tag:theconversation.com,2011:/nz/topics/alcohol-342/articlesAlcohol – The Conversation2024-03-18T18:24:24Ztag:theconversation.com,2011:article/2222672024-03-18T18:24:24Z2024-03-18T18:24:24ZCheers to health? Uncovering myths around the health benefits of moderate drinking<figure><img src="https://images.theconversation.com/files/582572/original/file-20240318-22-wdfo1c.jpg?ixlib=rb-1.1.0&rect=15%2C31%2C3270%2C2206&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many studies exaggerated the benefits of moderate drinking due to methodological flaws known as selection biases.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>The notion that enjoying a casual beer or sipping on your favourite wine could not only be harmless but actually beneficial to one’s health is a tantalizing proposition for many. This belief, often backed by claims of research findings, has seeped into social conversations and <a href="https://www.cbc.ca/news/science/moderate-drinking-may-be-heart-healthy-says-new-research-1.293437">media headlines</a>, painting moderate alcohol consumption in a positive light. </p>
<p>As researchers at the Canadian Institute for Substance Use Research, we find ourselves frequently revisiting this topic, delving deep into the evidence to separate fact from wishful thinking. Can we confidently say, “Cheers to health?”</p>
<h2>Unpacking beliefs about moderate drinking</h2>
<p>The <a href="https://doi.org/10.1046/j.1360-0443.2001.96464113.x">commonplace belief</a> that moderate drinking can be beneficial to health can be traced back to the 1980s when researchers found an association suggesting that French people were less likely to suffer from heart disease, despite eating a diet high in saturated fat. </p>
<p>This contradiction was thought to be explained by the assumption that the <a href="https://doi.org/10.5344/ajev.2011.11013">antioxidants and alcohol found in wine</a> might offer health benefits, leading to the term “<a href="https://doi.org/10.1016/S0140-6736(94)92883-5">French paradox</a>.”</p>
<p>This concept reached a broader audience in the 1990s, following a segment on the American news show <em>60 Minutes</em> which had a <a href="https://doi.org/10.1108/07363769410058894">profound impact on wine sales</a>. Later <a href="https://doi.org/10.1111/j.1360-0443.2012.03780.x">research expanded on this idea</a>, suggesting that frequently drinking small amounts of any type of alcoholic beverage might be good for health.</p>
<p>This idea was formalized into what is now known as the <a href="https://doi.org/10.1016/j.jacc.2017.07.710">J-shaped curve hypothesis</a>. Put simply, the J-shaped curve is a graphical representation of the apparent relationship between alcohol consumption and death or disease. According to this model, abstainers and heavy drinkers are at higher risk of certain conditions, <a href="https://doi.org/10.1111/j.1360-0443.2012.03780.x">such as heart disease</a>, compared to moderate drinkers, whose risk is lower.</p>
<figure class="align-center ">
<img alt="An illustration of the J-shaped Curve." src="https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580343/original/file-20240307-20-h2zkss.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The J-shape curve is a graphical representation of the apparent relationship between alcohol consumption and death or disease. According to this model, abstainers and heavy drinkers are at higher risk compared to moderate drinkers, whose risk is lower.</span>
</figcaption>
</figure>
<h2>Current perspectives on moderate drinking</h2>
<p>People used to think that tobacco use was good for health, <a href="https://doi.org/10.1017/S0025727300012333">historically describing it as a remedy for all disease</a>. As scientific understanding has advanced, however, tobacco use has been increasingly recognized as a <a href="https://iris.who.int/bitstream/handle/10665/372043/9789240077164-eng.pdf?sequence=1">leading cause of preventable disease and death</a>.</p>
<p>Like tobacco, alcohol was once used in medicine and has since become recognized as a <a href="https://doi.org/10.1016/S0140-6736(22)02123-7">major cause of preventable mortality and illness</a>. For instance, recent global estimates suggest <a href="https://doi.org/10.1016/S2468-2667(19)30231-2">alcohol is responsible for 5.3 per cent of all deaths</a>. </p>
<p>Furthermore, in Canada, the revenue generated from selling alcohol does not come close to covering the damage it causes, leaving the government <a href="https://www.uvic.ca/research/centres/cisur/assets/docs/cape/cape3/fed-results-en.pdf">$6.20 billion short every year</a>. However, much of these costs can be attributed to heavy drinking. </p>
<p>So where does this leave moderate drinkers? We recently set out to answer this question by analyzing data from over 4.8 million people from more than 100 studies, covering more than 40 years. </p>
<p>We found that many studies exaggerate the benefits of moderate drinking due to methodological flaws known as <a href="https://doi.org/10.1111/add.13451">selection biases</a>. No matter if we <a href="https://doi.org/10.1001/jamanetworkopen.2023.6185">analyzed the studies as one big group</a>, using statistical methods to try and lessen these mistakes, or if we <a href="https://doi.org/10.15288/jsad.23-00283">separated the good studies from the not-so-good ones</a>, one thing was clear: moderate alcohol consumption does not appear to offer the health benefits once believed.</p>
<h2>Explaining the contradiction</h2>
<p>Selection biases represent data distortions caused by how research participants are selected. Such biases lead to unfair comparisons between groups, which skews analyses towards finding a J-shape curve. Essentially, it is like comparing two runners in a race, where one wears heavy boots and the other wears lightweight running shoes. Concluding that the second runner is more talented misses the point; it is not a fair comparison.</p>
<p>Here are five examples of selection bias in the context of the alcohol J-shaped curve which can accumulate as people age:</p>
<ol>
<li><p><a href="https://doi.org/10.1016/S0140-6736(88)92890-5">Poor health, less alcohol</a>. As health declines, especially in older age, people often reduce their alcohol consumption. Not distinguishing between those who cut back or quit for health reasons can falsely indicate that moderate drinking is healthier.</p></li>
<li><p><a href="https://doi.org/10.1136/jech-2013-202576">Unhealthy lifetime abstainers</a>. Comparing moderate drinkers with individuals who have never consumed alcohol due to chronic health issues may falsely attribute health advantages to alcohol consumption.</p></li>
<li><p><a href="https://doi.org/10.1016/j.amepre.2005.01.011">Moderate in other ways.</a> Moderate drinkers often lead balanced lifestyles in other areas, too, which may contribute to their perceived better health. It is not just moderate drinking, but also their healthier overall opportunities and choices, such as better health-care access and self-care, that make them seem healthier.</p></li>
<li><p><a href="https://doi.org/10.1177/009145090403100304">Measurement error.</a> Assessing alcohol consumption over a short period of time, like a week or less, can lead to a misclassification of drinkers. Heavy drinkers who happened to not consume alcohol during the week of assessment would be incorrectly classified as abstainers, for example.</p></li>
<li><p><a href="https://doi.org/10.1111/add.13709">Early alcohol-attributable deaths.</a> The inevitable exclusion of individuals who may have died from alcohol-related causes before a study of older people starts can result in a “healthy survivor” bias, overlooking the earlier detrimental effects of alcohol.</p></li>
</ol>
<h2>Continuing the conversation</h2>
<p>We should be skeptical of results suggesting that moderate drinking is healthy because selection biases can muddy the waters. For instance, multiple implausible J-shape curve relationships have been published, <a href="https://doi.org/10.1002/hep.510230513">including between moderate drinking and liver disease</a>.</p>
<p>We are well aware that this news might not be what you were hoping to hear. <a href="https://doi.org/10.1080/08870446.2024.2316681">It might even stir up feelings of unease or skepticism</a>. For many people, limited alcohol consumption <a href="https://doi.org/10.1007/s40750-016-0058-4">is enjoyable</a>. However, it is not without risk and it is important for people to understand these risks to make informed decisions about their health.</p>
<p>The risks are reflected in the 2023 <a href="https://www.ccsa.ca/sites/default/files/2023-05/CGAH-Drinking-Less-is-Better-en.pdf">Canadian Drinking Guidance</a>. The guidance attempts to “meet people where they are at,” suggesting that one to two drinks per week represent a low risk of harm, three to six drinks a week represent a moderate risk, and seven or more drinks a week represent an increasingly high risk. Ultimately, they enable people to make informed decisions that best suit their health and well-being.</p><img src="https://counter.theconversation.com/content/222267/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s time to revisit the evidence for the health benefits of moderate drinking, and separate fact from wishful thinking. Can we confidently say, ‘Cheers to good health?’James M. Clay, Postdoctoral Research Fellow, Canadian Institute for Substance Use Research, University of VictoriaTim Stockwell, Scientist, Canadian Institute for Substance Use Research and Professor of Psychology, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2252852024-03-11T19:13:13Z2024-03-11T19:13:13ZMother’s little helper: interviews with Australian women show a complex relationship with alcohol<figure><img src="https://images.theconversation.com/files/580616/original/file-20240308-16-prhzxy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5751%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alcoholism-alcohol-addiction-people-concept-drunk-2187785169">Syda Productions/Shutterstock</a></span></figcaption></figure><p>Men have historically, and still do, <a href="https://pubmed.ncbi.nlm.nih.gov/19686518/">drink more than women</a>. But in recent years there has been an uptick in women’s drinking, particularly among women in their late 30s <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13428">through to their 60s</a>. </p>
<p>This is concerning, as <a href="https://www.who.int/europe/news/item/04-01-2023-no-level-of-alcohol-consumption-is-safe-for-our-health">no level of alcohol is considered safe</a> for our health, and <a href="https://www.sciencedirect.com/science/article/abs/pii/S0955395922001189?via%3Dihub">women are especially susceptible</a> to <a href="https://www.sciencedirect.com/science/article/pii/S0376871615016166">alcohol’s long-term health harms</a> (for example, cancer and heart disease). </p>
<p>We’ve also seen the emergence of the “wine mum” <a href="https://theconversation.com/winemom-humour-and-empowerment-or-binge-drinking-and-mental-health-challenges-161338">in popular culture</a> and <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.12215">greater social acceptance</a> of women’s drinking.</p>
<p><div data-react-class="TiktokEmbed" data-react-props="{"url":"https://vt.tiktok.com/ZSFyYHa68/."}"></div></p>
<p>But women still drink differently to men, and there are some important reasons why – particularly for women who <a href="https://doi.org/10.1016/j.drugpo.2022.103699">juggle both paid work and motherhood</a>.</p>
<p>In 2022, we conducted interviews with 22 Australian working mothers aged 36 to 51, to learn more about their daily lives and the role alcohol played. Most of the women were middle-class professionals. Many were partnered to men, some were single, and all had school-aged children they looked after alongside their jobs.</p>
<p>We’ve <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041">recently published</a> two <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2299392">new papers</a> exploring what we found.</p>
<h2>Modern working mothers</h2>
<p>Now, more than ever, <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-status-families/latest-release">women are entering the workforce</a> and developing careers. At the same time, many also have to meet the demands of having children. While we like to think we’re moving towards a more equal society, women are still expected to do the <a href="https://www.tandfonline.com/doi/full/10.1080/13668803.2015.1080664">majority of childcare and domestic duties</a>.</p>
<p>This means many women are having to do “<a href="https://www.sciencedirect.com/science/article/pii/S0955395922001189?via%3Dihub">double shifts</a>” of paid and unpaid labour, increasing the chance they’re stressed, and limiting how much time they have to relax, unwind, and pursue hobbies. This is where alcohol comes in.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/oh-well-wine-oclock-what-midlife-women-told-us-about-drinking-and-why-its-so-hard-to-stop-188882">'Oh well, wine o’clock': what midlife women told us about drinking – and why it's so hard to stop</a>
</strong>
</em>
</p>
<hr>
<p>Most women we talked to felt <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041">over-committed</a> because of their competing roles. Whether they had partners or not, they were often taking on the “default” caregiver role. This involved tasks such as getting kids ready for school, cooking, cleaning, and organising appointments. </p>
<p>At the same time, their jobs could be mentally or emotionally stressful, such as working in health care or project management.</p>
<p>And it wasn’t uncommon for these two worlds to overlap. For example, some women talked about needing to send emails or make calls from home outside work hours, or feeling there was an expectation for them to take time off work to take kids to appointments. </p>
<p>Many women were fatigued, and they felt a sense of guilt at not being able to commit fully to either role. As Mia, a full-time employed, partnered mother said:</p>
<blockquote>
<p>You’ll spend your life feeling compromised, doing a half job as a parent, and a half job as a worker.</p>
</blockquote>
<figure class="align-center ">
<img alt="A woman in the kitchen with two children talking on the phone." src="https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580614/original/file-20240308-24-v6huqa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">For many women, work and home life overlaps.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/busy-stressed-mother-talking-on-phone-1584282157">Onjira Leibe/Shutterstock</a></span>
