Author: Dan Malleck

If you remove something as complex as consuming alcoholic beverages from its cultural context, the knock-on effects are remarkable.

Consider the fact, recognized broadly even by some of the most ardent advocates of the population health epidemiological approach to distorting health effects of drink, that people of higher incomes tend to have better health outcomes in general than those of lower socio-economic status (SES).

This relates to something we call the Social Determinants of Health (SDH). These are a variety of factors that affect our health, but are not directly related to biology: income level, housing quality, employment opportunities, access to decent food, social services, etc.

These things all affect our health but they are normally out of our control. Someone who has a low income can’t just magically get a great job. Someone with limited education can’t just magically have a better education (especially if they’re working 60 hours a week just to get by). And on it goes.

This has been widely recognized by health bodies around the world. It has also led to some remarkable progressive efforts to equalize the conditions that can be addressed, such as eliminating “food deserts” in cities and advocating for food programs in schools, improved social housing, etc.

Now when you strip away considerations of social class, economics, and so on from things like the health outcomes of drinking, you get a highly distorted picture (and I’d argue a mostly theoretical picture) of the impact of drinking on health. All of those social determinants of health are ignored or at least seriously marginalized while theoretical models of health outcomes based upon theoretical individuals who theoretically all all in the same context.

So for example, a poor person and a rich person could drink the exact same quantity in the same patterns, and their health outcomes could be different because of those broad SDH factors and many of these cannot be managed (or “controlled”) statistically.

Even if you could control for every cultural factor that goes into an individual individuals risk for certain harms related to alcohol, even if the relative risk increases at the same rate, the overall risk (we usually call this “absolute risk”) of them developing certain conditions or falling victim to certain unfortunate outcomes related to alcohol is significantly different. It is not, however, captured in most of the alcohol harm research and such complexity is hardly ever included in public health anti-alcohol messaging.

Alcohol researchers recognize cultural context, but do their best to eliminate it. For example, when Zhao et al published their article claiming to have proven there is no benefit to moderate drinking, they did it by eliminating any data about abstainers because abstainers are a complicated bunch. Some of them are lifetime abstainers, some stop because they are sick, some claim to abstain but do not.

So instead of digging into these complications, they eliminated them. They decided that people who claim to drink very little (itself a cultural factor) could be a “proxy” for abstainers (even though they do not abstain) and then ran their numbers until they had results that showed no statistically significant effect of moderate drinking compared to this group of [non-]abstainers. Cultural considerations were intentionally erased to get cleaner (and for anti alcohol researchers, more satisfying) results.

Along with being just another way context is dismissed, what does this type of culture scrubbing do?

I would argue that by dismissing Social Determinants of Health, culture scrubbing opens a door for a much more virulent form of paternalism: arguments about Commercial Determinants of Health

See, marginalizing SDH, which are something on which I’d argue governments should (and could) act to allow people to live in a reasonable level of healthfulness, opens the door for arguments about the “Commercial Determinants of Health” to take hold. This idea that people are surrounded by commercial forces that undermine the individual’s ability to be healthy is appealing to governments and progressive public health advocates.

We see such arguments in statements about advertisements for sugary drinks and ultra processed food, all of which rest on an assumption– or even an assertion — that the industry behind this is determined to ruin people’s health, or at least is not bothered about issues of health. This then leads to arguments that, with such predatory bad actors out there, governments need to crack down on all these things that hurt people’s health. (Ban advertising, label everything that even seems unhealthy, and so on)

I’m no supporter of the big food industry–I prefer locally sourced, home made, and so on, and to be clear I have the income that allows me the luxury of acting on that preference–but I do see such arguments as problematic for a few reasons.

1. They are deeply paternalistic: they do not accept that people make their decisions for purchasing food for all sorts of reasons, and many of them are entirely reasonable based upon the context (for example, fast food is quick and easy for parents who are rushing from one job to another to make ends meet; some people simply enjoy it). This is called “agency” and CDH arguments generally deny it to the “victims” of CDH.
2. They distract from the Social Determinants of Health: maybe people would make healthier choices if they had the time, money, and access to better food, and if they didn’t have to work 60 hours a week to make ends meet.
3. They reiterate a classic narrative of some predatory outsider going after unwitting innocents for personal gain. Although this is not entirely fictitious (if you think capitalism and profit are toxic predatory factors, then it’s entirely reasonable to think all these bad actors are just in it to profit on the misery of others).

