Why is the abuse of alcohol one of the greatest causes of loss of human productivity, and of suffering and death in our world?
Why can the majority of people who drink alcohol do so without harm to themselves, but others — between 5 percent and 15 percent of drinkers in many nations — become alcoholics, and others become problem drinkers?
What is our human responsibility, given the evidence that hereditary factors, as well as environmental ones, affect our response to alcohol? And equally important, what kind of education is essential for the proper use and control of this widely used substance?
We live in a world of diverse human backgrounds, attitudes and experiences in regards to alcohol. Many people come from homes where alcohol is not used at all. Others come from homes where alcohol is used and enjoyed in moderation. Others come from backgrounds where alcohol is regularly abused. Many have suffered trauma because someone close to them has misused alcohol or is an alcoholic. Some non-Western nations make nonmedical consumption of alcohol illegal.
A sizable minority in some Western nations reject use of alcohol for religious reasons. Some people come from homes where drinking simply isn’t a regular practice. Still others do not drink alcohol because even small amounts cause unpleasant physical reactions or health problems.
Much is known about alcohol, but much has still to be understood about the causes of differing human reactions to it, including differing kinds of alcoholism. Here are some important facts about the chemical compound ethyl alcohol or ethanol, hereafter simply called alcohol.
Important basic knowledge
Alcohol is produced by natural fermenting processes of sugars or starches. It is poisonous in large amounts, but most people are able to metabolize, or process, small amounts.
Alcohol is technically classified as a drug because it alters the functioning of the body in a way that foods normally don’t. Yet it is the only drug that can also be classified as a food in small amounts because it provides calories. Please note the emphasis on the words “small amounts.” In larger amounts, which vary from person to person, alcohol can be toxic and physically damage cells and organs as well as cause drunkenness and addiction.
Research demonstrates that the same levels of alcohol in the bloodstream of different people can produce different responses in brain and body. Part of this is due to human physiological and metabolic differences. But more than body weight or the natural properties of alcohol on individual metabolisms are involved in human reactions to it.
How many people have been educated to realize that mental attitudes and moods of one’s physical environment have an effect on human reactions to alcohol (as they do with most mind-altering drugs)?
Mood, setting, instruction important
Clinical experiments have demonstrated that attitudes of drinkers (sometimes called “set” in medical terminology) and their physical and social drinking environment (“setting”), especially their learning environment, can be as important as the natural physiological effects of alcohol on how they react to it.
This means human response to alcohol, in part, involves:
- learned or conditioned expectations of its effects on mental states of mind during use,
- on the mood of the surroundings in which a person drinks, and
- on the attitudes of drinkers and associates with whom they drink.
These factors help account for different subjective experiences when different people in different situations use the same amount of alcohol. In addition, human response to alcohol is affected by whether food is in the stomach and what kind of food, by the concentration of alcohol in the drink, and by what the drink is mixed with.
Depending on learned and conditioned cues or expectations when drinking, alcohol may produce a calming, relaxing effect in one situation, belligerence in another, frivolity in another, sleepiness in another and sexual abandon in another.
Controlled experiments have demonstrated the curious fact that many people act tipsy or drunk merely thinking they have drunk a certain amount of alcohol, when they have actually drunk only a small amount or even none at all.
Beneficial only in small amounts
In people who can metabolize alcohol satisfactorily, a small amount of alcohol often initially acts as a stimulant. This is because a small amount of alcohol slows down the tense, driven part of the brain that deals with new learning or making judgments. It also slightly dulls the centers that make us aware of exhaustion or discomfort.
A small amount of alcohol often takes the edge off self-criticism and self-doubt. Many people feel emotionally freer, more communicative, yet are in control of their emotions and actions. Many find that this adds enjoyment to certain social occasions.
What happens if people drink more than this small amount? Drink then becomes excessive. Alcohol starts suppressing deeper areas of the brain that control attitudes, perceptions and bodily movements. Loss of social restraints, loss of control over body movements and loss of emotional control start to occur. Harmful aspects of the human personality — defects of character normally controlled — often come out. A person may manifest a Dr. Jekyll/ Mr. Hyde personality.
Those people whose personalities are essentially shy or timid often become even more quiet and retiring. Those struggling with deep anger or strong emotional problems may become belligerent, abusive, destructive or immodest.
Still higher alcohol levels in the bloodstream depress areas of the brain controlling vital organ functions. Breathing, heartbeat and central nervous system responses dangerously weaken. Further use leads to coma or death.
Study after study shows family and social attitudes about alcohol are extremely important in the results that come from its use.
The startling fact is, alcohol-related diseases account for 30 percent or more of all hospital admissions. Alcoholism costs Americans vast sums annually in medical expenses and industry losses. The abuse of alcohol in many Western nations is involved in over half of traffic fatalities and many accidents. And law enforcement agencies have found it is involved in large percentages of homicide, rape, aggravated assault and domestic violence.