</figcaption>
</figure>
<p>When participants talked about drinking alcohol, it was something accessible they could do alongside their home duties. For example, a glass of wine while cooking dinner was almost ubiquitous. Drinking helped women manage busy days, and the amount they drunk was not always something they had the capacity to be mindful of. As Caroline, a full-time employed, separated mother explained:</p>
<blockquote>
<p>We don’t sit down and stand around like the boys do drinking, with the beer cans round our feet. We drink a glass of wine while we cook tea […] while we’re sitting doing the kids’ homework or arguing with them about, ‘where’s your sock? Where’s your library book?’ […] it makes it very easy to think ‘I’ve only had one glass of wine’ when you’ve had three or four, because you’re not mindful of what you’re doing.</p>
</blockquote>
<p>Many of the women we talked to also described feeling under-supported. This included at work, where they felt there wasn’t always enough flexibility to accommodate their parental obligations, and at home, where their partners were not always around to share the workload. </p>
<p>These stresses and pressures meant alcohol became a “prize” or “reward” for getting through the day. And when participants felt particularly stressed or under-supported (which was often), the reward of a drink at the end of the day was all the more important. According to Penelope, a part-time employed, separated mother:</p>
<blockquote>
<p>I think that I reach out to drinking at the end of the day because I’m really quite overwhelmed, or quite exhausted mentally and physically from the day.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
</strong>
</em>
</p>
<hr>
<h2>What about the pandemic?</h2>
<p>Things became even more complicated during the <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2299392">COVID pandemic</a>. Women suddenly took on “triple shifts” – mothering, working and home-schooling – leaving many feeling even more overwhelmed. As Belle, a partnered mother who worked part time, said:</p>
<blockquote>
<p>We were all working and trying to home school, and it was just so awful […] so I guess my girlfriends were going through that too, the ones with kids, and they were all definitely drinking a lot more.</p>
</blockquote>
<figure class="align-center ">
<img alt="A woman at a kitchen bench drinking a glass of red wine." src="https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580612/original/file-20240308-18-kztkea.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The chaos of the pandemic left working mothers feeling even more overwhelmed.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-beautiful-lonely-young-woman-drinking-1802268634">Gorodenkoff/Shutterstock</a></span>
</figcaption>
</figure>
<p>Alcohol was classified as an “essential service” during lockdowns (bottle shops remained open while many other retail stores closed), and against this backdrop, participants felt it became even more normalised. They talked about seeing media depictions and advertising of alcohol, including online memes that made wine out as a way to cope with the pandemic. Belle said:</p>
<blockquote>
<p>Everyone would send each other little memes of women just drinking, and it definitely became […] a socially acceptable way of getting through that really shit time.</p>
</blockquote>
<p>Hobbies and exercise activities they would previously turn to to relieve stress were often restricted because of the pandemic. As such, alcohol became one of the few things left. Many women we talked to were either drinking more, more often, or felt an increased desire to drink, especially during the height of the pandemic and when they were home-schooling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-are-drinking-more-during-the-pandemic-and-its-probably-got-a-lot-to-do-with-their-mental-health-139295">Women are drinking more during the pandemic, and it's probably got a lot to do with their mental health</a>
</strong>
</em>
</p>
<hr>
<p>To understand why and how modern working mothers drink alcohol, it’s also important to consider how the alcohol industry targets women, often framing alcohol as a <a href="https://www.tandfonline.com/doi/full/10.1080/16066359.2024.2314041#:%7E:text=This%20study%20investigated%20the%20social,meanings%20around%20reward%20and%20relaxation.">symbol of relief and relaxation</a> among busy working mothers. </p>
<p>But it’s equally important to realise being a modern working mother is tough, especially as traditional gender expectations of women as carers persist. Almost 60 years ago, the Rolling Stones sang about “<a href="https://en.wikipedia.org/wiki/Mother%27s_Little_Helper">mother’s little helper</a>” in reference to women using substances to manage everyday life. </p>
<p>Until we see changes in the way women are supported at work and home, alcohol may continue being “mother’s little helper” for many working mothers.</p><img src="https://counter.theconversation.com/content/225285/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Maree Patsouras receives funding from an Australian Government Research Training Program Scholarship and the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Cassandra Wright receives salary funding from the Australian Research Council. She also receives funding from the Medical Research Future Fund, Northern Territory Motor Accident Compensation Commission, Music NT and Menzies School of Health Research internal grant scheme.</span></em></p><p class="fine-print"><em><span>Emmanuel Kuntsche receives funding from La Trobe University, the Victorian Health Promotion Foundation (VicHealth), the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), and the University of Bayreuth Centre of International Excellence "Alexander von Humboldt". Emmanuel Kuntsche serves as that Secretary of the Australasian Professional Society on Alcohol and other Drugs (APSAD).</span></em></p><p class="fine-print"><em><span>Gabriel Caluzzi receives funding via the Australian Research Council and the Victorian Health Promotion Foundation.</span></em></p><p class="fine-print"><em><span>Sandra Kuntsche receives funding from the Australian Research Council. </span></em></p>Men and women often drink alcohol differently. This is especially the case for women who juggle both paid work and motherhood.Maree Patsouras, PhD Candidate, Centre for Alcohol Policy Research, La Trobe UniversityCassandra Wright, Senior Research Fellow in Alcohol and other Drugs, Menzies School of Health ResearchEmmanuel Kuntsche, Director of the Centre for Alcohol Policy Research, La Trobe UniversityGabriel Caluzzi, Research Fellow, Centre for Alcohol Policy Research, La Trobe UniversitySandra Kuntsche, Associate Professor Family Therapy and Systemic Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2173602024-02-27T12:33:24Z2024-02-27T12:33:24ZHundreds of thousands of US infants every year pay the consequences of prenatal exposure to drugs, a growing crisis particularly in rural America<figure><img src="https://images.theconversation.com/files/567417/original/file-20231228-29-57e4ok.jpg?ixlib=rb-1.1.0&rect=50%2C10%2C6659%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Substance use during pregnancy can lead to a broad array of harmful effects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adorable-newborn-baby-with-pacifier-and-toy-in-royalty-free-image/1407722363?phrase=baby">Liudmila Chernetska/iStock via Getty Images Plus</a></span></figcaption></figure><p>Nearly 1 in 12 newborns in the United States in 2020 – <a href="https://www.samhsa.gov/data/sites/default/files/reports/slides-2020-nsduh/2020NSDUHWomenSlides072522.pdf">or about 300,000 infants</a> – were exposed to alcohol, opioids, marijuana or cocaine before they were born. Exposure to these substances <a href="https://www.cdc.gov/reproductivehealth/maternalinfanthealth/substance-abuse/substance-abuse-during-pregnancy.htm">puts these newborns at a higher risk</a> for premature birth, low birth weight and a variety of physical and mental disabilities. </p>
<p>These substances can have <a href="https://doi.org/10.1038/npp.2014.147">direct and indirect consequences on fetal development</a>. By crossing the placental barrier directly, they can cause abnormal development. And by affecting the mother’s organs, they can reduce blood flow to the placenta and damage the health of the growing fetus.</p>
<p>Considerable <a href="https://doi.org/10.1111/j.1521-0391.2010.00079.x">sociodemographic and geographic disparities</a> exist in the U.S. regarding the rates of prenatal substance exposure. This includes in West Virginia, where I live, a rural Appalachian state struggling with extraordinary rates of substance use and an opioid crisis. </p>
<p><a href="https://directory.hsc.wvu.edu/Profile/47295">As an epidemiologist</a>, I study the relationship between substance use during pregnancy and infant health outcomes. I am a member of the <a href="https://www.wvdhhr.org/birthscore/">Project WATCH</a> team, which is a long-standing, state-mandated surveillance and referral system in West Virginia funded by the <a href="https://dhhr.wv.gov/Pages/default.aspx">West Virginia Department of Health</a>. The surveillance system expanded in 2020 to include substance exposure data from all births in the state. </p>
<h2>Staggering numbers</h2>
<p>Our research work showed that between 2020 and 2022, prenatal substance exposure in West Virginia was <a href="https://doi.org/10.1111/jrh.12752">nearly 50% higher, at 124 per 1,000 births</a>, than the national rate of 80 per 1,000 births. This means that nearly 1 in 8 infants born in the state had exposure to substances during pregnancy. </p>
<p>We found that the <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">rate of prenatal cannabis exposure</a> in West Virginia was 80 per 1,000 births, similar to the national rate. However, the rates of opioid exposure, 44 per 1,000 births, and stimulant exposure, 21 per 1,000 births, during pregnancy were nearly 10 times higher than national rates. Additionally, 1 in 5 women in the study smoked, and 64% of the infants exposed to substances were also exposed to smoking during pregnancy. </p>
<p>There are many reasons why the numbers in West Virginia are staggering. <a href="https://doi.org/10.3390/healthcare11081182">Economic challenges</a>, including poverty, low education and limited job opportunities, contribute to chronic stress, a known risk factor for substance use. Moreover, nearly half the population lives in rural areas with a <a href="https://www.marchofdimes.org/maternity-care-deserts-report">limited number of hospitals and clinics</a>. The geographic isolation <a href="https://doi.org/10.1186/s12954-023-00795-w">limits access</a> to health care and substance use treatment services. Finally, <a href="https://doi.org/10.1016/j.mhp.2019.01.010">stigma and judgment</a> within close-knit rural communities may discourage these mothers from seeking help.</p>
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<figcaption><span class="caption">Substances that can affect a developing embryo include alcohol, tobacco, cannabis and prescribed drugs such as methadone.</span></figcaption>
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<h2>Substance exposure and infant outcomes</h2>
<p>Our earlier work demonstrated that <a href="https://doi.org/10.1038%2Fs41390-019-0731-y">alcohol consumption during pregnancy</a> was associated with preterm birth, which is when a baby is born before the 37th week of pregnancy, and low birth weight, defined as babies born weighing less than 5 pounds, 8 ounces (2,500 grams).</p>
<p>Our more recent study has shown that <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">prenatal opioid exposure</a> is also associated with low birth weight, while stimulant exposure was associated with preterm birth. </p>
<p>Stimulants include cocaine, methamphetamines, ecstasy and prescription stimulants such as those used for the treatment of attention-deficit/hyperactivity disorder. Illicit or misuse of prescription stimulants have <a href="https://www.cdc.gov/pregnancy/meds/treatingfortwo/features/keyfinding-ADHD-med-increase.html">increased among pregnant women</a> over the past decade. </p>
<p>While many national and statewide efforts have focused their attention on addressing the opioid crisis, the prevalence of prenatal stimulant use remains a growing and <a href="https://doi.org/10.1097%2FGRF.0000000000000418">underrecognized epidemic in the U.S</a>.</p>
<p>After alcohol, cannabis is the <a href="https://doi.org/10.1186/s12978-020-0880-9">most common psychoactive substance</a> used during pregnancy and its rate is increasing. This trend in cannabis use may be due to the increasing legality for medicinal or recreational purposes and the social acceptability that comes with it. </p>
<p>In addition, <a href="https://theconversation.com/mounting-research-points-to-health-harms-from-cannabis-thc-and-cbd-use-during-pregnancy-adolescence-and-other-periods-of-rapid-development-198206">many people wrongly assume</a> that cannabis is relatively safe and helps manage pregnancy-related conditions such as morning sickness, nausea, vomiting, weight gain and sleep difficulty. </p>
<p>However, a <a href="https://doi.org/10.1001/jama.2023.21146">growing body of research</a>, including our own, has shown that <a href="https://www.marchofdimes.org/find-support/topics/pregnancy/marijuana-and-pregnancy">prenatal cannabis exposure</a> is associated with <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">adverse pregnancy outcomes</a>, including low birth weight, preterm birth, stillbirth or hypertensive disorders of pregnancy. </p>
<p>In addition, using multiple substances during pregnancy poses a higher risk to infants than using a single substance. We found that compared to no substance exposure during pregnancy, the risk of low birth weight was twice with opioids alone, four times with concurrent exposure to opioids and stimulants, and <a href="https://doi.org/10.1016/j.jpeds.2022.11.040">almost six times with concurrent exposure</a> to opioids, stimulants and cannabis.</p>
<p>Another adverse outcome that is associated with prenatal substance exposure, primarily to opioids, is a <a href="https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas#">set of withdrawal symptoms</a> experienced by the newborn known as <a href="https://www.ncbi.nlm.nih.gov/books/NBK551498/">neonatal abstinence syndrome</a>. Symptoms include irritability, feeding difficulties, tremors and respiratory issues. The syndrome requires specialized care and attention in neonatal units and a prolonged stay in the hospital.</p>