The Commercial Determinants of Health are peak paternalism. They deny agency of these poor victims who would never go for fast food or a cola if they were not forced to do so by the predatory corporations. They allow these public health researchers to position themselves as heroes protecting the victims, while allowing governments to ignore the very considerable social factors that put many people in this vulnerable state.

(Ironically, some researchers squeeze millions of dollars out of governments to pursue their CDH agenda. I wonder what those millions could have done if redirected to healthy food programs, education, or housing.)

Just to be clear, I am not denying that companies and industry lobby governments to get preferential treatment. But that is very different than what CDH arguments advance as the insidious effect of commerce on individual health.

What does this have to do with drink? Well quite a bit actually. If you remove social context, generate data that does not consider cultural factors, and make big dumb statements about how the industry is out to kill everyone, then you’ve ceased to be a reasonable scholar or a reasonable health advocate, and you’ve become a zealot.

And yet… these arguments are the ones we hear. Partly this is because if an industry group says it, then it is framed as just self-interested, but if public health or health researchers say it, it is framed as disinterested public service. Notwithstanding the millions of dollars of funding that flows into this research.

This leads us to one final issue: the unbalanced research environment. People who seek to undertake more balanced research, and those who may find benefits in things like moderate drinking, have far fewer funding opportunities, and may risk becoming labelled as “industry apologists.” They may be (and some have been) black listed within the health research community.

This is a silencing that is skewing research and distorting our understanding of the health effect of drinking.

Silencing voices leads to ignorance not enlightenment.

While culture scrubbing limits the ability to discuss the complexity of everyday life and behaviour.

Data scientists often engage in a process called data scrubbing, or ” cleaning” the data. It’s not nefarious, it is just the way to ensure that the data they are using is the most reliable and analyzable data available. Although the decisions on data scrubbing are based upon researchers’ ideas of what kind of data is most reliable, it is necessary for coherent analysis.

Data scrubbing involves removing unreliable or complicating data.

One other thing that happens, especially in population level alcohol studies using epidemiological data is something I call culture scrubbing. The process of lifting the activity of drinking from its actual cultural context.

Culture scrubbing is normally unintentional, but extremely important and prevalent in alcohol studies. It allows certain types of drinking to be compared, but also allows broader datasets to be analyzed. According to alcohol researchers, it is necessary for clean and reliable conclusions. To those of us who study drinking, not just drink, it renders much of those conclusions meaningless, or at least highly suspect.

To illustrate this, here are some simple questions. When you go for a drink, do you count the grams of alcohol in your beverage? No? Ok, well do you count your drinks per week or drinks per day? Do you drink regularly the same amount each week, or are there times of the year when you might drink more or less? Do you consume different types of alcoholic drinks at different times of the year, or week?

These are all examples of cultural idiosyncrasies of drinking that disappear in much alcohol research. And they are really important. not just because some grouchy contrarian like me will say “but you’re lifting drinking from lived experience” (which I say a lot and yes I am grouchy) but because, if the point is to give meaningful advice about an individual’s drinking, you need to recognize that different people drink differently at different times and in different places.

So alcohol research does a few key things to culture scrub:

• Calculates alcohol as grams of ethanol rather than drinks
• Eliminates considerations of different types of beverage(wine, beer, spirits) arguing that it’s all ethanol anyway and if we asked people, say, about the amount of wine they drank, that might not capture the other substances so the data will be meaningless
• Talk about drinking patterns as some kind of regular behaviour: drinks per day, drinks per week, not recognizing that people drink differently across the seasons
• Reduce or eliminate discussion of age or any other demographics except for biological sex
• Do not consider location where people are drinking
• Do not consider why people might drink, or other patterns rooted in culture.

Let’s take an example. When I was in my early 20s, I could really put it away. And sometimes I did. And then sometimes I did not.

Sometimes it was a bunch of beer on Friday. One time I went head to head with a bottle of tequila and a woman who was smaller than me, but kicked my ass metaphorically despite the lower body mass. (She was from the Canadian maritime provinces, which may explain a lot).

If I ever tried to drink in one session now (at 58) the amount I did when I was 25, I’d at best just pass out, but definitely make a call on the porcelain telephone.

So age matters.

