Rethinking Alcohol: Why It's More Dangerous Than Other Drugs Combined

All recreational drugs. If you sum all the deaths from those, yeah, alcohol is about three times that of everything else put together. Hello and welcome to Instant Genius, a byite-size masterclass in podcast form. In today's episode, we're speaking to Professor David Nut to talk about alcohol and its effects on your health. So, Professor David Nut, welcome to the podcast. Thanks very much for joining us. Thanks for inviting me. So, today we're talking all about alcohol. So let's start with some numbers first before we get into the sort of the meat of things. So people who are familiar with your work will know that

one of the messages you're keen to get across is the fact that the harm caused globally by alcohol is greater than that of any other drug and know it's more than excluding tobacco but all recreational drugs all recreational intoxicants if you sum all the deaths from those. So that's stimulants that's opiates canabonoids etc. Yeah, alcohol is about three times that of everything else put together. So I think for most people that would be quite shocking due to the prevalence of alcohol use. Yes. So let's have a look at the history of alcohol use then. You know how did we reach this point because it's so ingrained in our society. Yeah, that is really a critical question and the answer is we stumbled upon rotting

fruit. Uh when we moved out uh from the uh the sort of deep jungles into the savylvanas, we found fruit that was rotting. We ate it. We discovered I saw other animals eating it, enjoying it, and we realized actually it could take away some of the pain and distress of living a hand-to-mouth existence. and we've been seeking the pleasures and the and the relaxation of alcohol really ever since humans existed. But there's a really interesting theory by a American uh anthropologist called Edward Slingerland. His theory is that the core basis of human society was when we stopped being um nomadic and we settled down to grow things and we settle down wheat. And Johan Hariri thinks growing

wheat led to civilization because the it made people stable. So while they were waiting for the wheat to go they could do other things like develop language and um and mathematics etc. Slingan says no we didn't grow wheat to make bread like Heri thought. He said we grew wheat to make beer. So it was actually beer that brought humans together as a culture and we've used it ever since. Yes. Yeah. The other thing about alcohol is it's it's when you ferment water with you know sugars and yeast to make alcohol you kill off the toxic bugs. So until about 200 years ago the only safe potable form of liquid was actually beer weak beer or in the continent was alcoh was wine. So people were brought up to think of alcohol as the essentially the

safest drink and water as a rather dangerous thing. Yeah. I've heard before that sort of um you know back going back a few hundred years English housewives would all have a sort of bucket of beer in the kitchen that they' use as the their daily sort of liquid hydration. Absolutely. That was called small beer and it sort of less than about 3%. And then you went for the heavy beer. A great term they still use in Scotland. The heavy beer was sort of 4% upwards which you drank uh at night or at weekends for celebration. So I don't know if you'd agree with me, but I think personally one of the reasons that um alcohol use is so sort of I guess I'd say peritious is that drinkers can kind of make it fit any situation.

So I'm promoted at work, I'll celebrate with a drink. It's my birthday. I'll celebrate with a drink. I've lost my job. I'll console myself with a drink. I've had an argument with my partner. I'll console myself with a drink. You know, why is it what can we say about that? You know, do you agree with that? No question. I alcohol is present from the day we're born to after we're dead. And the reason for that is it is that it's a very social drug. When people are celebrating in groups, there's always a degree of anxiety. I like to say that humans are really social creatures. The reason we are the utterly dominant species on this

planet is because we work as an amazing team. I mean, look, we got a team here already. You know, I don't know any of you, but I, you know, I'm working with you. But so we are phenomenally social but we're also a little bit anxious of strangers and sometimes we're quite anxious of our own extended families and alcohol reduces anxiety. So it's used in social engagements to dampen down social anxiety and actually that's why it should be used. That's why it exists. That's why it has been perpetuated. I mean yeah go back to the Bible. You know what everyone knows? You know the after the raising of Lazarus, the next great uh achievement of Jesus was turning water into wine in the wedding at Kaa. Why was wine important in

Jewish weddings? Because that's how you really it was a celebratory drink. It brought the whole of the family and maybe the tribe together. But of course, it's evolved also to be a deadening agent, a dampening agent. And that's where people get into problems. If we just use it to celebrate once in a while, it would be okay. But if you're using it on a daily basis to deaden the stress of work or to, you know, deaden the trauma that you've had sometime in your life to numb yourself from stress, then it does that, but you it builds up problems because you actually get dependent and also in the withdrawal state, what you're trying to deaden gets worse. So, sort of sticking with the social thing.