<p>Alongside the rising prevalence of opioid use in pregnancy, a <a href="https://doi.org/10.3390%2Fchildren10061030">fivefold increase</a> in incidence of infants with this condition has been documented over the past two decades. The highest rate <a href="https://doi.org/10.1111/ppe.12728">has been observed in West Virginia</a>, at 53 per 1,000 births. Other states with high rates include Maine, Vermont, Delaware and Kentucky, which are between <a href="https://doi.org/10.1001%2Fjama.2020.24991">three and four times the national average</a> of 7.3 per 1,000 births. </p>
<h2>Substance exposure in the womb and long-term outcomes</h2>
<p>Research on long-term outcomes of infants exposed to substances in the womb is still evolving. Limited studies have shown an association between neonatal abstinence syndrome and long-term neurodevelopmental consequences that may develop as early as <a href="https://doi.org/10.1001/jamanetworkopen.2019.7025">6 months old and persist into adolescence</a>. These include delays in learning and language skills, physical growth and motor skills, as well as difficulty in regulating <a href="https://doi.org/10.1007%2Fs10802-020-00766-w">behavior and emotions</a>.</p>
<p>However, research on the long-term effects of prenatal alcohol exposure is well established. A broad range of deficits are referred to as <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-fetal-alcohol-spectrum-disorders">fetal alcohol spectrum disorders</a>. These include growth deficiency, developmental delay, craniofacial malformations, intellectual disabilities, behavior issues and emotional well-being. A recent study of first graders in the U.S. estimated that the prevalence of <a href="https://doi.org/10.1001/jama.2017.21896">fetal alcohol spectrum disorders range from 1% to 5%</a>, which means up to 1 in 20 school-age children may have this disorder. </p>
<p>With the <a href="https://doi.org/10.1016/S2215-0366(23)00235-3">changing landscape of substance use</a> in the U.S., more research is needed to understand and establish the association between the various emerging types and forms of substance exposures and their lasting effects. But the findings are difficult to discern because of the influence of other environmental factors, preexisting medical conditions and <a href="https://www.cdc.gov/publichealthgateway/sdoh/index.html#">social determinants of health</a>.</p>
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<figcaption><span class="caption">Natalie is 6 years old. She has fetal alcohol syndrome.</span></figcaption>
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<h2>Efforts to reduce harms</h2>
<p>As a maternal and child health epidemiologist, I am fortunate to be part of the <a href="https://www.wvdhhr.org/birthscore/index.html">Project WATCH</a> team that works closely with health care providers and policymakers. </p>
<p>As high-risk infants are identified through this program, its referral system notifies pediatricians of substance exposure and connects these families to early intervention services and home visitation programs. </p>
<p>These services include developmental testing, interventions appropriate to the child’s needs and case management during the first few years of life. The data also informs state-level strategies and initiatives to address the substance use crisis for this vulnerable population.</p><img src="https://counter.theconversation.com/content/217360/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Project WATCH is a grant funded by the West Virginia Department of Health. </span></em></p>Many people wrongly assume that cannabis use during pregnancy is safe. Research is increasingly documenting a host of serious health harms from prenatal exposure to cannabis and other substances.Amna Umer, Associate Professor of Pediatric Epidemiology, West Virginia UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2238542024-02-26T23:31:54Z2024-02-26T23:31:54ZYoung people are drinking less in real life. But film and TV paints a different picture<figure><img src="https://images.theconversation.com/files/577810/original/file-20240226-26-t1kw3w.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5973%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pile-empty-beer-green-glass-bottles-1118733461">Nokwan007/Shutterstock</a></span></figcaption></figure><p>The new Mean Girls is a fresh take on a classic teen comedy, this time appealing to a new audience: Gen Z. So how does the film paint the new generation? As one that loves to drink. </p>
<p>Mean Girls is filled with references to and depictions of alcohol. There’s drinking at parties, a scene where Cady gets drunk, and even a joke about a <a href="https://www.commonsensemedia.org/movie-reviews/mean-girls-2024">vodka-filled inhaler</a>. </p>
<p>On-screen alcohol exposure is an important issue, particularly when underage drinking is shown. Greater on-screen exposure to alcohol is associated with an increased risk of beginning to drink alcohol <a href="https://www.tandfonline.com/doi/full/10.1080/15332640.2018.1548319">at a younger age</a>, and increased likelihood of weekly drinking and binge drinking <a href="https://publications.aap.org/pediatrics/article-abstract/135/5/851/33689/Alcohol-Use-in-Films-and-Adolescent-Alcohol-Use">among young people</a>. </p>
<p>But despite the attempts to appeal to a young audience, the new Mean Girls film doesn’t reflect most of Gen Z’s attitudes towards drinking. In fact, research shows <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12255">young people are increasingly rejecting alcohol</a>, especially when compared to older generations. So why does alcohol retain a chokehold on our screens? </p>
<h2>Drinks all round?</h2>
<p>A 2023 <a href="https://www.health.gov.au/resources/collections/australian-secondary-school-students-alcohol-and-drug-survey">Cancer Council report</a> found in 1996, 90% of Australian secondary school students aged 16–17 reported drinking alcohol in the past year. By 2023, this had dropped to 64%.</p>
<p>The report also found recent risky drinking – that is, consuming five or more alcoholic drinks on any day within the past week – among 16- and 17-year-olds has particularly declined, dropping from 22% in 1996 to 9% in 2023. </p>
<p>This trend isn’t <a href="https://academic.oup.com/eurpub/article/31/2/424/5981990">unique to Australia</a>. Gen Z-ers across the world are drinking much less alcohol than previous generations. </p>
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<a href="https://theconversation.com/youth-drinking-is-declining-myths-about-the-trend-busted-216948">Youth drinking is declining – myths about the trend, busted</a>
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<a href="https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Teenagers with beer bottles." src="https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/577813/original/file-20240226-17-wqqskz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Gen Z are drinking less alcohol than other generations.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/people-friendship-togetherness-hangout-youth-culture-514499065">Rawpixel.com/Shutterstock</a></span>
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<p>But we’re yet to see this decline reflected in films and television targeting young people. </p>
<p>A <a href="https://www.tandfonline.com/doi/full/10.1080/1067828X.2018.1561575">2019 analysis</a> found alcohol remains the most frequently portrayed substance in films, and substance use (including alcohol) on screen was more often portrayed as having either neutral or rewarding consequences (such as increased popularity), in comparison to unrewarding consequences (such as vomiting or headaches). </p>
<p>One-fifth of teenage characters in PG-13 (roughly equivalent to an Australia M rating) and R-rated <a href="https://www.tandfonline.com/doi/full/10.1080/10810730.2012.688251">films are shown drinking alcohol</a>, and nearly half <a href="https://pubmed.ncbi.nlm.nih.gov/11389259/">of G-rated</a> animated films show alcohol use. </p>
<p>One prime example is Ratatouille (2007). This Disney-Pixar film is so beloved by Gen Z it got turned into a <a href="https://time.com/5925560/ratatouille-tiktok-musical/">TikTok musical</a>. The film shows alcohol <a href="https://pubmed.ncbi.nlm.nih.gov/24799536/">a whopping 60 times</a>, even though it’s rated PG and aimed at children.</p>
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<p>Alcohol imagery isn’t limited to film or broadcast TV. Recent research found more alcohol in streaming content from <a href="https://bmjopen.bmj.com/content/9/2/e025807">Amazon and Netflix</a> than in broadcast television. </p>
<p>And despite the sheer volume of on-screen alcohol depictions, our research shows films depict alcohol exposure nearly <a href="https://link.springer.com/article/10.1007/s11469-022-00998-5">five times more frequently</a> than the average Australian adult thinks they do. </p>
<h2>Lack of regulation – and young filmmakers</h2>
<p>Locally, alcohol exposure in films is governed by the Australian Classification Board. The board considers <a href="https://www.classification.gov.au/classification-ratings/how-rating-decided">six classifiable elements</a>, such as sex and violence, when deciding on a rating. </p>
<p>Currently, alcohol is not explicitly represented among these, although excessive consumption and alcohol dependency is considered under the element of “themes”. </p>
<p>This has an impact: alcohol brand placements have nearly doubled in the last two decades, and alcohol brands appear in 41% of <a href="https://www.eurekalert.org/news-releases/911945">children’s films</a>. </p>
<p>When we consider why young people are so often shown drinking in films, it’s not just a matter of what can be shown under Australian regulations. Film and television is largely not yet directed, written or created by Gen Z-ers. A lack of representation can lead to young people’s perspectives not being understood, or unaccounted for.</p>
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<span class="caption">As Gen Z enters the film industry, the depiction of alcohol on screen may change.</span>
<span class="attribution"><span class="source">Grusho Anna/Shutterstock</span></span>
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<p>The mismatch between Gen Z’s drinking habits and the overexposure of alcohol in films is also surprising when we consider <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13756">most adults in our research</a> were supportive of a range of policies restricting alcohol exposure in films. A significant number of adult Australians support policies <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/dar.13756">de-glorifying alcohol consumption and beverages in films</a> – especially in films aimed at children. </p>
<p>Australia intends to <a href="https://www.classification.gov.au/about-us/media-and-news/media-releases/classification-amendment-bill-passed-parliament">reform its National Classification Scheme</a>. Perhaps these changes – along with Gen Z entering the film industry themselves – will allow for young people’s actual drinking habits to be reflected more accurately on screen. </p>
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Read more:
<a href="https://theconversation.com/australians-are-embracing-mindful-drinking-and-the-alcohol-industry-is-also-getting-sober-curious-160931">Australians are embracing 'mindful drinking' — and the alcohol industry is also getting sober curious</a>
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<p class="fine-print"><em><span>Maree Patsouras receives funding from an Australian Government Research Training Program Scholarship.</span></em></p><p class="fine-print"><em><span>Amy Pennay receives funding from the Australian Research Council, the National Health and Medical Research Council, the Victorian Health Promotion Foundation and the Victorian Responsible Gambling Foundation. </span></em></p><p class="fine-print"><em><span>Benjamin Riordan's research is funded by La Trobe University, the Victorian Health Promotion Foundation (VicHealth), the Australian Research Council (ARC), the National Health and Medical Research Council (NHMRC), and National Institute on Alcohol Abuse and Alcoholism (NIAAA; US).</span></em></p><p class="fine-print"><em><span>Emmanuel Kuntsche receives funding from La Trobe University, the Victorian Health Promotion Foundation (VicHealth), the National Health and Medical Research Council (NHMRC), the Australian Research Council (ARC), and the University of Bayreuth Centre of International Excellence "Alexander von Humboldt". Emmanuel Kuntsche serves as that Secretary of the Australasian Professional Society on Alcohol and other Drugs (APSAD).</span></em></p>Research shows young people are increasingly rejecting alcohol, especially when compared to older generations. So why does alcohol retain a chokehold on our screens?Maree Patsouras, La Trobe UniversityAmy Pennay, Research Fellow, Centre for Alcohol Policy Research, La Trobe UniversityBenjamin Riordan, Research fellow, La Trobe UniversityEmmanuel Kuntsche, Director of the Centre for Alcohol Policy Research, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232932024-02-12T05:53:46Z2024-02-12T05:53:46ZWhy it’s a bad idea to mix alcohol with some medications<figure><img src="https://images.theconversation.com/files/574811/original/file-20240211-26-dgcv36.jpg?ixlib=rb-1.1.0&rect=40%2C130%2C6669%2C4335&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-man-taking-prescription-medicine-home-1768003094">pikselstock/Shutterstock</a></span></figcaption></figure><p>Anyone who has drunk alcohol will be familiar with how easily it can lower your social inhibitions and let you do things you wouldn’t normally do. </p>
<p>But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk.</p>
<p>When you mix alcohol with medicines, whether prescription or over-the-counter, the medicines can increase the effects of the alcohol or the alcohol can increase the side-effects of the drug. Sometimes it can also result in all new side-effects.</p>
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Read more:
<a href="https://theconversation.com/hilda-survey-at-a-glance-7-charts-reveal-were-smoking-less-taking-more-drugs-and-still-binge-drinking-223004">HILDA survey at a glance: 7 charts reveal we're smoking less, taking more drugs and still binge drinking</a>
</strong>
</em>
</p>
<hr>
