge news. But when Stockwell looked at the hundreds of studies highlighting the health benefits of alcohol, he noticed these studies weren't exactly what they seemed.

And they might have actually shown the exact opposite. There's lots of respected, independent, fair-minded people who just look at some evidence, and I think less critically than they should. And they publish studies. It's very easy to do a big study finding health benefits if you don't look at it too critically. And you don't worry about who an abstainer is.

versus a moderate drink. You just look at how much they drink and compare the two. And not all of these studies were coming from a clean source. Some of them had huge conflicts of interest. There's big influences from people who make alcohol

and fund research. There's some famous studies by people who have long received money from beer or wine, but not all of them. In most countries, there are groups which are funded by the alcohol industry and they produce propaganda about their product.

under the guise of it being accurate, healthy information. I think there's going to be a lot of debate about this issue. There's going to be a pushback from people from an industry-friendly position attacking the kind of scientific basis. But the alcohol industry might have had a greater fight on its hands: consumers. Today, more and more people are becoming skeptical of the benefits of alcohol.

Trends like sober curiosity and non-alcoholic beverages are growing in popularity.

And the data suggests that the new science is having an impact. People are drinking less. I think we're going to see this cohort of people who were drinking less as young adults, aging and going through and being more open to health initiatives around alcohol. And then I think there's going to be more demand from people for alcohol.

better policies around alcohol, more evidence-based policies. So I think in the next 10 or 20 years we're going to see more rather than less

of that. There'll be more skepticism about alcohol and its health benefits and more concern to reduce the harms. Welcome to Big Brains, where we translate the biggest ideas and complex discoveries into digestible brain food. From the University of Chicago Podcast Network, I'm your host, Paul Rand. On today's episode, how the science on the benefits of alcohol was wrong and where the future of drinking culture goes from here.

The University of Chicago Leadership and Society Initiative guides accomplished executive leaders in transitioning from their longstanding careers into purposeful on-court chapters of leadership for society.

The initiative is currently accepting candidates for its second cohort of fellows. Your next chapter matters for you and for society. Learn more about this unique fellowship experience at leadforsociety.uchicago.edu.

Well, you know, I have to tell you, I did not want to have this discussion because it makes me very uncomfortable. Because even when I saw the report coming out, I was rethinking my own cocktail habit. And maybe my starting question is, how did we get off track?

into believing there were actually benefits to alcohol. Well, you know, you could go back to ancient Greece. I could give you a quote from Pliny the Elder, something to the effect that medical opinion is divided as to whether alcohol harms more people than it helps. The Bible, apparently there's an equal number of references to alcohol being good for you as bad for you. So it's a pretty hard message to take.

that actually this substance in the ethanol, let's just call it as name it, ethanol, is the chemical compound in there that does the harm. It also intoxicates and gives pleasure that we're now learning so much about the cancer risk. If we could pinpoint a moment in history when the narrative around alcohol and its health benefits took off, it would be the early 1990s when something called the French paradox became well-known in the media.

A key moment was a 60 Minutes program in 1991 where industry-funded scientists very persuasively talked about red wine, which is this wonderful cleanup job on your arteries. The French paradox was this observation that people in Mediterranean countries didn't get heart disease nearly to the extent as Northern Europeans or North Americans. And a lot of that's with diet, but really they highlighted the

the association with drinking red wine. So the answer to the riddle, the explanation of the paradox, may lie

in this inviting glass. And I think that took hold of the public imagination. And there was a moment where there were these little neck sleeves put on red wine bottles with no restrictions, just basically saying, buy this drink here, it'll stop you dying of heart disease. It all seemed fine to have a glass of red wine a day or to have a few cocktails a week.

But Stockwell wasn't sold. He had been working in substance use prevention and got a glimpse into the real consequences of alcohol. I ended up as a clinical psychologist for a while, working in alcohol treatment units and community-based services, drop-in services, doing home detoxification for people,

And anyway, it was a struggle. And I got invited to work in Australia and some national research centers that were being established. And I ended up in Australia for 16 years doing prevention and policy work. And he noticed a pattern in how studies were making it appear like alcohol had health benefits. The studies all depicted something called a J-shaped curve.

It's describing what you could say is the risk relationship between how much you drink and your risk of premature death from any cause.

