What do we Know about Beneficial Consequences of Moderate Alcohol Consumption on Social and Physical Well-Being? A Critical Review of the Recent Literature:

Although the preponderance of research studies on alcohol consumption has been concerned with the deleterious aspects of its ingestion by humans, the last decade has been marked by an increasing number of empirical studies that conclude that moderate drinking may be beneficial to one's health. Most notable have been the studies that deal with the incidence of coronary heart disease (CHD). Increased attention to the alleged health benefits of moderate alcohol consumption is in one sense the rediscovery of the folk wisdom paradigm, which existed in the first decades of the 20th century, of the medicinal value of alcoholic beverages. During American prohibition (1920-1933) one could obtain alcoholic beverages with a physician's prescription, and alcohol's use as a medicine has been documented by many scholars in various Western societies, such as Ireland, the Czech Republic, Poland, etc., both before and concurrent with the emergence of modern systems of health care. Therefore the increased research attention on possible benefits of moderate alcohol consumption should come as no surprise to students of the history of alcohol use. Beneficial alcohol health use claims have come to the attention of the American government. The 103rd (1994) United States Congress, in reports from appropriations committees for the Departments of Labor, Health and Human Services and Related Agencies, and for Agriculture, Rural Development, Food and Drug Administration and Related Agencies Programs, called for the National Institutes of Health to research "the impact of alcohol on cardiovascular health and longevity and on the dietary role of antioxidants and moderate alcohol consumption, and to develop a working strategy to assure future research on this important issue." In accordance with these instructions, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is currently soliciting research proposals under the title "Moderate Alcohol Consumption: Benefits and Risks" for the areas of alcohol and coronary artery disease, alcohol and hypertension, alcohol and stroke, alcohol, osteoporosis, and breast cancer, interactions between moderate alcohol consumption and various medications, risk/benefit analysis, and psychosocial issues. This paper critically evaluates recent research studies that suggest that moderate drinkers, as opposed to abstainers and heavy drinkers, have certain health advantages. It concludes with an evaluation of the classifications of abstainers and moderate drinkers for research purposes. Review of selected health studies In this section we critically evaluate some recent research studies that suggest that moderate drinkers, in contrast to abstainers and heavy drinkers, have certain health advantages. A word of caution is in order before we begin this review. Research on the benefits of moderate drinking for such conditions as osteoporosis, hepatitis, diabetes, rheumatoid arthritis, and colds is in its infancy; more research is needed on the role that various drinking patterns play in these conditions. The largest number of studies are in the area of coronary heart disease; numerous epidemiological studies indicate that CHD and moderate alcohol consumption are negatively related (Klatsky et al., 1990). It is beyond the scope of this paper to review all the studies in this area, for they number in the hundreds. Before one can conclusively state that moderate alcohol consumption has a positive impact on CHD, it is necessary to note certain limitations to these studies. First, the studies are correlation based; therefore the causal mechanism by which alcohol exerts its alleged protective benefits is unknown, although numerous hypotheses have been advanced (Haffner et al., 1985). Most of these concern the effect of alcohol on HDL cholesterol and platelet aggregation. Lifestyle factors have been shown to affect CHD rates (Barrett et al., 1995). If moderate alcohol consumption does have a protective effect, can the same benefits be obtained by abstainers who are characterized by habits that include nonsmoking, a low-fat diet, regular physical activity, weight control, an ability to manage stress levels, and membership in primary groups that support abstinence? …