<h2>How alcohol and medicines interact</h2>
<p>The chemicals in your brain maintain a delicate balance between excitation and inhibition. Too much excitation can lead to <a href="https://www.medicalnewstoday.com/articles/324330">convulsions</a>. Too much inhibition and you will experience effects like sedation and depression.</p>
<p><iframe id="JCh01" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/JCh01/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Alcohol works by increasing the amount of inhibition in the brain. You might recognise this as a sense of relaxation and a lowering of social inhibitions when you’ve had a couple of alcoholic drinks. </p>
<p>With even more alcohol, you will notice you can’t coordinate your muscles as well, you might slur your speech, become dizzy, forget things that have happened, and even fall asleep. </p>
<figure class="align-center ">
<img alt="Woman collects beer bottles" src="https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574812/original/file-20240211-16-viubsu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alcohol can affect the way a medicine works.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/a-group-of-people-standing-around-a-table-with-green-bottles-BeSMeRIrrDQ">Jonathan Kemper/Unsplash</a></span>
</figcaption>
</figure>
<p>Medications can interact with alcohol to <a href="https://awspntest.apa.org/record/2022-33281-033">produce different or increased effects</a>. Alcohol can interfere with the way a medicine works in the body, or it can interfere with the way a medicine is absorbed from the stomach. If your medicine has similar side-effects as being drunk, those <a href="https://www.drugs.com/article/medications-and-alcohol.html#:%7E:text=Additive%20effects%20of%20alcohol%20and,of%20drug%20in%20the%20bloodstream.">effects can be compounded</a>. </p>
<p>Not all the side-effects need to be alcohol-like. Mixing alcohol with the ADHD medicine ritalin, for example, can <a href="https://www.healthline.com/health/adhd/ritalin-and-alcohol#side-effects">increase the drug’s effect on the heart</a>, increasing your heart rate and the risk of a heart attack. </p>
<p>Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-happening-to-us-when-we-get-drunk-51245">What's happening to us when we get drunk?</a>
</strong>
</em>
</p>
<hr>
<p>Alcohol can increase the break-down of certain medicines, such as <a href="https://www.sciencedirect.com/science/article/abs/pii/S0149763421005121?via%3Dihub">opioids, cannabis, seizures, and even ritalin</a>. This can make the medicine less effective. Alcohol can also alter the pathway of how a medicine is broken down, potentially creating toxic chemicals that can cause serious liver complications. This is a particular problem with <a href="https://australianprescriber.tg.org.au/articles/alcohol-and-paracetamol.html">paracetamol</a>. </p>
<p>At its worst, the consequences of mixing alcohol and medicines can be fatal. Combining a medicine that acts on the brain with alcohol may make driving a car or operating heavy machinery difficult and lead to a serious accident.</p>
<h2>Who is at most risk?</h2>
<p>The effects of mixing alcohol and medicine are not the same for everyone. Those most at risk of an interaction are older people, women and people with a smaller body size. </p>
<p>Older people do not break down medicines as quickly as younger people, and are often on <a href="https://www.safetyandquality.gov.au/our-work/healthcare-variation/fourth-atlas-2021/medicines-use-older-people/61-polypharmacy-75-years-and-over#:%7E:text=is%20this%20important%3F-,Polypharmacy%20is%20when%20people%20are%20using%20five%20or%20more%20medicines,take%20five%20or%20more%20medicines.">more than one medication</a>. </p>
<p>Older people also are more sensitive to the effects of medications acting on the brain and will experience more side-effects, such as dizziness and falls. </p>
<figure class="align-center ">
<img alt="Woman sips red wine" src="https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&rect=321%2C47%2C7618%2C5249&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574809/original/file-20240211-24-ckwjbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Smaller and older people are often more affected.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-drinking-glass-of-wine-I-_Zmz6G6PU">Alfonso Scarpa/Unsplash</a></span>
</figcaption>
</figure>
<p>Women and people with smaller body size tend to have a higher blood alcohol concentration when they consume the same amount of alcohol as someone larger. This is because there is less water in their bodies that can mix with the alcohol.</p>
<h2>What drugs can’t you mix with alcohol?</h2>
<p>You’ll know if you can’t take alcohol because there will be a prominent warning on the box. Your pharmacist should also counsel you on your medicine when you pick up your script.</p>
<p>The most common <a href="https://adf.org.au/insights/prescription-meds-alcohol/">alcohol-interacting prescription medicines</a> are benzodiazepines (for anxiety, insomnia, or seizures), opioids for pain, antidepressants, antipsychotics, and some antibiotics, like metronidazole and tinidazole.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574894/original/file-20240212-26-ltev6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Medicines will carry a warning if you shouldn’t take them with alcohol.</span>
<span class="attribution"><span class="source">Nial Wheate</span></span>
</figcaption>
</figure>
<p>It’s not just prescription medicines that shouldn’t be mixed with alcohol. Some over-the-counter medicines that you shouldn’t combine with alcohol include medicines for sleeping, travel sickness, cold and flu, allergy, and pain. </p>
<p>Next time you pick up a medicine from your pharmacist or buy one from the local supermarket, check the packaging and ask for advice about whether you can consume alcohol while taking it. </p>
<p>If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ten-reasons-some-of-us-should-cut-back-on-alcohol-70406">Ten reasons some of us should cut back on alcohol</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nial Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. He is a Fellow of the Royal Australian Chemical Institute, a member of the Australasian Pharmaceutical Science Association, and a member of the Australian Institute of Company Directors. Nial is the chief scientific officer of Vaihea Skincare LLC, a director of SetDose Pty Ltd a medical device company, and a Standards Australia panel member for sunscreen agents. Nial regularly consults to industry on issues to do with medicine risk assessments, manufacturing, design, and testing.</span></em></p><p class="fine-print"><em><span>Kellie Charles was a previous Board Member of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists. </span></em></p><p class="fine-print"><em><span>Associate Professor Tina Hinton has previously received funding from the Schizophrenia Research Institute (formerly Neuroscience Institute of Schizophrenia and Allied Disorders). She is currently a Board member of the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists.</span></em></p><p class="fine-print"><em><span>Jasmine Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Taking a medicine with alcohol can increase effects like sedation, poor hand and eye coordination, dizziness and poor judgement.Nial Wheate, Associate Professor of the School of Pharmacy, University of SydneyJasmine Lee, Pharmacist and PhD Candidate, University of SydneyKellie Charles, Associate Professor in Pharmacology, University of SydneyTina Hinton, Associate Professor of Pharmacology, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2230042024-02-11T19:07:40Z2024-02-11T19:07:40ZHILDA survey at a glance: 7 charts reveal we’re smoking less, taking more drugs and still binge drinking<p>Australians’ vices, including drinking, smoking and illicit drugs, have been revealed in the latest <a href="https://melbourneinstitute.unimelb.edu.au/hilda/publications/hilda-statistical-reports">HILDA survey</a>.</p>
<p>The <a href="https://melbourneinstitute.unimelb.edu.au/hilda">Household, Income and Labour Dynamics in Australia survey tracks</a> the same 17,000 Australians each year, with participants followed over the course of their lifetime. The survey collects information on many facets of life and is the only study of its kind in Australia.</p>
<h2>Smoking is declining, but young people are more likely to vape</h2>
<p>There has been substantial progress in reducing smoking rates since 2001, when 25% of males and 20% of females aged 15 and over reported being smokers. In 2021, these rates had dropped to 16% for males and 12% for females. This likely reflects the effects of tobacco control measures, as well as increased public awareness of the harmful health effects of smoking.</p>
<p>Declines have been biggest for young people, which reflects the fact that it is easier to prevent the take-up of smoking than it is to get smokers to quit. Indeed, HILDA shows that over 60% of people who quit smoking take it up again within three years.</p>
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<p>The progress on reducing smoking appears to have been somewhat offset by the rise in vaping or using e-cigarettes. In 2021, 14.1% of people aged 15 and over reported having tried vaping, and 16% of these people vaped daily.</p>
<p>Vaping is very much a young person’s activity. It is most common among people aged 15 to 24, and also relatively common among people aged 25 to 29. Many people who report vaping also report being smokers.</p>
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<h2>Binge drinking remains common, especially for young men</h2>
<p>Risky drinking, here defined as usually consuming five or more standard drinks on each occasion, is relatively common, applying to over 20% of males and about 10% of females who ever drink alcohol. </p>
<p>After rising slightly between 2003 and 2009, there has since been a small decline in this measure of risky drinking for males. There has been little change in this measure for females. </p>
<p>Another measure of risky drinking, presented in the figure, is “excessive binge drinking”, defined as drinking at least five (if female) or seven (if male) drinks per occasion at least twice per month. This measure of risky drinking is more prevalent, but it has declined for both males and females since 2007.</p>
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<p>Risky drinking is most common among men aged 20 to 24, followed by men aged 25 to 29. However, for both males and females, <em>regular</em> (but not necessarily “risky”) consumption of alcohol (drinking on five or more days per week) is more common in older age groups, and highest among people aged 60 and over.</p>
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<hr>
<h2>30 to 34 year-olds had the largest increase in using drugs</h2>
<p>The HILDA survey shows use of illicit drugs, such as marijuana, methamphetamine and cocaine, increased between 2017 and 2021, with annual use increasing from 15.7% to 17.6% for males and from 8.6% to 11% for females.</p>
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<p>People aged 20 to 24 are the most likely to use illicit drugs, but the increase in use was greatest for people aged 30 to 34.</p>
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<p>The use of multiple types of illicit drugs, known as polydrug use, is common for users of methamphetamine, cocaine and ecstasy, but much less common for users of marijuana.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/hilda-data-show-womens-job-prospects-improving-relative-to-mens-and-the-covid-changes-might-have-helped-222897">HILDA data show women's job prospects improving relative to men's, and the COVID changes might have helped</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/223004/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Wilkins receives funding from the Australian Research Council.</span></em></p>Some 17,000 people told us exactly how much they drank, smoked and used illicit drugs. Here’s a unique snapshot of Australians’ vices.Roger Wilkins, Professorial Fellow and Deputy Director (Research), HILDA Survey, Melbourne Institute of Applied Economic and Social Research, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169482024-02-06T12:29:33Z2024-02-06T12:29:33ZYouth drinking is declining – myths about the trend, busted<figure><img src="https://images.theconversation.com/files/573094/original/file-20240202-29-rq3yjg.jpg?ixlib=rb-1.1.0&rect=122%2C57%2C5340%2C3579&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-beer-bottles-close-204543214">Africa Studio/Shutterstock</a></span></figcaption></figure><p>Alcohol consumption among younger generations has been declining for years. And with many pubs and <a href="https://luxurylondon.co.uk/taste/drink/best-london-bars-alcohol-free-drinking/">cocktail bars</a> now catering to the sober and <a href="https://www.verywellmind.com/what-does-it-mean-to-be-sober-curious-4774971">“sober curious”</a>, it’s easier than ever to opt out. </p>
<p>Starting in the US in the late 1990s, and spreading to several other wealthy countries in the early 2000s, young people began to <a href="https://pubmed.ncbi.nlm.nih.gov/33188681/">drink less</a> than previous generations, or avoid drinking alcohol altogether. </p>
<p>The proportion of 16- to 24-year-olds who report drinking alcohol in the last week fell from <a href="https://eprints.whiterose.ac.uk/136587/1/Oldham_Holmes_Youth_drinking_in_decline_FINAL.pdf">67% in 2002</a> to <a href="https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021">37% in 2021</a>. The decline was even steeper for younger teens. In England, the proportion of 15-year-olds who have drunk alcohol in the past week fell from <a href="https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2021/data-tables">52% to 20% between 2001 and 2021</a>, although some of this may be due to changes in the survey methods over that period. </p>
<p>We have been researching the decline in youth drinking in <a href="https://sarg-sheffield.ac.uk/y-did-youth-drinking-in-decline/">England</a> and Australia, using both <a href="https://doi.org/10.1093/eurpub/ckaa193">surveys</a> and <a href="https://www.tandfonline.com/doi/full/10.1080/13676261.2020.1778658">interviews</a> with young people. </p>
<p>When we present our findings to other researchers and the wider public, we find that adults are often surprised to hear that young people today drink less. In our experience, their reactions suggest a belief in outdated stereotypes of young people as irresponsible and feckless.</p>