And if you look at people drinking nothing, a little, a bit more, you know, all the way up to people drinking an awful lot, that's the X axis, the horizontal axis. And the vertical axis, the Y axis, is your risk of dying. So you start at zero, that's where the first point is. And then you look at people's risk as they drink more and their risk of getting heart disease or dying or

from death of any cause, that they're moderate drinkers at this point in time, is going to be lower than people who say they're abstainers. But as they drink more, that risk increases and you get this kind of J-shaped curve. But when Stockwell and his colleagues reviewed over 100 observational studies, they started to find a problem. It wasn't clear that this J-shaped curve was actually being caused by the alcohol itself.

Probably only 5% of reasons we die in Western countries is due to our drinking. So 95% most of deaths are not caused by drinking.

So there's a lot of room there for bias and confounding from lifestyle. And there's so many ways of looking at this which pull it apart. A very simple one is if you just compare a moderate drinker and abstainer, they are very, very different groups of people. I mean, obviously there's overlap, but the abstainers tend to have

less access to health care. They have lower incomes. They tend to exercise less. They tend to have poorer diets. They tend to have lower education. So there's systematic differences from the get-go. And if you look at young adults or late teenagers, those who are completely teetotal are systematically different than their drinking peers in ways that predispose them to

to a shorter life. They have lower income, more disability, poorer access to health care. And it's not just that these abstainers were categorically unhealthier. It was also the fact that they had given up drinking for a whole host of reasons. People currently abstaining have often given up, or they can't drink, and not necessarily because they were heavy drinkers in the past. They might have been light drinkers, but they now...

don't drink because they're on medication, they're unwell. So these systematic differences between drinkers and abstainers accumulate across the life course. It's like a cascading effect. And if you get to people at 50 or 60, when a lot of these studies that we looked at start, they get people at age 50 or 60 and then follow them up for 20 years to see what they die from. There's been so much selection bias by the time they enter those studies. They're only going to get people who have

survived to that age. They often screen them to see if they are still healthy but by the age of 50 or 60 a lot of people will have gone through a period of heavy drinking in their youth

and then they meet various obstacles and cut right down. So if you don't check out the former drinker piece, you're going to get a bias and the health status of people currently drinking will look better and better and better with advancing age compared with their peers who are abstainers. So there's a whole range of reasons for that. And sometimes that's taken account of in these studies.

And often it isn't. And we found that in about 80% of studies, they haven't taken even the smallest account of that problem. By not accounting for it, what impact did that have on the studies? You would exaggerate any advantage that moderate drinkers have compared with abstainers.

because the abstaining group is filling up with sick people as time goes by. They already start off at a disadvantage, but with advancing age, the abstainers as a group, current abstainers, get less and less healthy.

And then we're weeding out unhealthy people from the drinking group. These are healthy, surviving drinkers. They're still able to drink. And so the comparison between the two gets more and more crazy. We basically looked at the good and bad studies. We attempted to control statistically for some of these characteristics. And we basically found the more you do that, the J-shaped curve just shrinks.

Let's talk about the impact of drinking. What are we talking about in terms of likely causes of cancer from alcohol, diminished life expectancy? What is the actual threat that we are talking about here and at what levels? So there's a group I really respect in Toronto, the Center for Addiction and Mental Health. They've crunched the numbers on this using what they call an absolute risk approach.

They identified 20 ways, proven ways, alcohol can kill you. And there's like seven cancers. There's various strokes. There's various kinds of injury, liver diseases. Obviously, there's a range of nasty things that alcohol can do. They plotted from the best available studies the risk of each of those outcomes according to how much people drink, men and women.

And they estimate the risk of dying prematurely from an alcohol cause according to how much a person drinks. So they could calculate at one, two, three, four, five drinks a week, your risk of dying from an alcohol-related cause and what the impact that would have for the average person on their life expectancy. They said two drinks a week, your risk of dying from an alcohol-related cause over your lifetime was one in a thousand.

That's small, but they call that low risk. And there's various public health scientists

refer to that high bar, one in a thousand increased lifetime risk as low risk. Personally, I would give it another name. I'd say tiny. So that's if you're doing two drinks a week. And then if you say, well, I can't only make it, I need to have a drink every night except Sunday, we're up to our six drinks. That's about 11 weeks of life expectancy for the average person. If at this point you're thinking to yourself,

Okay, maybe you just have a couple of drinks a week. Is it really worth giving up alcohol just to save a few weeks of your life? Well, it really depends on your genetics, your lifestyle, and your personal choices. And we humans are very different. We have different constitutions, and we are at risk of different diseases according to our genetic inheritance and our lifestyles. And alcohol just adds a little tweak.

to this broad spectrum of risk and protection that applies to every individual and we are all different. I mean, the Queen Mother, what a wonderful example. I don't know if you remember, she's probably not as familiar to people in the States, but you can tell I'm from Britain.