Then there are patterns of the year. At holidays people might drink more, and different seasons are conducive to different drinking patterns and different types of drinks. Long slow drinking bouts on a patio may mean vastly exceeding recommended limits, but the slow part is important: your liver is doing the work it’s evolved to do. A Friday night session with work colleagues (the ones you like, not with that guy–you know who I’m talking about) may involve different types of drinking–a round of shots? Maybe (even at 58).

My local brewpub used to gift me a shot of bourbon on my birthday. I think it was an excuse for the bartender to join me in a shot…Ah the good old days.

My point is this: consuming alcohol is deeply embedded in our culture. And the process of lifting it out of cultural uniqueness, under the excuse of more adequately analyzable data, actually undermines the entire process of providing meaningful advice to people.

At the least the advice will be misunderstood, at the worst such advice will be dismissed as more paternalistic finger wagging. Neither is ideal.

It is time to bring culture back into the discussion.

Aka: The horror. The horror

*Originally posted on Linked in May 2026*

I’ve been thinking a lot about the dominant narratives coming out of alcohol research that uses population-level data and the advocates who amplify it.

A subtle but dominant undercurrent reiterates a link between pleasure and risk. This has deep cultural manifestations:

-Hansel and Gretel were tempted by the tasty looking gingerbread house,
-Sailors were lured to destruction by the beautiful siren song.
-King Midas’s desire for gold left him unable to eat.

Debates about alcohol today are imbued with this same suspicion of pleasure: it should be scrutinized, disciplined, and if not eliminated, at least severely reduced.

Self-restraint meanwhile is a moral good.

It reminds me of classical asceticism, where the denial of bodily pleasure was tied to the hope for salvation.

Today the concern is no longer about preparing for “the next life” but ironically, about extending this one as long as possible.

That in itself would not be worth commenting upon, except that asceticism, then as now, was founded on an evaluation of the body’s moral weakness.

In short: health has become a new morality. And as with any moral cosmology, it is a basis for judgement.

Since many things that bring bodily pleasure are risky, a good (aka responsible) person is expected to avoid them.

Consequently, the amount one drinks (or whether one drinks at all) can be a way to assess an individual’s character.

Research exploring alcohol’s harm appears to provide helpful guidance through this wilderness of temptation.

While those who criticize the new morality are apostates, to be shunned or ignored.

*Originally posted to LinkedIn May 2026*

In a recent JAMA Network article reassessing evidence of alcohol harm over time, the authors concluded that there was no significant benefit to moderate drinking; they effectively eliminated the J-curve. One reason the J-curve disappears is that the researchers treated self-reported abstainers as unreliable and removed them from the dataset. They used those who reported very low levels of consumption as a proxy for abstainers.

That seems like a reasonable adjustment. But if the issue is the health impact of abstinence versus moderate drinking, removing abstainers from the analysis effectively undermines the purpose of the study.

It does, however, support the narrative.

The study was published in a highly respected journal and widely circulated (at times triumphally) as evidence that alcohol has no positive health value.

This illustrates the power of narrative in steering research. When certain elements are accepted–for example, that alcohol is harmful–the analysis can begin to move in that direction. Adjusting the analysis to address results that do not fit expectations (often referred to as “torturing the data”) begin to seem reasonable.

The result is often a set of findings that appear more consistent and more certain than the underlying data would suggest. It creates the impression of consensus in a field where there are, in fact, many complicating variables.

But it tells a clear story.

At that point, it becomes harder to tell where the evidence ends and the interpretation begins. The story doesn’t just emerge from the data; it starts to organize it.

The challenge is not just evaluating the evidence, but understanding how it is being shaped.

*Originally posted to LinkedIn April 2026*

As a historian, it’s my job to think about what story the evidence tells us: who is doing what, and why. I approach current alcohol research in much the same way.

Consider, for example, the CCSA’s low risk alcohol guidance. We see a narrative designed to lead readers in a specific direction. It’s a familiar structure:

–Alcohol (and by extension the alcohol industry) is the villain, the agent of harm.
–People who drink are the unwitting victims.
–Researchers, working with population-level datasets and increasingly sophisticated analytical tools, identify the problem.

From here the story can move in several directions:
–Policymakers, now equipped with this evidence, are expected to address the threat.
–Drinkers, now informed by science, are expected to change their behaviour.

