I must warn the reader that I have personally treated over 1,000 individuals with alcoholism and it is not a pretty picture.  Huge numbers of good men and women have had their lives taken over and destroyed by alcohol.  Alcohol changes people.  Alcohol is also much more addictive than 95% of Americans realize.  I am the Research Director of Doctors and Lawyers for a Drug Free Youth (DFY).  I have fought against governmental agencies for many years trying to get them to take alcohol more seriously.  This includes not just the U.S., but also in Canada, Mexico, Brazil, Uruguay, and Argentina.  

In fact, despite the fact that the U.S. government is strongly influenced by the beer, wine, and liquor industries and is doing far too little, the U.S. is actually doing more than any other country with which I have worked.  At least we have an age 21 law that is enforced somewhat.  However, the heavy advertising of alcohol, the very low taxes on alcohol, the easy availability of alcohol, and the numerous bars where large percentages of patrons drink heavily and drive home are evidence of the problem.  My organization was the first to do alcohol and tobacco stings in the City of Chicago and many other cities and states in the early 1990s to demonstrate how easily 16-year-olds could purchase tobacco and 18-year-olds could purchase alcohol.  Things have improved considerably since those days.  In another DFY study, funded by the State of Illinois, we demonstrated how poorly clerks and bartenders look at driver's licenses, even in locations which have recently gone through a State-run server-training programs.

My own position is that abstinence in the best policy at least until age 45.  Obviously, second best is to wait until at least the legal age and to be a very light drinker.  I am opposed to social drinking.   Tavern and party drinking is strongly associated with binge drinking, which is strongly associated with the development of alcoholism.  What's more, the large majority of bar patrons and party-goers drive home afterwards.  Driving even after one drink increases the accident rate significantly.  If one does drink, at least limit drinking to a maximum of one drink in a single day.  While I have to admit that the research shows that alcohol consumed in small quantities up to one drink per day can have a positive health effect in middle-aged individuals, the health benefits are mostly short in duration.  Thus, the alcohol consumed before age 45 has very little, if any, health benefit.  

Alcohol is without a doubt the #1 drug of violence.  It is responsible for 50% of the murders, suicides, rapes, and beatings that occur on American streets and in American homes.  I saw the tragic results when I worked as a consultant in Illinois prisons and with patients in my practice.  If you ask people about their families, it is amazing how many have been serious damaged by alcohol.  Of course, it also causes about 40% of auto fatalities and causes hundreds of thousands of cases of cirrhosis and brain damage each year.  It ties tobacco addiction as the #1 preventable cause of loss of life before age 65.  Between the two, tobacco and alcohol result in the deaths of over 20% of all Americans.

The research clearly shows that non-drinking parents set the best example for their children and that parents who give a strong non-drinking message to their children, at least until age 21 (and ideally age 45), will have children suffering the fewest alcohol-related problems. 

Alcoholism & Drug Use Very Common in British Street Sleepers: In a nationwide study of 389 men who were sleeping or recently sleeping on the streets, an incredible 324 were drug users (89%). Of these, 52% wanted help with their drug abuse. Also, 68% were abused alcohol. Of these, only 33% wanted help. However, few were receiving any help other than needle exchanges. Unmet drug and alcohol service needs of homeless people in London: a complex issue. Fountain J, Howes S, Strang J. Subst Use Misuse. 2003 Feb-May;38(3-6):377-93.

Teen-Female Alcohol Abuse Up in UK: A new report in the British Medical Journal notes there has been a significant decline in hospital admissions for drug abuse amongst teenagers and other groups. However, there has been a dramatic increase in the number of young British women and girls admitted for mental and behavioral problems related to alcohol. Psychiatric admissions for girls under 15 rose by 24% in 1996-97 to 23.2 per 100,000 population. British has weak and poorly enforced age laws, higher teen alcohol abuse than the U.S., and also has relaxed alcohol sales licensing in recent years. 1/14/05. Teen smoking, like adult smoking is higher in Britain 

Alcoholic Liver Disease Soars in Britain: Between 1989 and 2003 admissions in Britain for the disease increased by 116% in men and 108% in women to 42/100,000 per year for men and 27/100,000 for women. The figures, from London's St George's Hospital and the Office for National Statistics, were presented at a British Society of Gastroenterology meeting. BBC News 5/15/05