She lived to 100, maybe it was 101. Anyway, she had about a quarter of a bottle of gin, I believe. She had a quarter bottle of gin of what? I think she had a few gin and tonics a day, and she smoked. She sounds like she would have been fun to hang out with. Yeah, well, that's the deal, because the other thing with alcohol, it helps us be lively and energetic.

interact and socialize and have it makes us feel we have fun but that wears off i mean that's the other thing doesn't it it's it's a buzz you get for maybe half an hour and then you're probably worse the simple message is you know less is best drink less live longer um drinking less if you're a heavy drinker because the heavy drinkers have the biggest reduction in risk so if you cut down from five to three drinks you have a massive reduction

And then it tails off as you drink less and less and less. I mean, it's always better, but

But it's a very steep decline if you cut down from heavy drinking to moderate drinking. And it's always better. Moderate to light is better, but it's not as big a deal as going from heavy to moderate. Well, maybe I'm going to start with a question that I'm sure will cross everybody's mind. Tim, have you stopped drinking? No. Why have you chosen not to stop drinking, knowing what you know? I have to say I've tried. I've done dry January. That was a struggle.

And, you know, over time, I've been drinking less. And probably on an average week, I have maybe three, four drinks, something like that. And I guess I view it as something that if you drink a little, it's a small risk. And I take a lot of small risks, maybe some quite large risks when I go skiing or there's all manner of things we do that are risky. Driving from Victoria down to California is in January, I find very risky.

and that's probably far riskier than if I was drinking five beers a day. - But I wonder if we can go back, because you talked a little bit of alcohol being ethanol and what it actually does to the body.

Let's start by talking about the different kinds of alcohol, whether it's a spirit or a beer or a wine or something in between. And what impact does alcohol end up having on the body and how does it cause damage? Yes. So the common denominator between the alcoholic beverages is ethanol.

By and large, there's a fairly strong consensus it doesn't matter. When you're trying to plot the risks of what we've been talking about, they are the same for beer, wine or spirits. When we drink beer,

when alcohol with ethanol in it, it changes into a thing called acetaldehyde. Now, if you test the effect of ethanol on human tissue, it damages it. And so there's an issue of replicating the DNA accurately. But if you look at acetaldehyde, that's way more powerful than ethanol. But, you know, ethanol becomes acetaldehyde. Every time we drink alcohol,

Alcohol comes through our digestive system being metabolized into acetaldehyde, which will literally burn human tissue that it comes in contact with. The body then has to repair itself.

If you repeat that over and over again, drink, burn, repair, drink, burn, repair, they will become a failure to replicate. The DNA will not replicate. And that's when tumors can occur. So it's even moderate drinking. This is where with that damage to the DNA, it actually could end up causing cancer and all kinds of cancer, not just liver cancer.

Yes, cancer of the mouth, the throat, the esophagus, the stomach, the rectum, the colon. Breast is a huge issue. There are different proportions of these cancers caused by alcohol. I think cancer of the mouth is up there at about 30, between 30 and 40 percent are alcohol caused. Breast cancer, the estimate about 15 percent of breast cancer deaths and illnesses will be alcohol attributable in the U.S.,

There's effects on hormones, male and female hormones that can put your risk of breast cancer or cancer of the prostate. This is a big deal that doesn't get discussed much. The US Centers for Disease Control accepts evidence that alcohol is a cause of prostate cancer. So the risk for cancer, the simplest models for how it's caused, it's due to the total volume

your exposure to alcohol across your lifetime. So at any point in time, whatever age you are, you look at the total volume. How many liters of pure ethanol has your body processed?

And once you stop that, the risk goes. It's as simple as that. But it's not just your risk of developing cancer or liver disease that are associated with drinking. There's also more and more cognitive effects that we're learning about. So it is a concern. And with advancing age, drinking is associated with an increased risk of cancer.

dementia, early dementia. What we know is that heavy drinking for sure is associated with brain damage, increased risk of dementia. There's no plausible biological process whereby moderate drinking would be good for your brain. So knowing what we know about alcohol consumption and life expectancy and the effects on our bodies and brains, what will it take to change the discourse around alcohol?

Stockwell and his colleagues have researched regulatory measures that have had a significant impact across the globe. That is after the break.

If you're getting a lot out of the important research shared on Big Brains, there's another University of Chicago podcast network show you should check out. It's called Entitled, and it's about human rights. Co-hosted by lawyers and New Chicago Law School professors Claudia Flores and Tom Ginsberg, Entitled explores the stories around why rights matter and what's the matter with rights. ♪

You've done some other studies, and particularly around the pandemic, the COVID-19 pandemic and alcohol consumptions. And can you talk a little bit about this whole idea of the different...