<p>They also sometimes jump to incorrect conclusions about the reasons why young people are drinking less, projecting adults’ motives for abstaining onto young people.</p>
<h2>Why are young people drinking less?</h2>
<p>The reasons behind the decline are complex, but by analysing survey data and interviewing young people in England and Australia, we can provide some answers.</p>
<p>The change reflects a general trend in young people’s attitudes toward risk. From smoking to sex, young people – including those in early adolescence and in their early twenties – are generally <a href="https://doi.org/10.1111/dar.13709">more risk averse than previous generations</a>. </p>
<p>This extends to where they choose to, or feel able to, spend time. Some young people have less independent access to public spaces, like parks, than past generations because of increased restrictions on their ability to access such spaces. There is also evidence that they view socialising in such spaces with alcohol to be <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.13710">unsafe and morally suspect</a>.</p>
<p><a href="https://doi.org/10.1111/add.15611">Recent research</a> shows that drinking has become less routine and expected for young people, while not drinking has become more socially acceptable. This could be due to more efforts by governments and businesses like supermarkets to make alcohol less available to young people. </p>
<p>However, it can’t be the only explanation, as in some countries where there has been a decline in youth drinking, policies regulating young people’s access to alcohol haven’t changed. </p>
<p>Adolescents’ attitudes toward drinking have generally become more negative, while their attitudes toward non-drinking have become <a href="https://doi.org/10.1016/j.drugpo.2018.12.001">positive and accepting</a>. Researchers argue that this stems from a longer, more protracted transition into young adulthood, as well as young people’s <a href="https://doi.org/10.1177/00380385211008370">concerns about the future</a> and feeling a strong sense of <a href="https://onlinelibrary.wiley.com/doi/10.1111/1468-4446.12964">pressure to succeed</a> in life, including economically.</p>
<p>We found most of the young people we spoke to didn’t consider peer pressure to be an important factor in their decisions to drink or not, except for a small number of university students who resented how <a href="https://www.tandfonline.com/doi/full/10.1080/13676261.2023.2190013">alcohol-centric</a> social life at university is. </p>
<h2>Misconceptions about youth drinking</h2>
<p>People we have spoken to about our research often assume that if young people aren’t drinking, they must be doing something else instead that is equally (or even more) harmful, such as smoking cigarettes or cannabis. </p>
<p>In fact, the opposite is true: <a href="https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2018">smoking and cannabis use</a> decreased at the same time as alcohol. There were some signs of increases in cannabis use among schoolchildren <a href="https://digital.nhs.uk/data-and-information/publications/statistical/smoking-drinking-and-drug-use-among-young-people-in-england/2021#data-sets">before the pandemic</a> and smoking among young adults <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-03157-2">after the pandemic</a>. </p>
<p>But both of these – like the <a href="https://www.theguardian.com/society/2023/mar/18/uk-health-expert-raises-alarm-at-epidemic-of-vaping-among-teenagers">rise in teen vaping</a> – occurred years after the decline in youth drinking was well-established. In other words, some groups of young people may be smoking cannabis or tobacco and vaping more, but they are unlikely to be doing so in place of drinking alcohol. </p>
<p>And while the rise of the internet and social media happened at the same time as the drinking decline, there is little evidence that young people are using technology in place of drinking. On the contrary, it is those who use the internet the most who also tend to <a href="https://www.bmj.com/content/383/bmj-2022-073552">drink the most</a>.</p>
<figure class="align-center ">
<img alt="Two teen girls smoking electronic vapes and seated side by side on a picnic blanket in the woods" src="https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/573097/original/file-20240202-29-61ytvr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Teens are not necessarily replacing alcohol with other risky behaviour.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/vape-lgbt-teenagers-bisexual-lesbian-young-1535887709">Aleksandr Yu//Shutterstock</a></span>
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<p>It is important to note that the decline in youth drinking is not the same as the growing “sobriety movement”. The latter has been behind temporary abstinence campaigns like Dry January, and helped by social media influencers, <a href="https://www.cosmopolitan.com/uk/body/health/a33323277/sober-celebrities/">celebrities</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8695609/">online communities</a> promoting sobriety as a way a of life. </p>
<p>Those who speak publicly about their decision to go sober usually describe how this decision was made after years of binge drinking. The sobriety movement is about adults reassessing their relationship to alcohol. This is very different from teenagers deciding, actively or passively, not to take up drinking. </p>
<p>Though at least one study has identified links between young people’s decisions not to drink and their <a href="https://onlinelibrary.wiley.com/doi/10.1111/1467-9566.13237">health consciousness</a>, the general trend is not about giving up alcohol, but about not really developing a drinking habit in the first place.</p><img src="https://counter.theconversation.com/content/216948/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Fenton receives funding from Wellcome Trust (208090/Z/17/Z) for her research on the decline in youth drinking.</span></em></p><p class="fine-print"><em><span>Amy Pennay receives funding from the Australian Research Council, the National Health and Medical Research Council (Australia) and the Victorian Health Promotion Foundation. </span></em></p><p class="fine-print"><em><span>John Holmes receives funding from Wellcome (208090/Z/17/Z) for his research on the decline in youth drinking. </span></em></p>Adults are often confused about the reasons young people are drinking less.Laura Fenton, Research Associate, Public Health, University of SheffieldAmy Pennay, Research Fellow, Centre for Alcohol Policy Research, La Trobe UniversityJohn Holmes, Professor of Alcohol Policy, Sheffield Alcohol Research Group, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215322024-02-05T13:34:49Z2024-02-05T13:34:49ZStigma kills people with alcohol addiction<figure><img src="https://images.theconversation.com/files/572878/original/file-20240201-17-j3u58p.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/empty-bottles-green-container-207599350">sirtravelalot/Shutterstock</a></span></figcaption></figure><p>One of my patients, Emma (not her real name), recently told me that she didn’t seek help for her alcohol problem because she was ashamed. She said that she didn’t want to waste anyone’s time on a self-inflicted problem. She lived with it for years, hiding bottles of alcohol so her partner wouldn’t find out. Only when she turned yellow and vomited blood did she call an ambulance.</p>
<p>What stopped Emma from asking for help? The answer, in large part, is stigma. The word stigma comes from ancient Greek, meaning a mark of shame or disgrace. Originally used to label slaves and criminals, these days, stigma is used to mean a sign of something socially undesirable – in this case, alcoholism.</p>
<p>Alcoholism, or <a href="https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder">alcohol use disorder</a>, as it is known in medical terms, is the compulsion to drink alcohol even when it can cause physical or mental health problems. </p>
<p>Alcohol use disorder is a medical condition, not a lifestyle choice. This is different from heavy drinking and shouldn’t be used to describe someone who drinks too much by choice. </p>
<p>In people with alcohol use disorder, there may be a physical need to drink alcohol to stop withdrawal symptoms like the sweats or shakes. There may be psychological reasons including uncontrollable craving. </p>
<p>Most of the patients I see in hospital with alcohol-related liver disease have alcohol use disorder. We don’t fully understand why some people develop alcohol use disorder. It is partly <a href="https://www.nature.com/articles/s41467-019-09480-8#Abs1">genetic</a> but other factors such as social support and mental health conditions play a role.</p>
<p>Why does the stigmatisation of people with alcohol use disorder matter? As Emma’s story shows, the problem is that people don’t come forward to ask for help until it is too late and irreversible damage is already done – the case in around half of all people diagnosed with alcohol-related liver disease. </p>
<p>Worse still, one in six people diagnosed late die on their first admission to hospital and more than a third <a href="https://britishlivertrust.org.uk/new-research-reveals-late-detection-of-liver-disease-crisis-with-more-than-a-third-dying-within-a-year-of-diagnosis/">within a year</a> of their diagnosis.</p>
<h2>Stigma is common</h2>
<p>Most people with liver disease have experienced stigma <a href="https://britishlivertrust.org.uk/stigma-survey-results/">first hand</a>. </p>
<p>Several types of stigma are important to understand. First, there is public stigma. This is the most common type of stigma, where people believe in negative stereotypes, develop prejudice, and avoid or look down on people with alcohol use disorder – the drunk on the street might be aggressive so best to avoid him.</p>
<p>Second, there is stigma from healthcare professionals. Some of us do not appreciate that alcohol use disorder is a disease of addiction. We see people with alcohol use disorder time and again coming into hospital in a terrible state and perhaps consider them a hopeless cause, a drain on medical resources or a waste of our valuable time. It is disappointing that this attitude can come from doctors, nurses and other trained healthcare professionals, but it is a sad reality that my patients report.</p>
<p>Third, there is structural stigma. This is the way services are designed that might exclude certain groups of people. For example, same-day appointments with general practitioners may only be available to book early in the morning, and some people may not be able to access them.</p>
<p>All this external stigmatisation of the person with alcohol use disorder drives self-stigma: a feeling of low self-worth and self-esteem. </p>
<p>The more stigma they experience, the more self-stigma they develop and the more they feel that they deserve such treatment. They conceal and deny their alcohol use and are six times <a href="https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-021-00587-0">more likely to avoid healthcare</a>. They enter a vicious cycle of increasing alcohol use causing more mental and physical harm to themselves.</p>
<h2>Things may have turned out differently</h2>
<p>Let me come back to Emma. She battled her addiction for several years and with the support of alcohol services and her family, managed several months at a stretch without alcohol. Sadly, she relapsed into heavy drinking and a few months later had a serious bleed from her gullet (a side-effect of severe liver disease), which couldn’t be controlled. Sadly, she died. </p>
<p>I can’t help but think that if Emma hadn’t experienced all that stigma, things may have turned out differently for her. She may have been able to get help to control her addiction and prevent liver disease from taking her life.</p>
<p>What do we learn from Emma’s story? We should remember that alcohol use disorder is not a lifestyle choice. We, the public and healthcare professionals, should reflect on how we treat people with alcohol addiction. </p>
<p>The first step in removing stigma is to recognise the prejudices and stereotypes that we hold and try to overcome these by seeing the person behind the bottle. If we work together, we can eliminate stigma and support people with this terrible medical condition.</p>
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Read more:
<a href="https://theconversation.com/what-happens-to-your-liver-when-you-quit-alcohol-220490">What happens to your liver when you quit alcohol</a>
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<img src="https://counter.theconversation.com/content/221532/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashwin Dhanda receives funding from the National Institute of Health and Social Care Research for a study investigating methods to tackle stigma in alcohol-related liver disease. </span></em></p>One in six people diagnosed late with alcohol use disorder die on their first admission to hospital.Ashwin Dhanda, Associate Professor of Hepatology, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2222992024-02-02T16:25:32Z2024-02-02T16:25:32ZCompleted Dry January? Reading fiction can help newly sober mothers decide what’s next<figure><img src="https://images.theconversation.com/files/572156/original/file-20240130-27-fh57zq.jpg?ixlib=rb-1.1.0&rect=88%2C35%2C5841%2C3920&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/european-girl-reading-book-drinking-tea-2124750215">WellStock/Shutterstock</a></span></figcaption></figure><p>More people in the UK have gone dry this January <a href="https://www.bbc.co.uk/news/business-68019470">than ever before</a>, so drinking, not drinking, and navigating a course between the two, is on many of our minds.</p>
<p>Many of those people <a href="https://alcoholstudies.rutgers.edu/women-increase-drinking-during-pandemic/#:%7E:text=Recent%20data%20show%20the%20pandemic,overall%20population%20increase%20of%2014%25.">are mothers</a>. The pandemic saw an unprecedented <a href="https://www.channel4.com/news/the-frontline-of-britains-lockdown-drink-problem-as-alcohol-deaths-soar">escalation in domestic drinking</a>. With the arrival of high-speed home delivery companies, alcohol became more readily and rapidly available than ever before. For many women juggling not just work and childcare but also homeschooling, alcohol may have seemed to offer a coping mechanism, a way to survive <a href="https://www.theguardian.com/commentisfree/2024/jan/15/smoking-weed-motherhood-son-child-habit">“the grind of motherhood”</a>.</p>