(Often, both are expected)

This format can affect the type of evidence presented and highlighted. Decisions about which effects to emphasize (such as mildly increased risk of cancer versus decreased risk of heart disease), how to group categories, or how to illustrate results aren’t just technical decisions: they help hold the story together.

When this is combined with a narrowed field of vision—where certain kinds of evidence or perspectives are set aside—the story begins to move in a particular direction.

This may be illustrated by the difference between the risk table in the CCSA’s preliminary report (Aug 2022) and the final guidance (Jan 2023). (I’ve attached examples below and the colour coding itself is telling.)

We are no longer just looking at data. We are looking at data being organized into a particular kind of narrative that points toward a single, consistent conclusion.

I have highlighted the way the data presentation has changed. The death rates have disappeared, which were really the only way a reader could get a sense of absolute risk. The alcohol intake data has changed (in the preliminary report it was grams per day, but the final report was drinks per week–which is better since peple tend not to think of drinking in terms of grams of alcohol).

The little notation that bolded data indicates “significant estimates” is now gone. That change may be useful because what does “significant estimate” mean, Does “significant” mean “major” or “big” or does it mean statistically significant–the latter actually. Also what does “estimate” mean in terms of how that informs the final guidance.

Also notable is that the final data table indicates drinks up to 7 drinks per week then jumps to 14. It does not show 8-13 drinks even though the advice does specifically talk about what happens at 7 drinks or more. See the final two images.

Why can’t they just leave us alone?

*Originally posted on LinkedIn April 2026*

Over the past few years I’ve spent a lot of time thinking about alcohol research that emphasizes harms and minimizes benefits. The more I read, the more familiar it began to feel.

As a historian, I realized I was reading a repackaging of the Victorian temperance movement.

It took a while to realize what that meant. At first I engaged with the research in the way it is intended: looking at data, assessing methods, and challenging the arguments on their terms.

But in my field, we think in terms of context; we attempt to reconstruct and understand what was happening in the past. And we look at the activities of all involved in generating new knowledge. To do that we pay attention to narrative. We ask: what’s the story?

It occurred to me that much alcohol research is advancing a narrative which is clever and subtle, but also misleading in notable ways.

Consider the consistent talking points and arguments emerging from some major players. We see them in the US Surgeon General’s advisory on cancer labels on booze; the Canadian Centre on Substance Use and Addiction (CCSA’s) 2023 “Low risk drinking guidance”; and releases from the WHO.

They present clear, uncomplicated statements about alcohol harm, using language that lacks nuance: “no safe level,” “even moderate drinking is harmful” and (my least favourite) “harmful from the first drop.”

Drawing upon a vast body of complex and diverse research, there is the same clarity. Moral clarity.

That’s not typically how scientific investigation operates. It’s messier. Science is about investigation, disagreement, and debate. Researchers build on and challenge each other’s work, tweak methods, re-run experiments, generate new data, challenge existing paradigms, revise theories… It is dynamic, organic, complex and rarely lands at the same conclusions.

(This is, to be clear, the nature of all scholarship, which frustrates some people who look for easy answers).

So along with examining the challenges of the data, we need to think about the way that this evidence is being presented.

So: what’s the story here? I have thoughts (see my next posts)

One thing that has bothered me for a long time about the cancer-alcohol link is the fact that many of us who are of a certain age began drinking in bars where people smoked.

Even if you never smoked in your life, I mean, like you’re such a square that you didn’t even try a cigarette (that includes this square, by the way) you would have been exposed to smoking.

That is an association that is difficult if not impossible to exclude from research using large population databases, because although they ask about lifestyle issues like “do you smoke?” they tend not to ask things as granular as “where have you been drinking over the past few decades?” (As if there is a way to answer that anyway)

This all just sort of sat in the back of my mind until I saw the following info graphic on the US Surgeon General’s advisory about cancer warning labels on alcohol containers:

Check out Mechanism D: alcohol leads to greater absorption of carcinogens.

So those high levels of oral, pharynx, larynx, and maybe even esophagus cancers may be more about where people drank than the carcinogenicity of the booze. In other words, if you were drinking in a smoky bar alcohol caused you to absorb carcinogens.

It is not about alcohol as a carcinogen, but alcohol as a medium. And if you’re not drinking around smokers, that risk is much lower, but it would not yet be captured in longitudinal data because cancer often takes decades to manifest.