Alcohol Withdrawal Increases Glutamatergic Neurotransmission and Oxidative Stress: The cerebral spinal fluid was measured 1 wk and 1 mo after stopping alcohol in 18 patients with alcohol dependence and controls. This may contribute to neurotoxicty. Tsai, Mass Gen, Am J Psychiatry 6/98;155:726-32

Depression: Abstainers Were Less Depressed in Follow-up: In an 18-month follow-up of the Psychiatric Morbidity Among Adults Living in Private Households survey, hazardous and dependent drinking were not associated with onset of anxiety and depression at follow-up. Binge-drinking was non-significantly associated with higher anxiety and depression (OR=1.36). However, those not drinking at all at the beginning of the study were less likely to have new-onset anxiety and depression at follow-up. Alcohol consumption as a risk factor for anxiety and depression: results from the longitudinal follow-up of the National Psychiatric Morbidity Survey. Haynes JC, et al. University of Bristol, UK. . Br J Psychiatry 2005 Dec;187:544-51.

Depression Markedly Increased in Frequently Intoxicated Unemployed: Using the nationally representative 1996 Finnish Health Care Survey of 5993 adults ages 15-75 years, current unemployment was associated with major depressive episode (odds ratio, OR = 1.78) due entirely to long-term unemployment. Long-term unemployment with no frequent alcohol intoxication had a 72% higher risk of major depressive (OR = 1.72) and those with at least weekly alcohol intoxication had 1027% higher risk. Major depressive episode related to long unemployment and frequent alcohol intoxication. Hamalainen J, et al. Helsinki, Finland. Nord J Psychiatry 2005;59(6):486-91.

Serotonin Transporter Short Variant Homozygous Linked to Heavy Drinking: Students who shared two short copies of the serotonin transporter gene (5HTT) consumed more alcohol per occasion, more often drank expressly to become inebriated, and were more likely to engage in binge drinking than students without the variant. Alcohol and Alcoholism 9/03. Ting-Kai Li, M.D., director of the National Institute on Alcohol Abuse and Alcoholism. Paolo B. DePetrillo, M.D., and Aryeh I. Herman B.A., & George Washington University Study of 204 male and female Caucasian college students aged 17 to 23 years. 5-HTT gene, which is involved in recycling the chemical serotonin after it is secreted into the synapse of a cell. The researchers determined which students had long or short versions. Most people are heterozygous, but about 30 percent of the Caucasian population are homozygous (carry duplicate copies) of either the long or the short version. Two copies of the short version of 5-HTT were more likely to report troublesome drinking patterns.

Benefit Social Support Less Controlling for Alcohol: Social support was strongly assoc with longevity in study 223 men in a 50 year follow-up. However, if one controls for alcohol abuse, smoking, and depression at age 50, most of the benefit disappears. Vaillant, Harvard, Psychol Med 98;28:1159

60 Year Follow-up of Alcoholics: As part of a study of 268 Harvard undergrads started in 1940 and 456 socially disadvantaged Boston youth in 1950, all 20 years old at the start, 20% of the Harvard students and 31% of the disadvantage youth developed alcohol abuse at some time during their lives. Of the Harvard students, 19 alcoholics were successfully followed and 70 disadvantaged alcoholics. At 60 and 50 year follow-up of the respective groups, 58% and 54% had died. 11% were still abusing alcohol, 28% were abstinent, 5% were controlled drinkers. A 60-year follow-up of alcoholic men. Vaillant GE. Addiction. 2003 Aug;98(8):1043-51

5 Drinks/Week Lowest Sickness Absences and Disability Pension: Stockholm Health Population Study 1984 data with 5-7 yr f/u found drinking 10g/d males and 7g/d females or less resulted in the lowest disabilities during f/u (2 beers Q 3 day=10g). Moderate drinking (10-35g/d = 5-16 beers/wk) had slightly more disability (RR 1.1 & 1.3), non-drinking definitely more (RR 2.2 & 4.1) and heavy drinking (over 35g/d, over 16 beers per week) the most (RR 3.7 & 5.6). Marianne Upmark, Karolinska, J Epid Comm Health ’99;53:223-9

Hangovers Cause Massive $ Loss: Estimated $148 billion in absenteeism and poor job perf. Most financial losses due to hangovers in light to moderate drinkers. 15% of drinkers have monthly hangovers. Problems with visual-spatial and dexterity even after no detectable alcohol in blood. Annals Int Med 6/6/00