I mean, personally speaking, I know um like I say several times I've been to in a barbecue or somebody's birthday or something. Didn't really want to drink, but I had one anyway, you know, just because that's what's done. Well, you're quite right. It's become a social norm, hasn't it? And in fact, that's a is a huge problem because for people, particularly people presumably not you, but others who've actively decided never to drink, they're seen as weird. they're seeing as outcasts and there's huge pressure on them to drink and which is very unfortunate and I think that reflects like reflects two things. It reflects ignorance. Uh I it reflects advertising which basically shows that the best way to socialize is through

alcohol and that's that advertising is pervasive. And um but on top of that it's you know it's um I think it's also those of us who drink actively denying the harm. So someone like you is not drinking. We are exposing our frailties. We're exposing our basic illogicality. and people don't like that. So, do you think attitudes are changing? So, I can say um one like personal anecdote that I have when I was younger, I worked with an older person. I guess he must be in his late '7s now. And he told me in the 60s that he would go to the pub, have a few drinks, and then he'd go home and he'd go for a drive to sober up, which is just absolute mad absolute craziness, isn't it? Just that's why we

brought in the drink driving laws. But do you think so now these days like apparently younger people are drinking less, we have more alcohol-f free options. Do you think the shift that shift is actually happening? Well, the shift is slightly more complicated than that. So over Yes, there are definitely a larger proportion of young people are either drinking nothing or drinking less. But the overall consumption in young people hasn't gone down. And that tells you that others are drinking more. And so we're getting a sort of polarization, very heavy drinking, but exceptionally heavy drinking now in um particularly young professional women who are now drinking

actually drinking more than men, which is quite worrying because women are more vulnerable to the effects of alcohol in men, particularly metabolic effects. But the reason a significant proportion of people are drinking less is fascinating. And it there are several factors. Partly it's health or partly people realize that alcohol is more toxic than they were led to believe because of the sort of messages that this program is putting out. I think it's partly due to the mobile phone. I think the prospect of doing something really stupid when you're drunk and having it filmed and having immortalized forever by your friends sending it and putting it into the into the cloud, it's actually quite disturbing for somebody because it could

actually destroy people's careers. And we've seen that. I mean that student in Newcastle who got very drunk on a pub crawl and he peed on a war memorial and you know it almost destroyed his life the hustle, you know, the tax he had. Um, but also I think this we're actually moving now into another phase where younger people are actually looking to the old ones like the car you used to look after and they're saying, well, you know, that was rather blind. That was kind of thoughtless. You know, we know more. We're more educated. We can find out find the truth about the harms of anything much more easily than we did before. Because there used to be that wonderful old adage, you know, what's the definition of an alcoholic? An

alcoholic uh is by definition someone who drinks more than their doctor. And given the fact they dropped doctors, medical students and doctors drink more than the average. It was actually quite difficult to get a diagnosis for an alcoholic in the old days. And actually that did seriously impede the roll out of effective treatments. But now young people are much more cynical. They find out the data for themselves and come to their own conclusions. So let's sort of stick with the this cultural um aspect that surrounds alcohol which I think is really interesting which is the use of language. So you mentioned the um the women who are drinking. So we've got wine a clock. Yes. Um we've got have a tipple you know they're all very sort of

warm friendly terms you know and I think that's interesting. There's something psychologically going on there. You know it's harmful but you just say oh I you know I'll just have a I'll have a tip. will have a weed ram. Yeah. Well, of course, in the old days, the worst one of all was one for the road. Now, that was all right if you were sitting in the back of a horsedrawn carriage, but when you're driving a motor vehicle, that's extremely dangerous. And yeah, and it basically illustrates the point that alcohol is for many people a very warm, very beneficial drug. It makes people have fun socially. I mean most I think I can certainly say for my generation the vast majority of people who are in partnerships have met and

engage with their partners over alcohol. So alcohol has that rather special role and that's an important role for human society. One of the theories that Slingerland came up with for uh great sort of you know um pre ancient era monuments uh like Stonehenge was that they were built so that people would know where to go to get drunk. They were the they were festival sites. It brought together tribes uh to consume alcohol. most in the case of the UK beer obviously in places like Turkey that would be wine and that was there were two purposes of that one was to sort of make peace with the other tribes for a bit and the other was to get partners and spread the gene pool. So you and that you know you can argue you know that again if alcohol

