Drink?
by Professor David Nutt
Pub Date: 22 Dec 2020
I realize this has turned into more of a critique than a book review. You may just want to read the first three and last three of the following paragraphs if you want the short version of my review.
Labeled as "self-help," this book is then presented a little backwards. The beginning is the "why" alcohol does what it does, and the second half is the "how" one can reduce or eliminate alcohol use. By the time I got through the "why," I was almost uninterested in the "how." Granted, one might never read the "why" section if they get through the "how" section, since the self-help portion is the reason one would obtain the book in the first place. However, I was more impressed, and less confused, by the self-help section, so I'm glad I persevered.
Read the introduction; it contains some of the 'truths' about alcohol. "Marketing has altered our perception," "...its's absurd that coming of age should still be about alcohol," and "Would you take a new drug if you were told it would increase your risk of cancer, dementia, heart disease, or that it would shorten your life?"
Chapters 1-5 are the "why" - chemistry and biology - and chapters 6-10 are the "how" - psychology and sociology.
WHY: Chapters 1-5
There were a number of places in the book where I questioned whether Professor Nutt's statements were opinion or fact. These were the places I expected to see citations, like throughout the rest of the book, but where documentation for an assertion was lacking. For example, Professor Nutt's use of words like 'slight,' 'possible,' 'seems,' 'I think,' and 'some' caused me to search for citations to determine the research behind the associated statements, but the citations just as often weren't referenced. One example is "...the number of people living with it [alcoholic dementia] is expected to triple by 2050." THAT'S a statistic that requires a citation!
Irrelevant to which part of the book some of his suggestions appeared, a few concerned me. Although one section is subtitled, "Hangover Cures: What's the Evidence," implying he's presenting information and not recommendations, since this is a self-help book, I might assume that most readers aren't processing the "What's the Evidence" portion of the heading and merely focusing on the promise of "Hangover Cures."
For example, in number 2 he describes beta blockers and ends that paragraph with, "Whether they do more than that, I'm not sure." It's irresponsible to leave it at that; do beta blockers for a hangover do more good? More harm? Not enough 'evidence,' Professor Nutt.
Although one shouldn't expect 100% definitive guidelines, I'm bothered by some contradictions. At one point he says, ""...don't drink at all - because there are no health benefits" and "...no level of drinking is actually beneficial to health." However, one whole chapter (8) is about "The Social Benefits of Alcohol." Granted, health and social benefits are different, but he expounds in so many places how alcohol provides social benefits, which others can argue can positively affect health benefits. He concludes that "...But if you want the sociability benefits alcohol brings, it's a different story. In that case, you need to decide what risks you want to accept...." Teeter-totters go in both directions; he implies that the benefits of alcohol abstinence and social drinking have an inverse relationship, so one has to choose, to "balance out the pleasure you gain." Further into the book he says, "...that the amount of alcohol optimal to provide the protection ["partial protective effect on cardiovascular health - The Lancet"] appears to be very low - about one unit a day." So there are some health benefits; he just wants us to know "...that the benefit to the heart does not outweigh all the other risks of alcohol...." And remember the reference to alcoholic dementia above? Later in the book, he says, "...low levels of alcohol consumption - that is between one and ten drinks a week - reduced the risk of dementia. In fact, it appears that being teetotal may raise your risk of dementia...." He also includes "...a 2017 review [that] concluded that light to moderate drinking does reduce the risk of diabetes," and that report IS cited.
I also questioned some of his assertions like, "...there are wards full of these kids," while talking about "acute alcoholic hepatitis" in young binge drinkers. Then he goes on to say, "However bingeing is not the reason behind most cases of alcoholic hepatitis...." He also provided no citation regarding the number of kids or the number of wards. There were also some judgmental statements peppered throughout the book. In one instance, Nutt says that he doesn't think people seeing their doctors for hypertension are being asked about their alcohol use, "...perhaps because many doctors drink too much themselves?" If that's not just a judgment, then where's the citation?
The British perspective came through a few times. For instance, in the section, "Major Ways Alcohol Affects Your Length of Life," I had to look up Professor Nutt's reference to Damien Hirst's sharks and cows with regards to Nutt's mention of formaldehyde. However, I was pleased that Professor Nutt was inclusive and did include science references to Asia and Africa along with Europe, the UK, and the USA.
I liked his discussion (and the reality check) of the arbitrariness of legal blood alcohol limits. He points out that for .079 and .081 "...is not that one is safe and the other dangerous, but that one if legal and the other is not." I also appreciated that he found a way to show how one's alcohol use affects others and not just one's self. He cites that the estimated prevalence of fetal alcohol spectrum disorders is 8 in 1,000 while the prevalence of Down's Syndrome is 1 in 1000. Perspective on preventable disorders is powerful. These type of discussions absolutely support his goal of an individual being "...able to work out how little you need in order to get the effects you do want."
HOW: Chapters 6-10
Early in the second half of the book, Professor Nutt relays some social the history of alcohol. One interesting part discussed how "...ancient Persians would only finally make a decision after the issue at hand had been discussed both sober and drunk," since being drunk brought out one's creativity. And though I knew alcohol was ancient, I didn't know that "It's only been in the last millennium that it has been banned by some religious groups, for example in Islam." [The irony isn't lost on this reader that modern "Persia" now Islamic.]
But sometimes he still spouts a factoid that he doesn't substantiate with a citation. I'd like to see the documentation of these assertions, Professor Nutt!
- "...a view popular with conservative politicians, that addiction is fun and addicts enjoy getting drunk...."
- "...conflation of morality and science happens in addiction more than any other branch of medicine."
- "Drinking has become your hobby or the only way you socialize. This often happens with retirees or expats."
Professor Nutt does a much better job of citing some psychological aspects of why people drink, i.e., the self-help portion of the book. [Read the section on "Is Your Booze Buzz in Your Head?"] Later on he cites one study that "...showed that people drank lager 60 percent more slowly out of straight glasses than out of outward-curving (pilsner type) ones." Now that's interesting, don't you think? He also does a better job in this half of the book delineating when he is discussing fact or logic and not just opinion.
The best part of the book is headed, "How to Talk to Your Children about Booze." I can easily see this portion of the book being used with PTO/PTA groups. It was logical and could be easily implemented as a workshop program to support children and teens from succumbing to peer pressure, social norms, and advertising. While I did learn some things throughout the book, I'm not sure that much else is new or particularly persuasive that could convince an alcoholic to change their behavior; they'd just now be able to tell you why they are doing what they do.
And speaking of irony (which I did in the first ¶ of HOW: Chapters 6-10), his daughter runs a wine bar.