22% Canadians Report Alcoholic Parent: U Manitoba survey of 581 randomly selected found 22% adults reported at least one parent had alcohol problem. The adultchildren of alcoholics more likely to have drinking problems. El-Guebaly, Br J Add 90;156:249

20% Drunk by Minors, 30% More Excessive: Columbia University's National Center on Addiction and Substance Abuse analyzed three sets of data from 1999 and said underage drinking amounted to 19.7 percent of alcohol consumed that year, or $22.5 billion. "Excessive" drinking by adults -- consumption of more than two drinks daily -- amounted to 30.4 percent, or $34.4 billion. JAMA 2/26/03

One Drink & Bikes Don’t Mix: One drink increases risk of accident 4-fold and 4-5 drinks increases risk 20-fold. John Hopkins Dr. Guohua Li.

One Drink Impairs Auto Driving: One 75 ml vodka in OJ. Jim Horne, Loughborough University. The combination of the low level of alcohol and the naturally occurring "afternoon dip" in mental alertness affected driving performance significantly. Although the driver's brainwaves registered the lack of alertness, the drivers were unaware of their condition. Driving impairment, measured by "lane drifting", was 10 times more frequent, 30 to 60 minutes after the lunchtime drink in the men who had slept poorly than in those who had drunk no alcohol and slept well. The effect was less immediately after drinking but still five times greater two hours later. Occupational and Environmental Medicine, 8/03. Sleepiness accounts for about 10 per cent of all road crashes, with the risk increased on motorways and other monotonous roads. These accidents result in more serious injuries and death because of the driver's failure to brake and the higher impact of the crash. French research showed that when sleepiness was combined with alcohol, even in very small amounts, accidents were more likely.: found an effect when the driver had only 0.01 grams of alcohol per 100ml of blood. In Britain the alcohol limit for drivers is 0.08g/100ml.

BK Channel Effect Causes Intoxication: The gene known as slo-1 codes for a channel-like protein in the brain that can allow potassium ions to pour out of neurons, a normal process that temporarily slows down the neuron's activity. Alcohol makes the channel open more frequently, depressing neuron activity and leading to sluggish, uncoordinated movement. The BK channel is one of 200 known channels that regulate cell activities by controlling the flow of charged atoms, or ions, in and out of the cell. BK channels are active in nerve, muscle and gland tissue in mammals, where they control neurotransmitter release, muscle contraction and hormonal secretion. Animal research suggests that slo-1 mutations lead to resistance to the intoxicating effect. Andrew G. Davies, UCSF, Cell 12/12/03

Knocking out cAMP Gene Increases Sensitivity to Intoxication: Fruit fly research at UCSF has found that a gene known as amnesiac and which encodes for a protein that stimulates cAMP production, if knocked out, increases the sensitivity to alcohol intoxication. The cyclic AMP (cAMP) pathway, a signal transduction cascade is known to be affected by alcohol through studies in human cells. Hugo Bellen, Cell 6/12/98.

Liver Transplanted Alcoholics Live Average of Three Years: A report on the transplant of 20 alcoholics abstinent an average of 24 months before transplantation says 25% were dead in one year and 50% in three. Outcome of liver transplantation in patients with alcoholic liver disease. Parolin MB, Coelho JC, da Igreja M, Pedroso ML, Groth AK, Goncalves CG. Arq Gastroenterol. 2002 Jul-Sep;39(3):147-52. Ed: Unless the costs have come down, an unlikely event in the field of medicine, a liver transplant costs $250,000 in the U.S. This study doesn't give enough information to figure out the cost per year of life gained, but it looks pretty expensive.  I also don't know if this limited survival is typical of all liver transplants.

PKC Enzyme Lack Increases Sensitivity to Intoxication and Decreases Consumption in Mice: 11/99, UCSF researchers report that mice genetically engineered to lack the enzyme, known as PKC , were 75 percent less apt to imbibe than their normal brethren. Alcohol and benzodiazepines, which latch on to an adjacent spot on the GABA-A receptor, act by enhancing the response of the receptor to the GABA neurotransmitter, prompting the receptor to keep its channel open longer than normal, which leads to the release of more signals of gratification, relaxation or sedation. Without PKC, but in the presence of alcohol or the other drugs, the GABA-A receptor becomes even more sensitive to the GABA neurotransmitter. Due to the increased sensitivity to alcohol in the absence of PKC, mice lacking PKC became twice as active in response to low doses of alcohol (dashing around their cages) than normal mice. And they became more sedated in response to high doses.