successfully spreads sort of the genetic diversity of humans it actually have quite a big impact on maintaining humanity as a or humans as a species. So let's move on to physiology then. So say I have an alcoholic drink. What happens? What's going on in my body and my brain? Yes. So, I get asked that question a lot and I always have to ask a question back. Would that be your very first ever drink or would that be a drink that you your favorite drink? So, let's let's start with your first ever drink. You know, I don't know why. You spit it out. The first time you I mean I don't

know if you can remember your first ever drink. Yeah. Dad, can I have a lag of Chandi? I hated it. Yeah. But why chandi? Um I suppose I wasn't allowed a proper laga. I was probably about 13 or course shies exist in pirate so that the horrible bitter taste of the hops that is in laga don't doesn't make you want to spit it out. If you take a ch a baby and you put your finger in them you know into a vodka glass and put it on their tongue they will out. It's really horrible and aversive. People say they drink alcohol. I say no one unless serious alcoholics drink pure alcohol because it's really aversive. We all

drink alcohol that is flavored in some way and some of that flavoring is like shandi is sweetener to encourage people to drink. And of course that's one of the huge one of the worst I think marketing behaviors we've had over the last 30 years is to make breezes to make sweet forms of rum and vodka so that young people can drink them without dis knowing there's an alcohol taste in them. They drink them like lemonade and of course that can lead to serious intoxication and even death sometimes. But as you get more sophisticated get more used to drinking other things happen. So if you are a regular drinker and say you have your favorite glass of wine, the first thing that happens is that you're already enjoying it as you pour the cork

as you begin to pour it to melt it and taste it. that all those actions are activating a circuit in your brain that has over you I don't know in your case maybe 20 years become conditioned by the experience of the alcohol eventually getting into the brain and you saying wow I enjoyed that. So you so when people say I'd absolutely adore this aroma of you know my 1964 you know shatter whatever what they're actually saying is over the time the alcohol has made them enjoy that cuz the to give it to some someone who has never drunk it before and appreciate they wouldn't appreciate at all it would actually be rather different from any other wine they had before and there's a really interesting anecdote so there is this very famous

wine you know lour wine the lator um clarret and the guy I was giving a lecture in a university in the economics department and we were having dinner afterwards and the uh the professor of economics said yeah we were drinking some quite pleasant wine cuz he was a wine buff and he said I got to tell you this story David he said I was in China a couple of years before he said and they opened the shore 64 you know like 500 pound bottle of wine. I had never tasted it, he said. I was gagging. I thought, "Fantastic. I'm going to taste one of the ultimate wines." So, they poured it out and before he could pick it up, they filled it out with Coke because they hate the taste, but they wanted to show after the

fact they were drinking the one of the world's most expensive wines. He said, "I didn't know what to do because I didn't want to embarrass them. I thought, you know, it was like talking about having the class taken from your lifts." So, how about our brains? You know, because obviously anyone who's been around people who have had too much drink knows that somebody who's very previously mildmannered can become aggressive or there's the old, oh, I love you mate thing. And you know what's going on there? It's complicated. Alcohol is a very promiscuous drug and promiscuous in the sense that it works on multiple neurotransmitters. So you know you're aware that there are maybe 80 different neurotransmitters in the

brain and it's almost certain alcohol affects all of them at certain concentrations but it does it in a stepwise fashion and that's one of the reason why it has survived so long because if you just have one drink you generally just relax and you don't get into trouble. In fact, you generally don't have massive increase in road accidents. And that's because the first drink turns on the relaxing transmitter in the brain called GABA. That's that's that when you get anxious, GABA levels are down and alcohol pushes them up or pushes the function of GABA up to take away social anxiety. Great. You get to the next drink, GABA is acting maximally and fine. But something begins for many people begins to trigger at that level of the second drink and