What happened during the pandemic, the policy implications, where that led in terms of consumption. When people are drinking, their personal spaces shrink and people care less about the consequences of their actions under the influence. So there's a range of factors. But with micro, very strong data on sales and COVID risks, we predicted that

Two weeks after a spike in alcohol sales, there'd be a spike in COVID infections. And basically, that's what we found and vice versa. If the drinking was reduced, then COVID infections two weeks later would be reduced.

I know in Canada, I think the US and Canada, we had in common that alcohol was declared an essential commodity. It was given the same status as food, fuel, and pharmaceuticals as something that was an essential commodity, and everything had to be done to allow people to have continued access to it.

Look, I'm not saying differently, it should have been completely banned. But what happened was steps were taken to make it even more available. And the alcohol industry were delighted. I'm talking about some local Canadian experiences. The fees that liquor store owners had to pay for their license were reduced significantly.

And there were also for businesses that suffered, obviously, during the pandemic when bars and restaurants were closed, the service for alcohol, the fees they had to pay for a liquor license were reduced. And this gave a huge opportunity for the industry to rip apart the existing regulatory structures and tax structures and reduce.

Certainly in Canada and most of North America, there was an increase in consumption. Basically, alcohol could be delivered to your door at a much cheaper price than if you went out to a bar or restaurant. We know liquor store prices are, you know, a third or whatever of bar restaurant prices. If you ordered in bulk,

You'd get free delivery. So there were incentives for people to order large quantities of alcohol. They didn't have to go to work and show themselves in a sober, competent state. They could turn off their camera on Zoom if they were worried. And the police reported in Canada people being under the influence all hours of the day. It wasn't just focused on the evening after work.

There was, so there was an increase of problems. The regulatory control structures around alcohol were weakened. And then the other kicker was there was a direct link between how intoxicated, how much we drank and our risk of contracting COVID. Now you've also done some of your studies and you talked a little bit about pricing and buying in bulk and so forth, but you really make a point of stressing of the importance of minimum unit pricing.

And I wonder if you can talk about what that is and why do you put so much emphasis on it? So we've known for a long time pricing and taxation policies are really effective ways of influencing how much a population drinks.

So whenever there's an increase in alcohol taxes, some wonderful US researchers, Alex Wagner, who's at the University of Florida, showed, for example, in Alaska, each time there was a tax increase, deaths from alcohol would plummet. People might be surprised. People think that alcoholics aren't affected by the price of alcohol. It's nonsense.

The more you drink, the more price sensitive you are. And vulnerable people are really price sensitive when it comes to alcohol. So we've known for a long, long time studies all over the world increase the tax, reduce deaths from alcohol or injuries or car crashes. So people hate taxes.

I think there's probably one thing we can all agree. People hate paying taxes. They hate governments saying they're going to increase taxes. Profoundly unpopular. So the idea that our favorite recreational drug is going to have an increase in tax, profoundly unpopular and not feasible. Along comes this idea of minimum pricing.

Ah. The idea of minimum unit pricing is not novel. In fact, a number of countries around the world have already implemented it. In Canada, we've had minimum prices with our government monopolies for years, mainly to protect it against you guys shipping cheap beer across the border. The government monopolies have wanted to maintain their revenue.

and restrict so that you can't sell below a given price of beer, wine or spirits. And that's been in place in Ontario since the end of prohibition, you know, in the 20s. People in Scotland contacted us and said, we want to look at minimum prices. We've got soaring liver cirrhosis deaths. They're like the highest in the Western world. We've got to do something. What do you recommend we do about minimum prices? And I'd said, you don't do it like we do in Canada.

Set a minimum price for the amount of ethanol, not the amount of liquid. So in Canada, there's these flat minimum price rates per litre of liquid, regardless of the stuff that causes harm, because all they cared about was revenue, not health. So if you care about public health outcomes, it's like a carbon tax. You attach a minimum price to a specific amount of ethanol in the UK or

or unit of alcohol is a little tiny tot of, it's a sixth of a gill or something, these tiny Scottish measures of spirits, half a pint of beer. Anyway, they set it at 50 pence. You know, the rest is history. They did the most expensive, thorough investigation of the impact of minimum unit pricing in Scotland, introduced in 2018.

deaths went down from alcohol, specifically deaths from liver cirrhosis, deaths in Scotland compared with England and Wales which had no minimum unit price,

they went down 23% for people with alcohol use disorders. But it's not just minimum unit pricing that has had a significant impact on reducing alcohol consumption. Some countries have also started adding warning labels on all alcoholic beverages, just like you would see on a pack of cigarettes warning about the risk of lung cancer. Ireland is set to become the first country in the world to impose warning labels on alcoholic drinks and explain how dangerous they are to your health if you drink them.