It will be interesting in 30 years–if anyone is still drinking–to see if these levels have changed, because most people drinking will not have been drinking around smokers.

I also want to point out the classic example of how zealous anti-alcohol advocates misrepresent how the liver metabolizes alcohol.

See Mechanism A: Yes, the liver breaks alcohol to acetaldehyde, and it is labeled a carcinogen.

But it’s not as if we are left with all this carcinogen sloshing through our bodies.

The liver then breaks acetaldehyde down into acetic acid (aka vinegar) which is not a carcinogen–it is in fact a food for cells.

They always seem to forget to mention that part.

I wonder why.

This is an evolved process. Our primate ancestors developed the ability to metabolize alcohol as a food source for their cells, which was especially valuable in times of food scarcity. Alcohol is a compact calorie source.

All this is not to say there is no risk of cancer from drinking but it does indicate how we need to be very to accept uncritically such distorted information because it is clearly leading us down a carcinogenic garden path. The risk, if at all, is much lower than often implied, and the benefits may be much greater than acknowledged.

In November 2025 I spoke to a committee of the Canadian Senate that was contemplating Bill S-202, which would mandate warning labels on alcohol containers.

I was on a panel that was supposed to be industry people, but I spoke as an independent citizen.

I’m not going to revisit that fun experience here, but wanted to refer to it because…. it’s BA-ACK

It’s currently going through its third reading . If it passes, it goes to the House of Commons

Given the current debatable state of research on cancer “causation” and alcohol, it is most definitely an excessive measure. I’d say go head put nutrition labels on booze (spirits are more harmful but lower calories so there is that issue), and if you need to, sure put standard drink amounts (although I think that can be productive of a certain discourse of control so misleading in itself).

But if you’re going to do cancer warnings, the information should be balanced against health benefits.

And I’m not talking about cardiovascular protective effects or the crazy protective effects vs diabetes. Believe it or not, some good research shows alcohol has protective effects vs. kidney, bladder, and lymphatic cancers. I’m not sure why that doesn’t come up in the [anti-]alcohol research, but I have my suspicions that it’s something to do with their perception of “the rigour” of the research.

If that is the case, here is something else to think about: the Yukon alcohol labelling study that so many people refer to as showing real impact of labels was terrible. It was cancelled early, it did not gather useful information, and it was designed to cover not even an entire year of purchasing data. That means you don’t track the ebbs and flows of purchasing patterns across a year. Since the study was cancelled in December or January, its data covers a specific purchasing pattern basically the binges up to New Years and the drying out pattern in January.

However, they published over a dozen research papers (mostly repetitive) which means when you do a search to research the effects of alcohol labels, their results show up. This eclipses better research on the limited effect of labelling in general and the problems with overly-restrictive labelling language.

Ironically, when Tim Stockwell was talking to Felicity Carter about his research, he kept referring to every study that contradicted or complicated his results as poorly done or bad studies. I guess he would know, because he was involved in the v Yukon labelling study.

(At this point someone would point out that the study was interrupted by the drinks industry, but that is a red herring that helps to demonstrate my point. The very fact that it was interrupted means that the study was weakened. The industry action made the study more visible, so you don’t get clean data when asking people if they noticed the labels. With the amount of exposure the study and controversy had in the media, people would be more likely to remember the labels–and one of the questions people were asked was whether they had noticed the labels. In other words, the integrity of a study that was already of questionable design was corrupted. But they still published a lot.)

Anyway, all this to say that the bill is heading to third reading.

I’ll be frank and note that I don’t really care how this affects the industry. The industry can look after itself.

I am most certainly concerned about how a limited and incomplete picture of health effects of drinking will affect everyday people who just want a drink unharassed by histrionic and narrowly focused information.

Recent discussions about alcohol and risk often repeat the mantra that “the science has changed.” This is especially apparent in the difference between the 2011 Canadian low risk drinking guidelines and the 2023 “Low Risk Drinking Guidance” from the Canadian Centre on Substance Use and Addiction (CCSA).

This is not an unreasonable thing to state, given that nearly a decade of research had been published between 2011 and when the research for the CCSA study was initiated in 2020. (Let’s just not get into how much of that research was done by the contributors to the 2023 report).

But even a cursory comparison of the two documents shows that it is not only the “science” that changed: it is the tone, moral positioning, cultural understanding of the place of alcohol in lives, and the underlying theme of the two reports.

