Justifying Alcohol On Economic Grounds Seems Wrongheaded
A recent Op-Ed in the Louisville Courier Journal laments recommendations being considered at the National Institutes for Health about binge drinking and heavy drinking (“Kentucky's bourbon business is vital to our economy. Don't let DC dry it up”, May 28, 2025). The author claims that these recommendations are based on incorrect science and that they will harm the economy in Kentucky that is reliant on great measure on bourbon. While we may agree in some part with the author, basing an argument for alcohol on economic grounds seems wrongheaded.
If there is a near-prohibition lobby we, too, would disagree and think them Menken’s Puritans. While we will make the argument for consumption here, doing so on economic grounds for a substance that costs the nation $249B and results in 178,000 annual deaths seems antithetical.
To start, the science is clear, “We cannot talk about a so-called safe level of alcohol use. It doesn’t matter how much you drink – the risk to the drinker’s health starts from the first drop of any alcoholic beverage. The only thing that we can say for sure is that the more you drink, the more harmful it is … the less you drink, the safer it is”.
Further, the purported health benefits of alcohol use have been repudiated. From JAMA “Observational studies have repeatedly demonstrated a lower risk of cardiovascular disease with light to moderate alcohol intake compared with either abstinence or heavy consumption, suggesting J- or U-shaped epidemiologic associations. However, the observed cardiac benefits of alcohol have been hypothesized to be the product of residual confounding (variables) because of favorable lifestyle, socioeconomic, and behavioral factors that tend to coincide with modest alcohol intake.” In sum, there is no safe use and no cardiovascular benefit of alcohol.
However, there is evidence of human use of alcohol from 900,000 years ago and alcohol is a well-established part of life in America. Many alcohol-containing beverages provide flavors and sensations that people enjoy and the effect on how we act and respond in social situations are two of several reasons for widespread alcohol use in our culture.
Concerning responsible drinking the data are split. The United States Census Bureau estimates that there are 258.3 million adult Americans. The National Institutes for Health estimates that 63% used alcohol at least on occasion in the past year or 177 million Americans who imbibe. Among these, the NIH estimates that 61.4 million have participated in binge drinking in the past month by consuming toxic amounts in one sitting. The NIH estimates that there are, separately, 16.4 million heavy drinkers who drink beyond moderation every week. The NIH estimates that there are 54 million Americans who need treatment for Substance Use Disorder. Many Americans drink responsibly. Using some rough, back of the envelope math, assuming overlap in these data points, 100 million or more Americans drink responsibly but many others do not.
The National Institutes for Health defines moderate drinking as two drinks per day and seven per week for men and one drink per day and four a week for women (alcohol is on the whole metabolized differently by gender). This is likely the source of the Op-Ed author’s lament. Of course, this recommendation requires the definition of a standard drink which is 12 ounces of beer at 5% alcohol by volume (ABV), 5 ounces of wine at 12% ABV, or 1.5 ounces of spirits at 40% ABV.
Concerning risk, it is also true that Americans take similar and more severe risks than alcohol use on a regular basis. For instance, Driving Test America estimates that in 2021 Americans drove cars and light trucks 3 trillion miles. These drivers are guided by rules of the road and formal laws that guide their driving behavior, and the manufacture of automobiles is very regulated for safety purposes. Nonetheless, there were 6.1 million vehicular crashes, resulting in 1.7 million injuries and 39.3 thousand deaths in 2021. This analogy falls apart at some point, as all do, but the point is made that alcohol use is not the only widely popular, risk taking behavior in America.
Applause to the author for contributing to the public debate. We would agree about a near-prohibition agenda if such exists. America and most of Europe has tried prohibition. We know how that ends. Further, regulating the amount of consumption would be a regulatory nightmare. We should consider the NIH information as advisory. However, holding up the economic benefit as a reason to ignore the science is not the way to go. Better for the alcoholic beverage industry to recognize and promote responsible use and take those steps within their ken to reduce heavy and binge drinking. A market we can reasonably assume to be 100-120 million American adults who drink responsibly should suffice. For the nation as a whole increasing access to treatment would be a far better use of our time and treasure.
Gene Gilchrist, Ph.D.
Louisville, KY