How can individuals and families avoid falling into these tragic problems? By understanding and respecting the mental, emotional, environmental, physiological and hereditary factors that influence alcohol response!
Educational environment is very important
First in importance is the right social learning environment in the proper use of alcohol. Conversely, wrong social influences, attitudes and backgrounds plant the seeds of future alcohol abuse.
Dr. Morris E. Chafetz, former director of the U.S. National Institute on Alcohol Abuse and Alcoholism, said: “Under ideal circumstances children should learn healthy attitudes about drink in the familiar surroundings of their homes. However too many parents are too confused or too guilty about their own drinking to teach a youngster to drink moderately.”
In the early 1950s, a study of over 15,000 U.S. college students demonstrated that the most important social factor in determining student drinking habits was parental example. Many, but of course not all, of the young people in this sample were found to drink, or abstain, like their parents.
This study found that what the parents taught on the matter of alcohol was of little importance compared with what parents did. The attitudes and practices of the parents were much more influential on the young peoples’ thinking and action than were the teachings of their schools or churches.
The next most important social influence on students’ drinking patterns has been found, not unsurprisingly, to be attitudes and practices of their closest friend or friends.
Yet, researchers have found children are not all alike in their response to even poor drinking examples. Some children become so deeply disgusted with the alcohol abuse they have witnessed in parents or peers that they want nothing to do with alcohol. They can associate nothing positive or beneficial about any alcoholic drink.
Other studies have found that young people from backgrounds of total abstinence, but with no ethical guidelines from their families or churches to distinguish responsible from irresponsible drinking, tend to have a high incidence of problem drinking behavior if they start drinking. Many of these people develop an abusive pattern that rapidly grows out of control.
Support from cultural studies
A very good book summarizing studies and research on alcoholism was published by Harvard University Press in 1983. The book is The Natural History of Alcoholism, by George E. Vaillant. One of the important points Vaillant emphasizes in this book is research as to why some cultures are plagued with serious alcohol abuse problems and others are not.
Various studies have demonstrated that social groups that introduce responsible drinking and attitudes within the family unit, with reinforcement by adult example, have the lowest rates of alcohol abuse among cultures that allow drinking.
Vaillant summarizes the evidence discovered in these studies as follows: “Introducing children to the ceremonial and sanctioned use of low-proof alcoholic beverages taken with meals in the presence of others, coupled with social sanctions against drunkenness and against drinking at unspecified times, would appear to provide the best protection against future alcohol abuse” (page 105).
Study after study shows family and social attitudes about alcohol are extremely important in the results that come from its use. Certain Mediterranean nations such as Italy, Portugal and Greece and some Eastern cultures have had a tradition similar to the aforementioned pattern of using alcohol. Unfortunately, in recent years more affluent and permissive drinking influences are weakening this pattern in many of these nations, and alcoholism is a growing problem.
The disciplined and family-educated moderate drinking tradition is even more pronounced among conservative and orthodox Jews. Drinking is widespread in this culture, involving most children and adults, yet there exists an extremely low rate of alcoholism. The reason is the Jewish children from such an environment acquire strong inner controls as to the proper use of alcohol. From their early years of life these children witness the moderate use of alcohol among parents, and strong social sanctions against alcohol abuse and drunkenness are enforced. Alcohol tends not to be drunk daily. It is commonly reserved for the weekly Sabbath and special occasions.
Since moderate use of alcohol is part of Orthodox Jewish life from early years, and closely tied in with family religious traditions and meals, and a deep sense of responsibility to the family is expected, there is a very low occurrence of undisciplined experimentation by adolescents or abuse of alcohol as a symbol of revolt against authority by them.
More evidence from cultural studies
One southern European culture, the Italian, has had the custom of providing children with a long education in moderate alcohol use, usually low-proof wine, and encourages responsible drinking with family members at meals. Alcohol used by children is often diluted with water and drunk in small amounts. Such drinking diminishes the alcohol “high” and tends to establish and enforce moderate drinking habits. Drunkenness is also frowned upon.
If a person cannot drink without alcohol being a problem to the self or others, then that person should not drink alcohol at all—privately or socially!
In contrast, several North and East European nations are noted for much higher alcohol problems. One European culture discourages children and adolescents from drinking, but they tolerate — even covertly praise — the ability of men to drink large amounts of alcohol. In this culture, heavy alcohol use is frequently indulged in away from other family members, often in pubs and apart from food of any kind. And high-proof liquors are more highly revered than low-proof drinks.
In one major Eastern European nation, men feel obligated to finish off a bottle of high-proof liquor after they open it. Drunkenness and alcoholism is undermining the health and productivity of that whole nation!