Consider this: the 2011 report opens with a broad and (to a historian) valuable quote from Greek philosopher Eubulus (375BC):

Three cups do I mix for the temperate; one to health, which they empty first, the second to love and pleasure, the third to sleep. When this bowl is drunk up, wise guests go home. The fourth bowl is ours no longer, but belongs to violence; the fifth to uproar, the sixth to drunken revel, the seventh to black eyes, the eighth is the policeman’s, the ninth belongs to biliousness, and the tenth to insanity and the hurling of furniture.

(Quoted in Butt et al 2011 p12)

It’s a statement about the value of moderation versus the hazards of over consumption, and would have no place in the 2023 report.

The authors then proceed to acknowledge that different people drink different substances at different times, indicating for example that there is a regional variation in both quantity and substance consumed (Butt et al, 2011, pp18-19) and a consideration of the behaviour within physical locations where people consume, such as “bars, discos or taverns.. [versus] in a restaurant or at home” (p18).

They define different types of health outcomes (short term/acute; long term/chronic) and engage with the difference between mortality (something that kills you) and morbidity (something that harms you).

The 2011 study also recognizes difference:

Different people drink different amounts in different frequencies, with varying consequences for their health and safety. The amount drunk (or ‘dose’ consumed) on one drinking occasion will determine their subjective experience, physical reactions and how they behave, in accordance with blood alcohol concentration (BAC) achieved and individual tolerance to alcohol effects

(Butt et al 2011 p 16)

It’s as if they recognize that people consume alcohol differently, have different subjective experiences, and that any guidance needs to recognize this difference and address it.

The study even frames its results in a degree of uncertainty, which to me indicates respect for the reader. It includes a clear statement about the difference between relative risk and absolute risk (p 14) and it recognizes that “the quality of science… is as yet far from perfect” (p13) (which arguably every scientist should say about pretty most topics) but the CCSA (2023) document most certainly does not.

What is most striking though about the two studies is not the results of the research. Of course if the research “has changed” over a decade, you might expect different results.

What is instead most notable to me is the acknowledgement in the 2011 document that there are a range of variables to consider, and that drinking patterns are different for different people, in different locations, and at different times of their lives.

For example younger people are more likely to binge and therefore the risks of accidents is higher for them (pp 21-22), and the cardio-protective effects of alcohol don’t really seem to matter until people are older. That’s right, they do recognize and address cardio-protective effects (pp 26-27). In fact they make the remarkable admission that

an estimated 1,828 deaths from cancer (as well as several thousand other causes of death) could be attributed to alcohol use in 2002, while alcohol prevented an estimated 2,589 cardiovascular deaths.

Butt et al 2011 p 27 emph added

Let me repeat: the very fact that there may be some protective effects of moderate drinking (which let’s be clear the CCSA 2023 document also shows) is addressed and not dismissed in 2011.

The CCSA 2023 document does give lip service to the idea of “risks and benefits” but then pretty much dismisses the benefits by generalizing all types of drinking, all types of people, and dismissing variety in patterns, ages, risk factors, substances consumed, and locations.

Even the huge bugbear of drinking during pregnancy is addressed with some equivocation. While concluding that it is better that pregnant women not drink at all, the 2011 study does recognize that some of the meta analyses they used indicate “significant “protective effects” for infant health associated with light drinking by the mother” (Butt et al 2011 p20).

In contrast, the 2023 CCSA study opted not to look at the literature about drinking while pregnant at all (arguing that since they are looking only at the effect of drinking on the drinker themselves, that a discussion of the effect of a mother’s drinking on her child is outside the scope of the study) (pp 20-21).

Nevertheless, their recommendations do include the statement that for pregnant women or women “trying to get pregnant… there is no known safe amount of alcohol use” (Paradis et al, 2023 p.9 ). They also repeat this advice for breastfeeding, even though the evidence about breastfeeding and infant health is, to put it mildly, mixed. (NASEM , 2024, 13-14).

Finally, and something that the CCSA writers may wish to consider is this statement: Alcohol is most safely and enjoyably consumed when mental, physical and social demands on the drinker are at a minimum. (p 22). What, alcohol can be consumed safely and enjoyably? Tell me more!