that then want makes them want to drink more and there's a sort of moorishness and we've seen that and you've seen that we all know people that say I'll just come for two drinks and you know soon as they have the second drink they will lose control and that's because that as the alcohol levels rise it begins to release dopamine know dopamine is an activating transmitter it also releases endorphins and endorphins are pleasure chemicals like dopamine, they're also disinhibiting as well. So, the push of dopamine makes you active and loud and noisy, and the push of endorphins makes you I don't care anymore. And then the vicious cycle of drinking more takes over. And then eventually once you've had about five or six drinks, you and

hopefully most people don't get to there you but many do, you get to a state where you have blackouts. You don't remember what you're doing or you've done. And that's because alcohol then blocks the transmitter called glutamate. And that is the main excitatory transmitter in the brain. Your brain is working. Everything that you have heard me say, every thought you've had about what I've said, every vision that's happened in the last 20 minutes has been encoded by glutamate. And if you block glutamate, eventually, you know, urinetize and alcohol used to be used as an anesthetic and eventually you're dead. And that complex sort of staircase effect of alcohol explains why people have different responses. And some people go deliberately to get the

dopamine. Some people go and I, you know, they will drink half bottle of wine or a bottle of wine before they go anywhere because they know they're going to be up and I'm ready for action or ready for fighting, etc. Yeah. So, how about the strength of the alcohol that you're drinking? So a lot of people say, "Well, you know, I don't have a problem cuz I only drink beers or wines. I never touch spirits." Yeah. So the strict answer is that um there's no difference provided you consume the same amount of alcohol. Of course, it's quite easy to drink far too much alcohol if you're if you're drinking a spirit. If you drink, you know, we don't serve spirits in pint

glasses for a good reason. But of course we used to, you know, when the gin craze hit London, when we liberated the basically liberated the market for distillation, people were drinking a lot of gin because it was the same price as beer, but you could get a, you know, get a lot more intoxicated. And that's that's when we started bringing in controls on drinking through taxation. And actually pretty successful. I mean by and large with the exceptions of strong ciders which are under taxed I mean a strong cider can have as much alcohol as a weak wine but part for historic reasons because cider is a good British drink. We haven't tax cider but we're beginning to do that now but by and large the taxation reasonably

reflects the amount of alcohol that's in the drink. So, how about real sort of what I guess you'd call problem drinking? Yeah. So, some people can just have a glass of wine on a I don't know on a Saturday with their dinner and just leave it at that once a week, once a month. Other people once they start it's so difficult for them to stop. Yeah. What do we know about that? Well, there are we know that there are at least three drivers to loss of control. So we know 80% of the British adult population drink alcohol to some extent. Probably about 15% have problems. And of course that is why it's still so popular because for most people alcohol doesn't lead to problems. But 15% of 80% of the population is millions

of people. And that is also why it's a huge problem because of the bulk of numbers of users. So why do people get into problems with alcohol? Well, there are as if there are three main drivers. The first is very typically uh young people who are drinking to get really high and when they get so high they lose judgment and uh they sometimes even damage their brain through fights or through traffic accidents etc. So they're in sort of the early onset people with alcohol dependence. And then there's another group and this is the largest group. These are people from sort of 20s onwards who are stressed, have tough jobs, who are, you know, maybe suffering, you know, maybe

they're, you know, financially strapped as well. So they life is stressful and they turn to alcohol to reduce stress. Uh, and which works. It relaxes them. They come home, you know, have a drink, it relaxes them. But if you do that every day for months or years, in the end you become more vulnerable to stress. So you have a that cycle of drinking. And then there are other people who have got formal psychiatric disorders like PTSD. Yeah. Where the traumatic memory comes back every day, every night. And we don't have good treatments for PTSD. And so many people, the majority of veterans with PTSD drink excessively because it numbs the experience or

the reliving of the traumatic memories and they end up becoming dependent on alcohol as well. So let's have a look at dependence then. Let's start with tolerance. So a lot of people talk about alcohol tolerance. Yes. In some ways it's seen as a badge of honor, isn't it? Like amongst certain people they can you he's a good lad or whatever. He can drink six, eight pints or something. But does it vary from person to person or is it only sort of based on habit acquired? Yeah. Well, both are both. It's really interesting and actually some fascinating work done. Brain and body adapt to alcohol. So you be you become less affected for a given dose. But it can also be inherited and there's some remarkable work done here

in Bristol with the alpac cohort. This is following children over a period of I think now they're about 30 and um they monitor drinking behaviors uh in when they were under in pre-teen a lot of people could start drinking before then and they essentially kind of proved a theory which was developed by a guy called Mark Shuket in America. He noted that the sons of male alcoholics had a very high propensity to become alcoholic. Uh and they often were less affected by alcohol. They were the people that would still be standing when all their mates and so they did get killed or you know wow he's a you know he's a hero because he can take his booze but they end up becoming alcoholic. And in fact, the