The law is due to be introduced in 2026, and there's now a push for the entire European Union to follow. Do you believe that the warning labels will have any impact on people? Probably not anywhere near the minimum unit price, but will they have an impact on consumption? Yes, I mean, it depends on how good the labels are. If they're colourful and they're simple and they use graphic images, if they communicate well,

and they touch on issues of concern to consumers, particularly issues they're not aware of. So 75% of people in the States and Canada are unaware alcohol is a carcinogen. You put a cancer warning label on their favorite, all drinks, that's news. That's something they haven't heard. A colleague of mine and I, we persuaded the Yukon Territory government in Canada to put warning labels, including a cancer warning,

And we found an effect on people's drinking. But one of the most interesting and important effects was once they became aware that alcohol was a carcinogen, and this was, you know, the World Health Organization has been stating this for 35 years, it changed their opinion about support for alcohol policies like minimum unit pricing.

So support doubled once people became aware of the cancer risk. So everything is related. It's important consumers are aware they can make informed choices. And some of those choices are not just about their drinking, but whether they will support their government on their behalf, trying to protect the health of their loved ones in their community. So

That's one of the contributions that warning labels could have. Do you expect if it follows and goes into law in 2026, do you think other countries, at least in the EU and maybe globally, will start looking to adopt similar steps? They already are. And I'm a member of WHO Euro Technical Advisory Group, which is trying to design

the kind of label that would be a standard. It's a painful process if you probably know anything to do with the EU, that 27 or whatever its country is, to agree on something. It's torturous and painful. And so if we look at what happened when the warnings came on cigarettes and the advertising restrictions that were put into place,

What if any concerns, and maybe they are articulating these, are you hearing from big alcohol? And is it getting into an existential concern for them? Oh, absolutely. And it's quite apparent that they have a number of think tanks.

and individuals they pay to troll people like me. So I get some of their surrogates attacking me online regularly, or not just online, or in the print media. The Daily Telegraph in the UK ran a whole piece just attacking me based on industry information.

surrogate ideas that I was connected to temperance organizations. But the industry tried to shoot the messenger. So to distract from the work me and my colleagues do, they attack us personally and make us out to be this shady, shadowy group of

of advocates ideologically driven to change the structure of society. And basically we're evil and we should be just stopped from doing whatever we're doing. Regardless of how industry executives and trade organizations might act to stop any regulation on alcohol, one thing is for certain, alcohol consumption is declining and sober curiosity is on the rise. And it's not just a trend in the United States.

One of the strands in this, it's very interesting, over the last 20 years there's been an unexpected trend. I was shocked, surprised and believed at first, but young adults have been reducing their drinking.

In developed countries, there's about 30 countries, developed countries around the world, finding that young adults are drinking less than they used to. There's fewer heavy drinkers, fewer young people engaging in heavy drinking. Now, my theory, my pet theory, and there's only little evidence for this, but it's such a big global idea, it's hard to prove or disprove.

I think it coincides with the internet, the development of social media and a radical change in how young people communicate and establish relationships.

So there's been a reduction in young people's consumption. And I think along with that has come other things to fill the space. There's also a general concern about health and longevity. It's a luxury in developed countries. How do we extend our time on this earth? And there's been increasing interest in that whole topic.

and people become aware of their food. We're really health conscious, so many people are very health conscious, not everyone. There's obviously great diversity and divergence on that. But those who are, are looking minutely at everything. We want labeled ingredients. We're looking for the sugar content, the calorie content, and healthy additives, everything. And then, "Ah, ethanol. Do I want to put ethanol in my body?"

So I think there is this sober, curious trend going on. The sort of research I've been doing just fits in and people have picked it up and said, look, yeah, this stuff's not so good for you. Big Brains is a production of the University of Chicago Podcast Network. We're sponsored by the Graham School. Are you a lifelong learner with an insatiable curiosity? Access more than 50 open enrollment courses every quarter. Learn more at graham.uchicago.edu slash bigbrains.

If you like what you heard on our podcast, please leave us a rating and review. The show is hosted by Paul M. Rand and produced by Leah Cesarine and me, Matt Hodap. Thanks for listening.