In some cultures, to refuse a drink is construed as unmanly, unsocial or even unpatriotic. Certain cultures tolerate open displays of drunkenness. Every nation, culture and family teaches what is acceptable and unacceptable behavior by how its influential adult members live and what they tolerate.
Drinking attitudes and environments
Millions of people in our present world find themselves drifting in the midst of a sea of increasingly permissive and often abusive alcohol crosscurrents. “Do your own thing!” — a popular attitude in the Western world — has led great numbers to abuse alcohol and then into alcoholism.
Millions of adolescents are not taught about alcohol in a disciplined, happy home environment. Instead they learn about alcohol in the peer-pressured “beer bash” with its so-called fun of “getting smashed,” “bombed,” “loaded,” “wasted,” “soused, “plastered,” or “clobbered.” There is a lot of popular terminology to lessen guilt and dress up the evil consequences of drunkenness and lack of self-control.
In the Western world there have been stronger and stronger social and advertising pressures to lead many people to think that alcohol is essential for having fun at any activity. In many social occasions, people are expected to drink (a trend that is now fortunately changing). There are still widespread attitudes that associate drinking and “holding one’s liquor” with masculinity and virility and being part of the “in” group.
Many businessmen find themselves pressured and expected to drink during business hours — before and after deals. Many people have gotten into wrong drinking habits from such modern drinking inventions as the “happy hour” — the before-meal high-alcohol-content cocktail party.
In many areas, numerous bars exist for people with any kind of drinking habit to stop off anytime they feel like it to have drinks. In many areas, low-cost liquor is available at a growing variety of food and nonfood stores and shops.
As a result of such common drinking practices and attitudes, many believe alcohol can be used any way they like. It’s no wonder abusers, heavy drinkers and alcoholics have trouble accepting the truth about the damage their habits do, and they do not stop or get help.
Laws reflect teen crisis
It is precisely because the disciplined family structure has so widely broken down, and permissive drinking practices are so widespread, that many health and government officials frown on any use of alcohol by young people, even within the home. They feel there is simply too much lack of understanding and carelessness about alcohol and too many permissive adult and peer drinking attitudes and pressures.
These authorities have additional reason to be concerned about improper use of alcohol by young people. Research indicates that adolescent metabolisms, which are in the developing stage, are much more sensitive to alcohol. Alcoholism can develop several times more quickly in teens who abuse drink than among adults.
Because alcohol abuse has become so widespread among young people in many nations, governments at various levels have passed laws forbidding use of alcohol by minors. In the United States and many other nations, any use of alcohol by underage people apart from that permitted within homes or other circumstances under parental control is illegal. Laws vary from state to state or area as to what is permissible drinking by minors even within the home.
Racial and hereditary differences
We now come to another critical area that adults and children need to be educated in: physiological and hereditary differences affecting alcohol metabolism.
In recent years, research studies have demonstrated there are significant differences in alcohol metabolism in humans. Differences of opinion exist among researchers on the relative contributions made by heredity and by environment in response to alcohol. But this much has been established. There are differing sensitivities and reactions to alcohol among various races or ethnic groups and even between individuals within a race or family.
Human response to alcohol can vary significantly due to enzyme and constitutional differences within the body. Some people are so sensitive to alcohol that just a small amount can produce acute discomfort, possibly accompanied by facial flushing, elevated skin temperature, rapid pulse or lack of sobriety.
Preliminary studies indicate that a high proportion, perhaps half or more, of peoples of Asian background have a rapid alcohol sensitivity producing some of these effects, whereas such effects are seen in 5 to 20 percent of Caucasian groups.
Many people in Asian populations have been found to have metabolic systems of enzymes that convert ethyl alcohol to acetaldehyde more rapidly than Caucasians. They are thought to experience unpleasant symptoms because high blood acetaldehyde levels, which act as an irritant, are not quickly disposed from the bloodstream. Hence, some Asians are less prone to alcohol abuse.
Clinical investigations have demonstrated that the human liver, where about 85 percent of alcohol metabolism takes place, contains multiple forms of enzymes responsible for that metabolism, each of which is inherited. Structural differences in these enzymes, small though they are, can have a great effect on the functional properties of an enzyme, either speeding up its action or slowing it down. Thus they accelerate or delay the elimination of alcohol byproducts from the body.
Clinical studies are also establishing that there are variants in alcohol metabolism among individuals depending not only on inherited characteristics, but sex, health, weight, age and diet. This research indicates that for anyone to assume he or she can drink exactly like others is both foolish and potentially health damaging.
It is a big mistake to assume individuals from different racial or family backgrounds, or body builds or health, can drink exactly like others. Adult family members need to realize their responsibility to respect and pass on any family history that indicates caution regarding alcohol!