Osbach cohort was a sort of independent verification that if you are very resistant to alcohol, paradoxically, you're more likely to become alcoholic because you drink more because you can drink more. And in fact, you know, it's very common in, you know, I'm a psychiatrist. It's quite common I to talk to people particularly people who are very anxious actually. They say even a small amount of alcohol makes them feel a bit different. So they'll never get drunk because they're just terrified that they won't be able to control themselves when they're drunk. So there is a genetic component, but then on top of that, yes, if the more you drink, the more tolerance you develop. And then the more tolerance you develop, the more you need to

drink. And then and that vicious circle is what eventually spirals people into severe dependence. So you mentioned their children. Does the sort of the age at which you take your first drink affect your drinking habits later in life? Yeah, that's a really difficult question and it's such an important question because you know there are protagonists for the theory well you can teach people to drink sensibly by introducing alcohol to them as your father did to you in a weak form in a social gathering so they can learn how to drink socially. and the other is say no don't let them have anything till they're 18. Uh and we don't know the answer to that. I mean it's it's quite likely that you know for some people one

work for other people the other work but there's it's impossible to dis you know to actually be to make a general statement. I think what we can say is that the drinking age doesn't seem to have a huge impact because we know in the UK the drinking age is 18 and the median age for becoming alcohol dependent is 15 and we know in the UK for the last 40 years we've been monitoring these data half of 15 to 16 year olds are drunk once a month. That's three years before. So early drinking is um very common. The drinking age doesn't seem to make much difference. An American is now the drinking age is 21. But the median age for becoming alcohol dependent is now like you 18. So people kids will drink before they're

allowed to drink because they see other people drinking. And uh so I don't what message does that have to us? I think the message is you need a different approach. You can't legislation isn't working. It's got to be something like education or as I've been trying to do give people alternatives. So let's sort of stick with dependence. So another tone that you that gets thrown around quite a lot is um there are functioning alcohol dependent person. I mean is there such a thing? Totally. And that's one of the more chilling discoveries in the last 20 30 years. And the most staggering data that um I came across from the work of Professor Nick Cheron from Southampton University. So he's a he was a world expert on alcoholrelated liver disease.

And in his liver unit in Southampton, you he would assess hundreds of people every year for liver disease, most of them were alcoholic. A third of them never met the criteria for being alcohol dependent. They were just people, ordinary people who just drank a bottle of wine every evening with their meal. Middle class people just drinking because that's what you do. I mean, doesn't everyone drink a bottle of wine? If you watch the TV, if you watch Netflix or HBO, that's what everyone does. You know, the placement of alcohol, particularly in relation to women's um eating and drinking on is staggering. It's be we have normalized that's maybe that's the biggest social change in the last 50 years is we've normalized wine drinking. You can see

that this massive increase in wine consumption. We've normalized wine drinking. with meals. Uh, drinking wine with meals doesn't make it less toxic, of course. So, we've talked about a lot there. So, let's let's have a look at some solutions then. What can we do? What can we do to stop this problem, which is obviously huge. Yeah. Well, the first thing is accept as a problem. And we're getting there. We haven't quite got there yet. I mean, we still advertise alcohol despite David Cameron saying we would stop doing that. Oh, we don't advertise tobacco, but we advertise alcohol. They don't actually promote drinking, but they promote the value of the entertainment industry. And the fact that the drinks

industry is also being really good at undermining in a very subtle way the uh evidence uh alcohol is harmful. So until about 10 years ago I and I remember this absolutely vividly because I remember where I was I was in my flat in London and I it was breakfast news and I remember University of Sheffield which is the sort of Britain's leading center for looking at the harms of alcohol came up someone one of their spokespersons came on just done this report and it was about the justification for minimum unit pricing in Scotland which eventually the Scots took on but this was before this is when the process was just beginning. So, we're probably talking about 201 10 or something. And the drinks industry had someone on there and the drinks