<p>If you’ve been participating in Dry January, you may be feeling relieved, proud or anxious now that the month has come to an end. If you are wondering what to do next, there are blogs, podcasts, memoirs and self-help books on hand to offer advice. But other books can also help. Fiction offers precious – sobering – insights into the impact of alcohol in the lives of women and children.</p>
<p>Two works in particular stand out. Doug Stuart’s Booker Prize winner, <a href="https://www.panmacmillan.com/authors/douglas-stuart/shuggie-bain/9781529019292">Shuggie Bain</a> (2020), and the short stories of American writer <a href="https://www.newyorker.com/books/page-turner/the-story-is-the-thing-on-lucia-berlin">Lucia Berlin</a> provide visceral, insider portrayals of the devastating effect of life with and – occasionally, blissfully without – drink for mothers and their children. </p>
<h2>How fiction can help</h2>
<p>What exactly do these works of fiction offer that you might not find elsewhere? Set against intimate domestic backdrops, they provide unflinching accounts of drinking as a woman and mother and where extreme addiction can take you. </p>
<p>One example comes from Lucia Berlin’s short story, Unmanageable, from the collection A Manual for Cleaning Women (2015). On waking – hyperventilating – during the night, the unnamed protagonist sets out on an unnerving trip to a liquor store to get the drink which will enable her to function. </p>
<p>She succeeds, returns home, and sets about making her children their breakfast and washing their school clothes. She is trying to hold it together and paper over the cracks and she very nearly succeeds – but the socks for her sons aren’t dry in time. </p>
<p>Unmanageable offers a glimpse of the experiences of children of alcoholics, as well as their parents. The protagonist’s sons take her bag and car keys in an effort to protect her, but are unsuccessful and must go to school sockless. </p>
<p>In Shuggie Bain, one of the things that Stuart does so brilliantly is combine and move between the experiences of the beautiful, wasted – in all senses – Agnes and her youngest son, the eponymous Shuggie. Over several hundred pages of often excruciatingly painful prose, he shows both how and why Agnes drinks and the impact of addiction on the lives of her children. This includes the astonishing range of strategies they undertake to keep her safe. </p>
<p>In Berlin’s stories it becomes clear that the same mother who heads out to the liquor store in the dead of night had also experienced the effects of drinking on her own mother and other family members when she herself was a child. Threading the stories together, the generational legacies become painfully clear.</p>
<h2>An offer of hope</h2>
<p>Neither work pulls any punches. Shuggie’s strategies are all ultimately futile. But these characters aren’t all doomed. Stuart <a href="https://news.stv.tv/entertainment/shuggie-bain-author-douglas-stuart-says-writing-booker-prize-winning-novel-called-him-home#:%7E:text=Stuart%20insists%20that%20Shuggie%20Bain,addiction%20when%20he%20was%2016.">has acknowledged</a> that aspects and characters in the book reflect his own childhood. His ability to write Shuggie’s experiences at all – as well as his successful career working in fashion in the US – suggests there is a way through. Lives can be turned around, relationships saved. </p>
<p>In another short story, So Long, Berlin describes a mundane, relaxed breakfast with her adult son: “The same son I used to steal from, who told me I wasn’t his mother.” They read the papers, chat about sport and politics, then he kisses her goodbye. “All over the world mothers are having breakfast with their sons, seeing them off at the door,” she writes. “Can they know the gratitude I felt, standing there, waving? The reprieve.”</p>
<p>One of the key insights of these works for those wondering about their own next steps is the extraordinary and often contradictory pressure exerted by what other people think. </p>
<p>Perhaps the most heartbreaking scene in Shuggie Bain occurs at a golf club restaurant where Agnes’s new partner badgers and seduces her until she finally capitulates “because it’s what normal people do”. His inability to accept her as, at that point, a 12-months sober alcoholic, and her fear of what other people think, is something Agnes never comes back from.</p>
<p>As this scene plays out, we feel with and for her: stiffening when wine is ordered, overwhelmed with tiredness and fear just before finally giving in. These aren’t works which point the finger, but which offer insights and understanding, tenderness and compassion. </p>
<h2>No perfect fix</h2>
<p>As the books themselves make clear, fiction doesn’t always work or help. Shuggie’s attempts to entertain Agnes by reading to her from Roald Dahl’s Danny the Champion of the World don’t keep her sober. But for the Lucia Berlin character in Unmanageable, literature literally saves her life:</p>
<blockquote>
<p>“She was shaking too hard to stand. She lay on the floor breathing deep yoga breaths. Don’t think, God don’t think about the state you’re in or you will die, of shame, a stroke. Her breath slowed down. She started to read the titles of books in the bookcase. Concentrate, read them out loud. Edward Abbey, Chinua Achebe, Sherwood Anderson, Jane Austen, Paul Auster, don’t skip, slow down. By the time she had read the whole wall of books she was better.”</p>
</blockquote>
<p>Ultimately then, as those who have participated in Dry January decide what comes next, looking to the world of fiction has the potential to do a lot more good than dwelling on what other people think. </p>
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<img alt="" src="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/536131/original/file-20230706-17-460x2d.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p class="fine-print"><em><span>Kiera Vaclavik does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fiction offers precious and sobering insights into the impact of alcohol in the lives of women and children.Kiera Vaclavik, Professor of Children's Literature & Childhood Culture, Queen Mary University of LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2201342024-01-22T13:32:06Z2024-01-22T13:32:06ZAlcohol and drugs rewire your brain by changing how your genes work – research is investigating how to counteract addiction’s effects<figure><img src="https://images.theconversation.com/files/569941/original/file-20240117-21-ycbpim.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C3600%2C1810&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Alcohol and other drugs can overpower the reward pathways of the brain.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/illustration-of-a-brain-cocktail-isolate-don-a-royalty-free-image/1263367270">Simona Dumitru/Moment via Getty Images</a></span></figcaption></figure><p>Many people are wired to <a href="https://www.penguinrandomhouse.ca/books/306396/the-compass-of-pleasure-by-david-j-linden/9780143120759">seek and respond to rewards</a>. Your brain interprets food as rewarding when you are hungry and water as rewarding when you are thirsty. But addictive substances like alcohol and drugs of abuse can <a href="https://doi.org/10.1016/S2215-0366(16)00104-8">overwhelm the natural reward pathways</a> in your brain, resulting in intolerable cravings and reduced impulse control. </p>
<p>A popular misconception is that addiction is a result of low willpower. But an explosion of knowledge and technology in the field of <a href="https://plato.stanford.edu/entries/molecular-genetics/">molecular genetics</a> has changed our basic understanding of addiction drastically over the past decade. The general consensus among scientists and health care professionals is that there is a <a href="https://www.penguinrandomhouse.ca/books/557515/never-enough-by-judith-grisel/9780525434900">strong neurobiological and genetic basis</a> for addiction.</p>
<p>As a <a href="https://scholar.google.com/citations?user=XgunjGkAAAAJ&hl=en">behavioral neurogeneticist</a> <a href="https://www.kaunlab.com">leading a team</a> investigating the molecular mechanisms of addiction, I combine neuroscience with genetics to understand how alcohol and drugs influence the brain. In the past decade, I have seen changes in our understanding of the molecular mechanisms of addiction, largely due to a better understanding of how genes are dynamically regulated in the brain. New ways of thinking about how addictions form have the potential to change how we approach treatment.</p>
<h2>Alcohol and drugs affect brain gene activity</h2>
<p>Each of your brain cells has your genetic code stored in long strands of DNA. For all that DNA to fit into a cell, it needs to be packed tightly. This is achieved by winding the DNA around “spools” of protein <a href="https://www.genome.gov/genetics-glossary/histone">called histones</a>. Areas where DNA is unwound contain active genes coding for proteins that serve important functions within the cell.</p>
<p>When gene activity changes, the proteins your cells produce also change. Such changes can range from a single neuronal connection in your brain to how you behave. This genetic choreography suggests that while your genes affect how your brain develops, <a href="https://theconversation.com/brains-work-via-their-genes-just-as-much-as-their-neurons-47522">which genes are turned on or off</a> when you are learning new things is dynamic and adapts to suit your daily needs.</p>
<p>Recent data from animal models suggests that alcohol and drugs of abuse directly influence <a href="https://doi.org/10.1523/JNEUROSCI.1649-20.2020">changes in gene expression</a> in areas of the brain that help drive memory and reward responses. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Diagram magnifying the nucleus of a neuron, showing spirals of DNA wound around bundles of protein" src="https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=358&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=358&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=358&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567627/original/file-20240103-29-mcair4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Within each neuron in the brain, how tightly DNA is wound around or bound to histones and other proteins determines which genes are expressed and which proteins are produced.</span>
<span class="attribution"><span class="source">Karla Kaun and Vinald Francis</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>There are <a href="https://doi.org/10.1523/JNEUROSCI.1649-20.2020">many ways</a> addictive substances can change gene expression. They can alter which proteins bind to DNA to turn genes on and off and which segments of DNA are unwound. They can change the process of how DNA is read and translated into proteins, as well as alter the proteins that determine how cells use energy to function.</p>
<p>For example, alcohol can cause an alternative form of a gene to be expressed in the memory circuits <a href="https://doi.org/10.1534/genetics.120.303101">in flies</a> <a href="https://doi.org/10.1038/s41598-023-30926-z">and people</a>, resulting in changes in dopamine receptors and transcription factors involved in reward signaling and neuronal function. Similarly, cocaine can cause an alternative form of a gene to be expressed in the <a href="https://doi.org/10.1016/j.neuron.2021.08.008">reward centers</a> <a href="https://doi.org/10.1016/j.biopsych.2017.11.027">of mice</a>, leading them to seek out more cocaine.</p>
<p>Exactly how these drugs cause changes in gene regulation is unknown. However, a direct link between alcohol consumption and changes in gene expression in mice provides a clue. A byproduct of alcohol being broken down in the liver called acetate can cross the blood-brain barrier and <a href="https://doi.org/10.1038/s41586-019-1700-7">unwind DNA from histones</a> in mouse memory circuits. </p>
<p>Alcohol, nicotine, cocaine and opioids also all activate important signaling pathways that are <a href="https://doi.org/10.1111/jnc.12725">central regulators of metabolism</a>. This suggests they can also affect many aspects of neuronal function and consequently affect which genes are expressed.</p>
<h2>Changing brain gene activity with lifestyle</h2>
<p>How addictive substances change cell function is complex. The version of a gene you’re born with can be modified in many ways before it becomes a functional protein, including exposure to alcohol and drugs. Rather than discouraging researchers, this complexity is empowering because it provides evidence that changes to gene expression in your brain aren’t permanent. They can also be altered by medications and lifestyle choices.</p>
<p>Many commonly prescribed medications for mental health disorders also affect gene expression. <a href="https://doi.org/10.1038%2Fs41398-019-0589-0">Antidepressants and</a> <a href="https://doi.org/10.1016/j.jpsychires.2013.05.028">mood stabilizers</a> can change how DNA is modified and which genes are expressed. For example, a commonly prescribed drug for depression called escitalopram affects how tightly wound DNA is and can change the expression of genes important to brain plasticity.</p>
<p>Additionally, <a href="https://theconversation.com/customizing-mrna-is-easy-and-thats-what-makes-it-the-next-frontier-for-personalized-medicine-a-molecular-biologist-explains-216127">mRNA-based therapies</a> can specifically change which genes are expressed to treat diseases like cancer. In the future, we may discover similar therapies for alcohol and substance use disorder. These treatments could potentially target important <a href="https://doi.org/10.1016%2Fj.tins.2021.09.006">signaling pathways linked to addiction</a>, altering how brain circuits function and how alcohol and drugs affect them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close-up of person sitting with crossed legs on a yoga mat, hands resting on knees with pointer finger touching thumb" src="https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569945/original/file-20240117-29-n459lb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Exercise and other lifestyle choices can affect gene regulation.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/indonesian-woman-is-meditating-in-a-half-lotus-royalty-free-image/1391023941?adppopup=true">Afriandi/Moment via Getty Images</a></span>
</figcaption>
</figure>
<p>Lifestyle choices can also affect gene expression in your brain, though researchers don’t yet know whether they can alter the changes induced by addictive substances. </p>