Dr. Sheila B. Blume, Medical Director of the National Council on Alcoholism and a member of the scientific advisory committee on the National Institute on Alcohol Abuse and Alcoholism, commented:
The more we learn [about alcohol], the more we know that the effect depends on individual differences. How people react depends on their genetic makeup. Genetic makeup influences psychological and physical reactions. One person may drink very moderately with no apparent harm to the organs. And yet the same amount of alcohol might cause harm in another. Men and women may have different reactions. Women get higher alcohol peaks in their blood than men. Also, age makes a difference. An amount a person could tolerate in young or middle age might be harmful when that person is older.
As a result of individual differences, some authorities say it is impossible for anyone to flatly say that one social drink a day won’t hurt someone, or that two social drinks a day will keep heart attacks away.
The majority of people in Western nations can drink a small amount of alcohol without adverse effects. But some people, because of some metabolic or health reason, cannot properly utilize or enjoy alcohol. To them, just a little alcohol is a toxin, producing distressing symptoms. A wise parent or host or hostess will be aware of this reality.
Family background important
At the other extreme, research is making it clear that the drinker who can “drink others under the table” but not get drunk is also in serious danger. Many of these people (they frequently come from families with a history of heavy drinking or alcoholism) often claim to feel less intoxicated after multiple drinks and show fewer early signs of drunkenness after heavy drinking. Dr. Marc Schuckit, professor of psychiatry at the University of California, San Diego, and an authority on alcohol problems, has found that many heavy-drinking men who come from this high-risk group often produce high levels of the alcohol metabolic breakdown acetaldehyde.
Schuckit speculates that certain people’s metabolisms with high levels of acetaldehyde blunt the typical drowsy response. Instead of finding large amounts of alcohol dulling, like others would, they find it stimulating. This misleads them to think they can continue drinking in amounts that cause others to get sick or drunk. Whether this particular response is due to genetic factors or the result of repeated alcohol abuse is a point of debate.
There are different patterns of alcoholism. The ability to drink larger and larger amounts without getting tipsy or drunk is one of the warning signs of developing or early stages of alcoholism. In all cases, immoderate drinkers are only kidding themselves. They are already in serious alcohol-related trouble! “Never envy a heavy drinker who does not seem to get tipsy,” warns one expert on alcohol. “Alcoholism may be the next station on his train ride.”
It is critical that everyone reading this be scrupulously honest with themselves. If you drink, where and how did you learn? Who were your childhood examples, and what was your learning environment? Were they — are they now — really wholesome and healthy and moderate or not?
Unfortunately, the problem with discussing any kind of limit in drinking is that those who abuse alcohol usually deceive themselves that they can handle much more than others, when they can’t. Abusers are usually the last to admit they drink too much. They think — or like to think — they drink in moderation, but they base their definition of moderation on their past habits or on the standards and practices of others around them.
Alcohol is being abused when it results in harmful spiritual, mental, and emotional attitudes of mind and in damaging physical and bodily reactions. Lack of moderation is another important criterion — even if some people do not get tipsy or drunk like others from heavy drinking. Immoderate use of any alcoholic beverage, even low-alcohol ones, will eventually cause problems and can cause alcoholism.
Sensible precaution indicates moderation even for people who can handle alcohol without adverse reaction or risk. This means having no more than a modest drink or two during any day or social occasion, and then spaced out over a period of time, not all at once. Some authorities advise not to drink alcohol every day.
Next, you need to ask, is there a pattern of alcohol abuse or alcoholism in your family? If so, you need to be extremely moderate if you drink at all — and perhaps you shouldn’t drink at all. Evidence is growing that a predisposition to more quickly develop alcoholism can be inherited.
Next, and critically important, if you drink and are a parent, you need to ask what is the example you are setting to others, particularly to impressionable children and adolescents in your care. You must set a proper example!
All held accountable
The Bible has many warnings and examples about the abuse of alcohol. In God’s eyes, humans do not need to drink alcohol to prove masculinity, sociability or maturity. In fact, humans do not need to drink alcohol at all. If we drink alcohol, God holds us responsible for how we do so. He holds us responsible for staying well back from levels that produce ill effects in our lives or others. Moderation is not always pushing the limits of sobriety. How we handle alcohol is a test of our character!
If individuals cannot drink without alcohol being a problem to themselves or others, then they should not drink alcohol at all — privately or socially! If you already find yourself failing to control alcohol, then it is your God-given responsibility to do all you can to get the help you need to stop. Since many alcoholics and abusers of alcohol will not face or admit they have a drinking problem, others may have to help them confront their problem and overcome it.
The use of alcohol can produce a benefit only if we are knowledgeable about alcohol and about human differences in its metabolism, and we discipline ourselves in our families and social responsibilities.
Author: This article was written in 1991 and updated in 2012