industry person said, "Well, there's no proof that minimum unit pricing will work." And you could I could feel the tension. It was silent. the Sheffield academic was silent because I knew he had to say yes, there isn't any controlled trial showing that and he didn't but he so he but he didn't want to say that but and he didn't know what to say. What he should have said of course was well actually you know the gin epidemic in you know 1720 showed that pricing has a huge impact on consumption but he got locked into this well is there real proof in the modern era and the great the drinks industry undermine the argument it took seven years for the Scottish Parliament to get minimum unit pricing

through eventually ended up in the European Court of Justice anyway so the drinks industry fights a very clever very long game that's the first thing and it uses all sorts some myths like, well, can we really say alcohol is bad when there's a bit of evidence that if you know red wine might be beneficial to the heart? That's that's been done for about 12 years, 15 years. Well, people believe that the reality is red wine is great for the heart. If you live in Provence, eat lots of polyunsaturated and get lots of vitamin D from the sun. Yeah, great. But if you're drinking red wine and you know cheap red wine in Glasgow or Belfast or Bristol, it's not going to protect your heart. So, so that the dissembling the machinations to

undermine the health message. Uh and then on top there's also this misunderstanding by the Treasury. I mean the one thing the drinks industry is good at is paying taxes every month, every quarter, drinks industry. So, you know, there's a steady income. And when we say things like well look let's if we could reduce drinking we would reduce health costs the treasury say yeah but that'll be a long time coming you know we might not even be in power you know the government well uh the reality is it's not actually it's one of the interesting aspects of that is that the Scottish experiment with minimum pricing show that actually that assumption was wrong because if you reduce alcohol

consumption even by about 10% which is what minimum pricing did in Scotland. The predominant impact is on two groups. It's on people who are really, really suffering from alcohol. One of the reasons the Scots brought in minimum pricing was because at that time 40% of all the intensive care beds in Scotland were occupied by people whose illness was due to drinking. And if you reduce that by from 40% to 30% which they did that's a massive health cost and it's immediate. So that's a so that so we can argue against the supposition that actually it takes a long time for changes in alcohol policy to come to benefit the treasury and we're winning you know I mean you

know programs like this are helpful as well because you know there's the public I think now are beginning to understand at least there's there's a debate both ways so sort of one final question that I wanted to ask you which I was going to earlier but forgot is so say alcohol didn't exist. Yes. And then tomorrow somebody invented it and it came onto the markets. What do you think that would be a legally controlled drug? Yes. In fact, it's one of the interesting aspects. I mean some of you may know that in 2016 Theresa May through when she was secretary Theresa May was convulsed by hatred of people using drugs. Uh and um so she brought in the psychoactive substances act

uh not realizing that alcohol was a psychoactive substance and that created huge problems for the government. Um and what they did was they said, "Oh, yes, it is a psychoactive substance, but we're exempting it from the act." And those of us who thought the psychoactive substance act was absolutely insane piece of legislation. The first time in the history of this country, you had a legal act that didn't have any examples of what it was talking about. There was not a single single agent drug mentioned in the psych assessment except alcohol, tobacco and caffeine. So alcohol was exempted proving the government knew it was psychoactives. So we wrote to them and said well on what is the criteria for

exemption and they said the exemption is based on precedence and actually I can accept you know 40,000 years of alcohol use is precedence but uh if we invented it today we wouldn't have that precedence would we? So what would we do? Well what we would do is this. you would put your alcohol through food safety testing and it would fail. Well, it would fail because the and this has been done the maximum recommended amount of alcohol to you any individual can should consume in a year based on the toxicology is a large glass of wine per year. So it would fail. That's why they had to exempt it because, you know, you couldn't put it through normal testing. So that tells you how relatively harmful alcohol is. But I want to finish with I don't want

Yeah, my approach to alcohol is not that it's all bad. If it was all bad, it would have disappeared. And the point is there are good aspects to it. And it would be really nice if we could maximize the benefits and minimize the harms. And that's, you know, what a lot of my research at present is about. So, Professor David Nut, thank you so much for your time. It's been an absolute pleasure. I'll come back anytime. Thank you so much. Thank you for watching this episode of Instant Genius, brought to you from the team behind BBC Science Facus. That was Professor David Nut. To discover more about the topics we've just discussed, check out his book, Drink: The New Science of Alcohol and Your Health. If

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