<p>Like alcohol and drugs, <a href="https://theconversation.com/what-you-eat-can-reprogram-your-genes-an-expert-explains-the-emerging-science-of-nutrigenomics-165867">dietary changes</a> can affect gene expression in many ways. In flies, a high sugar diet can <a href="https://doi.org/10.1126/sciadv.abc8492">reprogram the ability to taste sweetness</a> by tapping into a gene expression network involved in development.</p>
<p><a href="https://doi.org/10.1016/j.cpnec.2022.100152">Intensive</a> <a href="https://doi.org/10.1016/j.psyneuen.2013.11.004">meditation</a>, even after only <a href="https://doi.org/10.1016/j.bbi.2019.11.003">one day</a>, can also affect gene regulation in your brain through similar mechanisms. Attending a <a href="https://doi.org/10.1016/j.cpnec.2022.100152">monthlong meditation retreat</a> reduces the expression of genes that affect inflammation, and experienced meditators can reduce inflammatory genes after just <a href="https://doi.org/10.1016/j.bbi.2019.11.003">one day of intensive meditation</a>. </p>
<p>Work in animal models has also shown that exercise changes gene expression by altering both <a href="https://doi.org/10.1016/j.brainres.2020.147191">histones</a> <a href="https://doi.org/10.1016/j.molmet.2021.101398">and the</a> <a href="https://doi.org/10.1111/j.1460-9568.2010.07508.x">molecular tags</a> directly attached to DNA. This increases the activity of genes important to the activity and plasticity of neurons, supporting the idea that <a href="https://theconversation.com/high-intensity-exercise-improves-memory-and-wards-off-dementia-127001">exercise improves learning and memory</a> and can decrease the risk of dementia.</p>
<p>From <a href="https://doi.org/10.1037/hea0000297">Dry January</a> and beyond, many factors can have profound effects on your brain biology. Taking steps to reduce consumption of alcohol and drugs and picking up healthy lifestyle practices can help stabilize and bring long-lasting benefits for your physical and mental health.</p><img src="https://counter.theconversation.com/content/220134/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Karla Kaun receives funding from the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse and the National Institute of General Medical Sciences.</span></em></p>Improved understanding of the molecular mechanisms of addiction can change how researchers and clinicians approach treatments.Karla Kaun, Associate Professor of Neuroscience, Brown UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2175092024-01-22T13:28:26Z2024-01-22T13:28:26ZThink wine is a virtue, not a vice? Nutrition label information surprised many US consumers<figure><img src="https://images.theconversation.com/files/569115/original/file-20240112-21-1bz0bp.jpg?ixlib=rb-1.1.0&rect=56%2C85%2C9247%2C5164&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Decisions, decisions.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/rear-view-of-young-asian-woman-grocery-shopping-for-royalty-free-image/1366189228?phrase=wine+store&adppopup=true">d3sign/Getty Images</a></span></figcaption></figure><p>When you reach for that bottle of wine this Valentine’s Day, do you know how healthy it is? Many people have a too-rosy view of the beverage and are surprised when confronted with the facts about it on a nutrition label, according to a study my co-author <a href="https://www.depts.ttu.edu/hs/hrm/velikova.php">Natalia Velikova</a> <a href="https://www.depts.ttu.edu/rawlsbusiness/people/faculty/marketing/deidre-popovich/index.php">and I</a> recently published in the <a href="https://doi.org/10.1108/JCM-09-2020-4101">Journal of Consumer Marketing</a>. </p>
<p>Our findings could have big implications for the wine industry, particularly as <a href="https://www.fooddive.com/news/alcohol-labeling-lawsuit/633347/">some groups in the U.S. are pushing</a> for wine to have mandatory nutrition labels.</p>
<p>Right now, people usually think of wine as <a href="https://doi.org/10.1287/mksc.17.4.317">a “virtue” rather than a “vice,”</a> thanks to popular beliefs about its <a href="https://www.health.harvard.edu/blog/is-red-wine-good-actually-for-your-heart-2018021913285#">health benefits</a> and news coverage of its antioxidant effects. But requiring nutrition labels, which are currently voluntary, could change those views. </p>
<p>In our experimental research, which included nearly 800 participants, we found that American consumers aren’t used to seeing nutrition information on wine labels, and most are surprised by what they read since they don’t associate wine with calories, carbohydrates and sugar. People who were prompted to read labels viewed wine as less healthy than they did beforehand, and they were less likely to buy it. </p>
<p>We also found that people are more surprised by the sugar content of sweeter wines, such as Moscato, than by the number of calories. Sweet wines, in particular, may contain more sugar than consumers realize.</p>
<h2>Why it matters</h2>
<p>The European Union recently <a href="https://www.wineenthusiast.com/culture/industry-news/new-eu-wine-label-regulations/">mandated nutrition labeling on wine</a>, sometimes in the form of <a href="https://www.decanter.com/learn/eu-wine-labelling-the-changes-explained-507553/">QR codes</a>, and industry analysts expect <a href="https://wineindustryadvisor.com/2023/02/24/ingredient-labels-are-coming-you-need-to-know">the U.S. will eventually follow suit</a>. The Treasury Department’s Alcohol and Tobacco Tax and Trade Bureau, which regulates wine production, has already <a href="https://www.cspinet.org/press-release/consumer-groups-obtain-ttb-commitment-issue-rulemakings-mandatory-alcohol-labeling">agreed to issue some preliminary rules</a> for mandatory ingredient labeling.</p>
<p>Nutrition labels don’t need to be bad news for the wine industry. Wine sales have <a href="https://www.svb.com/globalassets/trendsandinsights/reports/wine/svb-state-of-the-wine-industry-report-2023.pdf">recently declined</a> among those 60 and younger, and greater transparency in labeling could help rekindle young consumers’ interest. </p>
<p><a href="https://doi.org/10.1016/j.wep.2018.11.001">Millennial and Gen Z consumers</a> may especially appreciate clearer labels, since it could help them view wine as less mysterious and more accessible. It may also allow them to fit an occasional glass of wine into their personal health goals. Younger consumers might also be more interested in <a href="https://doi.org/10.1016/j.wep.2019.02.001">eliminating as many highly processed ingredients as possible</a> from their diets. </p>
<p>What’s more, there’s been a recent trend toward wine packaging including labels like “organic,” “biodynamic” and “sustainable,” which may appeal to consumers’ preferences for sustainability. These labels have less to do with nutrition than with manufacturers trying to appear eco-friendly — but makers of natural wine would likely benefit most from offering nutrition information to support their front-of-label claims.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&rect=98%2C12%2C8120%2C5438&q=45&auto=format&w=1000&fit=clip"><img alt="In an over-the-shoulder photograph, a woman chooses between two bottles of wine at a liquor store." src="https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&rect=98%2C12%2C8120%2C5438&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568090/original/file-20240106-28-sl6le5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Americans generally view red wines as healthier than whites, research shows.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/over-the-shoulder-view-of-woman-walking-through-royalty-free-image/1308615779">D3sign/Getty Images</a></span>
</figcaption>
</figure>
<h2>What other research is being done</h2>
<p>German researchers have found that most consumers often overestimate calories in wine before viewing nutritional labels, and they <a href="https://doi.org/10.1016/j.wep.2019.02.001">don’t think the information is useful</a>. The researchers found that consumers often feel insecure and confused after reading wine ingredient information. Reviewing ingredient lists also made consumers less likely to view wine as a natural product. </p>
<p>On the manufacturer side, research shows that mandatory nutrition labeling would affect the wine industry in several ways — notably by <a href="https://doi.org/10.1016/j.wep.2019.05.002">increasing overhead costs</a> related to compliance, laboratory analyses and more challenging labeling processes. This could disproportionately hurt smaller wineries with fewer resources. </p>
<h2>What still isn’t known</h2>
<p>We still don’t know who is most likely to read and use nutrition labels on wine, but younger customers <a href="https://doi.org/10.1017/S1368980010003290">seem to be more interested</a> in food labels generally. Millennials report they are <a href="https://doi.org/10.1017/S1368980016002871">eating healthier</a> and <a href="https://www.physicalactivitycouncil.org/_files/ugd/286de6_292481f0e76443d4b0921fbb879f8cfc.pdf">exercising more</a> than previous generations.</p>
<p>And there’s still more to learn about how nutrition labels affect behavior. Studies have shown mixed results, but on the whole, labeling appears to make people <a href="https://doi.org/10.1016/j.amepre.2018.09.024">cut their calorie consumption</a> somewhat. Still, the U.S. put nutrition labels on foods in the 1990s, and that hasn’t stopped the <a href="https://www.cdc.gov/obesity/data/adult.html">obesity rate from rising</a>.</p><img src="https://counter.theconversation.com/content/217509/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deidre Popovich does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People may be surprised when they read a nutrition label on a bottle of wine. The industry should take note.Deidre Popovich, Associate Professor of Marketing, Texas Tech UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2204902024-01-16T17:48:04Z2024-01-16T17:48:04ZWhat happens to your liver when you quit alcohol<figure><img src="https://images.theconversation.com/files/568930/original/file-20240111-25-sxzwan.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4021%2C2678&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stop-alcohol-concept-person-refuse-drink-1518344570">Pormezz/Shutterstock</a></span></figcaption></figure><p>According to Greek mythology, Zeus punished Prometheus for giving fire to humans. He chained Prometheus up and set an eagle to feast on his liver. Each night, the liver grew back and each day, the eagle returned for his feast. In reality, can a liver really grow back? </p>
<p>The liver is the largest internal organ in the human body. It is needed for hundreds of bodily processes, including breaking down toxins such as alcohol. As it is the first organ to “see” alcohol that has been drunk, it is not surprising that it is the most susceptible to alcohol’s effects. However, other organs, including the brain and heart, can also be damaged by long-term heavy alcohol use.</p>
<p>As a liver specialist, I meet people with alcohol-related liver disease every day. It is a <a href="https://britishlivertrust.org.uk/information-and-support/liver-conditions/alcohol-related-liver-disease/">spectrum of disease</a> ranging from laying down of fat in the liver (fatty liver) to scar formation (cirrhosis) and it usually doesn’t cause any symptoms until the very late stages of damage. </p>
<p>At first, alcohol makes the liver fatty. This fat causes the liver to become inflamed. In response, it tries to heal itself, producing scar tissue. If this carries on unchecked, the whole liver can become a mesh of scars with small islands of “good” liver in between – cirrhosis. </p>
<p>In the late stages of cirrhosis, when the liver fails, people can turn yellow (jaundice), swell with fluid and become sleepy and confused. This is serious and can be fatal.</p>
<p>Most people who regularly drink more than the recommended limit of 14 units of alcohol per week (about six pints of normal strength beer [4% ABV] or about six average [175ml] glasses of wine [14% ABV]) will have a fatty liver. Long-term and heavy alcohol use increases the risk of developing <a href="https://www.nhs.uk/conditions/alcohol-related-liver-disease-arld/">scarring and cirrhosis</a>. </p>
<figure class="align-center ">
<img alt="A man with jaundice pulls down one eyelid." src="https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568934/original/file-20240111-17-txmq0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Yellow skin and eyes are signs of a damaged liver.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/liver-disease-young-man-face-yellowish-1898063578">Creative Cat Studio/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Good news</h2>
<p>Fortunately, there is good news. In people with fatty liver, after only two to three weeks of giving up alcohol, the liver can heal and looks and functions <a href="https://arcr.niaaa.nih.gov/volume/41/1/natural-recovery-liver-and-other-organs-after-chronic-alcohol-use">as good as new</a>. </p>
<p>In people with liver inflammation or mild scarring, even within seven days of giving up alcohol, there are noticeable reductions in liver <a href="https://www.mdpi.com/2072-6643/13/5/1659">fat, inflammation and scarring</a>. Stopping alcohol use for several months lets the liver heal and return to normal.</p>
<p>In heavy drinkers with more severe scarring or liver failure, giving up alcohol for several years reduces their chance of <a href="https://www.cghjournal.org/article/S1542-3565(22)01113-2/fulltext">worsening liver failure and death</a>. However, people who drink heavily can be physically dependent on alcohol and stopping suddenly can cause alcohol withdrawal. </p>
<p>In its mild form, it causes shaking and sweating. But if severe, it can cause hallucinations, fits and even death. Going “cold turkey” is never recommended for heavy drinkers, who should seek medical advice about how to safely give up alcohol.</p>
<h2>Other benefits</h2>
<p>Giving up drinking also has positive effects on <a href="https://alcoholchange.org.uk/blog/benefits-of-dry-january-and-when-you-can-expect-to-see-them">sleep, brain function and blood pressure</a>. </p>
<p>Avoiding alcohol for long periods also reduces the risk of several types of <a href="https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer">cancer</a> (including liver, pancreas and colon) and the risk of <a href="https://www.bhf.org.uk/informationsupport/heart-matters-magazine/medical/effects-of-alcohol-on-your-heart">heart disease and stroke</a>. </p>