Oh, and you may be saying “yes, but what about the dismissal of the J-curve and evidence that there is no health benefit to moderate drinking.” Well, that research came out mostly after the 2023 report, and that report did not engage in it at all. The 2023 report shows a J curve in its all-cause mortality graph, just as previous research had done (Paradis et al 2023 p 29). They just don’t talk about it.

I could go on, but I think you get the point.

What we see in the difference between the 2011 and 2023 guidelines is not just a change in the science, but a change in the tone, attitude, and ideology.

In 2011 alcohol was a potentially problematic substance with risks that could be moderated by most people; in 2023 it had become a health hazard that should be problematized and, ideally, eliminated from everyday life.

To summarize:

• 2011 is a moderation document
• 2023 is a reduction document
• 2011 treats alcohol as a risky but ordinary practice
• 2023 treats alcohol as a harmful exposure whose social normalization must be challenged
• 2011 speaks to the drinker as a practical decision-maker or what in liberal parlance is called a “rational actor”
• 2023 speaks past the drinker toward a public-health environment that should make drinking less likely, less acceptable, and more fraught with danger. The drinker is no longer a rational actor, so their choice should not be complicated by nuance

Anyone who is trying to figure out why the Canadian government decided not to accept the results of the 2023 CCSA report should think about these things first. What happened between 2011 and 2022 was not just “changed” “science” but an ideological repositioning of the role of alcohol research.

This is why I call it neo temperance.

References:

Butt, P., Beirness, D., Gliksman, L., Paradis, C., & Stockwell, T. (2011). Alcohol and health in Canada: A summary of evidence and guidelines for low risk drinking. Ottawa, ON: Canadian Centre on Substance Abuse.

National Academies of Sciences, Engineering, and Medicine (NASEM) 2025. Review of Evidence on Alcohol and Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/28582.

Paradis, C., Butt, P., Shield, K., Poole, N., Wells, S., Naimi, T., Sherk, A., & the Low-Risk Alcohol Drinking Guidelines Scientific Expert Panels. (2023). Canada’s Guidance on Alcohol and Health: Final Report. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.

Recently there was a discussion on LinkedIn in response to a post I made about the language of alcohol use in harm reduction circles.

It quickly spun madly off in all directions.

One direction included an attempt to shame me, as someone who studies this stuff, for providing misinformation.

I am not sure what I said that was deemed misinformation but I think the complaints went something like:

1) Alcohol is not a food it is a drug. It is a depressant and is studied as such.

2) Softening the language of alcohol is “normalizing” alcohol, something done by the drink industry over the past century.

3) To say otherwise is irresponsible.

Now I’m not one of those people who normally credentials myself by saying “I’m a historian so let me tell you” but… well, I am a historian and if someone presents a misleading call out to history I am professionally obliged to correct it.

So here we go:

1) Historically alcohol was a food. Biologically it functions as food. Our livers convert it to acetaldehyde, and then convert it to acetic acid. That is a food for cells.  Our primate ancestors developed the capacity to metabolize alcohol in fermented fruit, and DNA evidence indicates that this was in response to periods of resource scarcity. This is why most of us can metabolize it.

(to be sure acetaldehyde is the chemical that causes nasty side effects of drinking, and has also been deemed carcinogenic, although things like at what point exposure ticks over to toxicity is not clear).

I’m not saying it should be consumed as a food but just suggesting that to those who think it is just another drug, there is more to it.

It is also a depressant, but such categories (food/depressant) are not mutually exclusive.

2) Alcohol has been instrumental in developing human society, in bringing people together, and facilitating community cohesion. This may be credited to the endorphins that are released when drinking, endorphins being responsible for all sorts of good things like happiness, sense of well-being, connectedness, and pain relief.

In other words, drinking is an entirely normal part of human existence, and foundational to the creation of society.

(Note that this is a process that took place before some cultures emerged that banned or did not consume alcohol—such as Muslim communities or some Indigenous peoples. Do not take this as a suggestion that these folks are less evolved).

Consequently, to argue that the “normalization” of alcohol is an action of the liquor industry over the last hundred years has no basis in history. That seems more about advancing a “Big Alcohol” conspiracy theory than historical accuracy.

And:

3) To argue that alcohol is abnormal, and only problematic, is to encourage stigmatization and shame on people who may be doing something reasonable and moderate. It will also reinforce stigma on people who may have found that their drinking has become out of control and would like to look for help.

I’d call that irresponsible.