<p>However, alcohol is not the only cause of ill health. Giving it up has many health benefits, but it is not a panacea. It should be seen as part of a healthy lifestyle, including a balanced diet and regular physical exercise.</p>
<p>So, to answer the question posed by the myth of Prometheus, the liver has an amazing power to repair itself after it has been damaged. But it cannot grow back as new if it was already severely scarred. </p>
<p>If you stop drinking and only have a fatty liver, it can quickly turn back to normal. If you had a scarred liver (cirrhosis) to start with, stopping alcohol will allow some healing and improved function but can’t undo all the damage that has already been done.</p>
<p>If you want to look after your liver, don’t drink alcohol. But if you must, drink in moderation and have two to three alcohol-free days each week. That way, you won’t have to rely on the liver’s magical self-healing power to stay healthy.</p>
<p><em>Correction: The sentence: “If you want to look after your liver, drink in moderation and have two to three alcohol-free days each week” has been replaced with the more accurate: “If you want to look after your liver, don’t drink alcohol. But if you must, drink in moderation and have two to three alcohol-free days each week.”</em></p><img src="https://counter.theconversation.com/content/220490/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashwin Dhanda does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The liver has remarkable self-healing powers. But it has limits, so don’t abuse it.Ashwin Dhanda, Associate Professor of Hepatology, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2191492024-01-05T16:14:45Z2024-01-05T16:14:45ZCan you really be allergic to alcohol?<figure><img src="https://images.theconversation.com/files/565241/original/file-20231212-17-cvmrru.jpg?ixlib=rb-1.1.0&rect=14%2C21%2C4876%2C3233&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-two-people-cheering-cocktails-bar-2293053559">guys who shoot/Shutterstock</a></span></figcaption></figure><p>Some people get allergy-like symptoms when drinking alcohol, but can you really be allergic to alcohol? </p>
<p>Alcohol allergies are rare, with documented cases primarily involving a <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1369-1600.2004.tb00533.x">rash</a>. However, what often perplexes people are the symptoms that <a href="https://www.sciencedirect.com/science/article/pii/S108112061300690X">mimic allergies</a>, such as wheezing, headaches and skin flushing. </p>
<p>These reactions, more often than not, are attributed to alcohol <a href="https://onlinelibrary.wiley.com/doi/abs/10.1080/1355621031000069828">exacerbating underlying conditions</a> like asthma, urticaria (hives) and rhinitis. The reason is that alcohol dilates <a href="https://www.sciencedirect.com/science/article/pii/S108112061300690X">blood vessels</a>, which then sets the stage for a symphony of bodily responses.</p>
<p>The term <a href="https://link.springer.com/content/pdf/10.1007/978-3-642-74904-9.pdf">“alcohol intolerance”</a> becomes key in deciphering these reactions. Unlike allergies, which involve the immune system, intolerances arise when the body lacks the necessary <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6527027/#:%7E:text=Alcohol%20is%20eliminated%20from%20the,(CYP2E1)%2C%20and%20catalase.">enzymes</a> to digest and eliminate alcohol. The consequence? Unusual symptoms that may leave one questioning whether the drink in hand is a source of enjoyment or distress.</p>
<h2>Not just the alcohol</h2>
<p>As we peer into the bottom of our glasses, it becomes clear that the source of these reactions is not just the alcohol but the complex composition of the drink. </p>
<p>Red wine often takes centre stage as a provocateur of reactions, followed by whisky, beer and other wines. The usual suspects, however, are not the alcohol molecules but the enigmatic chemicals known as <a href="https://pubmed.ncbi.nlm.nih.gov/20712591/#:%7E:text=Congeners%20are%20minor%20compounds%20other,of%20distilling%20and%20fermenting%20processes.">congeners</a>.</p>
<p><a href="https://link.springer.com/article/10.1007/s12024-013-9411-0">Congeners</a>, responsible for the body, aroma and flavour of a drink, play a subtle yet significant role in the orchestration of reactions. But can these congeners induce true allergic reactions? To answer this, we delve into the substances within alcoholic beverages that might induce bodily responses.</p>
<p><a href="https://academic.oup.com/alcalc/article/34/2/141/192121">Histamine</a>, a familiar name to allergy sufferers, emerges as a prominent figure in this narrative. Present in abundance, particularly in red wines, histamine can be the <a href="https://pubmed.ncbi.nlm.nih.gov/17490952/">instigator of</a> headaches, flushing, nasal symptoms, gut disturbances or even asthma. Those intolerant to histamine may grapple with these symptoms because their body is unable to break down and eliminate this compound.</p>
<p>While yeast allergies are <a href="https://www.hindawi.com/journals/crii/2017/7958924/">not unheard of</a>, studies cast a reassuring light on the low levels of yeast allergens in alcoholic drinks. True allergic reactions stemming from yeasts are a rare occurrence, dampening the suspicion that this microscopic organism is the chief cause.</p>
<p>Sulphur dioxide, commonly found in home-brewed beers and wines, especially in the form of sodium metabisulphite, is another potential culprit. About one in ten asthmatics may find themselves wheezing in response to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2222.2009.03362.x">sulphites</a>, with rashes and anaphylactic reactions being the exception rather than the rule. </p>
<figure class="align-center ">
<img alt="Woman holding asthma pump to her mouth" src="https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/567698/original/file-20240103-25-otofoy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One in ten asthmatics find themselves wheezing in response to sulphites.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-woman-using-asthma-inhaler-on-611711816">Africa Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Sulphites are one of <a href="https://www.food.gov.uk/business-guidance/allergen-labelling-for-food-manufacturers">14 allergens</a> that must be listed in bold in all prepared foods and restaurants.</p>
<p>In the realm of additives, substances like <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2222.1977.tb01471.x">tartrazine and sodium benzoate</a> emerge as potential instigators of urticaria and asthma. As we sift through the components that constitute our favourite drinks, the awareness of these additives becomes pivotal for those navigating sensitivities.</p>
<p>The very essence of alcoholic beverages lies in the plants from which they derive – be it grapes, apples, juniper berries, coconuts, oranges, hops or malt. While these plant-derived allergens can theoretically trigger true allergic reactions, most are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/mnfr.200800236">destroyed</a> during processing. </p>
<p>An exception, albeit a rare one, is the potential trouble posed by fungal spores (mould) from the corks of wine bottles. Sensitivity to this fungus is uncommon, but for those at risk, a visible <a href="https://www.mdpi.com/2076-2607/8/1/12">mould-laden cork</a> could expose them to an unwarranted dose of allergen.</p>
<h2>Discover the culprit</h2>
<p>For those grappling with these enigmatic reactions, avoidance is often the best course of action. </p>
<p>Keeping meticulous records of the drink type, accompanying consumables, and physical activities during the episode can assist in identifying triggers. If all alcoholic drinks seem to induce reactions, it might signal an exaggerated response to alcohol or an exacerbation of an <a href="https://onlinelibrary.wiley.com/doi/abs/10.1080/1355621031000069828">underlying condition</a>.</p>
<p>As we raise our glasses to the complexity of alcohol-related reactions, a journey through the nuances of <a href="https://link.springer.com/article/10.1007/s12024-013-9411-0">congeners</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/17490952/">histamines</a>, <a href="https://www.hindawi.com/journals/crii/2017/7958924/">yeasts</a>, <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2222.2009.03362.x">sulphites</a>, additives and plant-derived allergens unfolds. In the spirit of scientific exploration, the quest for a comprehensive understanding of these reactions continues, promising insights that may one day unveil the mysteries behind the intricate dance between our bodies and the libations we savour.</p><img src="https://counter.theconversation.com/content/219149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you wheeze or your skin flushes when you drink alcohol, read on.Samuel J. White, Senior Lecturer in Genetic Immunology, Nottingham Trent UniversityPhilippe B. Wilson, Professor of One Health, Nottingham Trent UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2201952024-01-03T22:22:45Z2024-01-03T22:22:45ZHow drinking sustainable wine can help vineyards and the planet<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-drinking-sustainable-wine-can-help-vineyards-and-the-planet" width="100%" height="400"></iframe>
<p>The current global food and beverage system is <a href="https://doi.org/10.1126/science.aaq0216">unsustainable</a>. </p>
<p>In 2023, world leaders issued a <a href="https://www.cop28.com/food-and-agriculture">declaration at the UN climate change conference COP28</a> acknowledging the role that more sustainable and resilient agri-food systems can and must play in responding to the climate crisis. </p>
<p>The wine industry is both one of the <a href="https://doi.org/10.1111/cag.12665">sectors of our agri-food system</a> most affected by climate change and is also a <a href="https://doi.org/10.1016/j.jclepro.2013.04.036">small (if not insignificant) contributor</a> to system-wide greenhouse gas (GHG) emissions.</p>
<p>The wine industry has faced criticism over its <a href="https://www.weforum.org/agenda/2021/07/what-can-the-wine-industry-teach-us-about-sustainability/">environmental, economic and social sustainability</a> more generally. However, it is consumer purchase decisions (which wine do I buy?) which have the greatest potential to drive much needed systemic change to improve sustainability across the wine industry.</p>
<h2>Bottling grapes</h2>
<p>Conventional wine production is <a href="https://doi.org/10.3390/beverages7010015">not inherently sustainable</a>, degrading land, water and air while reinforcing social injustices and inequity. </p>
<p><a href="https://doi.org/10.1016/j.jclepro.2016.11.124">Wine grape production</a> is responsible for over 17 per cent of the sector’s GHG emissions, mainly through fossil fuel-powered machinery, while the application of pesticides, herbicides and fertilizers <a href="https://theconversation.com/europe-has-lost-over-half-a-billion-birds-in-40-years-the-single-biggest-cause-pesticides-and-fertilisers-206826">can reduce biodiversity</a>, <a href="https://doi.org/10.3389/fchem.2017.00043">cause soil infertility</a> and pollute local rivers and lakes. </p>
<p>Less visible are the social injustices experienced by many of the critical migrant workers employed during the grape harvest. In the 2023 harvest, two <a href="https://www.decanter.com/wine-news/human-trafficking-investigations-launched-in-the-champagne-region-512548/">human trafficking</a> investigations were launched in Champagne. Investigators discovered numerous undocumented workers living in squalid conditions describing their ordeal as being “treated like slaves.”</p>
<p>Wine-making accounts for up to <a href="https://doi.org/10.1016/j.jclepro.2018.11.206">81 per cent of sector-wide GHG emissions</a> through electricity, chemical and water use. However, <a href="https://search.informit.org/doi/10.3316/informit.822798874769665">the emissions from glass bottle production and transport can also be a signifficant factor</a>. Bottles can weigh from around <a href="https://www.15bodegas.com/es_en/blog/how-much-a-bottle-of-wine-weigh#:%7E:text=Currently%2C%20the%20average%20weight%20of,place%20in%20the%20bottle%20itself.">350 grams</a> to almost <a href="https://wineeconomist.com/2021/06/29/wine-bottle/">1,220 grams</a>. </p>
<p>It’s estimated that <a href="https://wineindustryadvisor.com/2022/05/16/beyond-the-standard-bottle-wineries-are-embracing-greener-packaging#:%7E:text=Between%2050%20and%2068%20percent,also%20the%20issue%20of%20recycling.">more than half of the bottles</a> used in the United States are shipped from China, crossing the Pacific Ocean before being filled and then distributed across the globe. The heavier the bottle, the more fossil fuels are required to <a href="http://dx.doi.org/10.1080/09571264.2010.530111">transport them</a>. Then once consumed, managing the waste creates further <a href="https://doi.org/10.1016/j.clet.2023.100649">emissions</a>.</p>
<h2>Growing actions</h2>
<p>The wine industry is responding to these challenges. In fact, Canada has been pioneering some of the important initiatives. For instance, the Liquor Control Board of Ontario (LCBO) is one of the world’s largest alcohol purchasers and requires that standard wine bottles (750 ml) sold through their stores <a href="https://www.doingbusinesswithlcbo.com/content/dbwl/en/basepage/home/quality-assurance/quality-assurance-policies---guidelines/lcbo-lightweight-glass-bottle-program.html#:%7E:text=Glass%20Weight%20Requirements,the%20weight%20tolerance%20is%2020g.">weigh no more than 420 grams</a>. </p>
<p>Both small and large producers in the <a href="https://napavalley.wine/articles/napa-valley-loses-weight-wineries-embrace-lighter-glass--276">U.S.</a>, <a href="https://www.forbes.com/sites/lizthach/2023/05/31/burgundy-wine-powerhouse-albert-bichot-goes-100-organic-and-reduces-bottle-weight/?sh=4882204d6a59">France</a>, and <a href="https://feltonroad.com/?cache=659053540d2a3">New Zealand</a> are using lighter bottles to reduce their environmental impact and save money. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-change-may-make-bordeaux-red-wines-stronger-and-tastier-215503">Climate change may make Bordeaux red wines stronger and tastier</a>
</strong>
</em>
</p>
<hr>
<p><a href="https://www.jancisrobinson.com/articles/bottle-weight-goodies-and-baddies">Wine writers</a> are also playing their part, by beginning to add the bottle weight in their reviews. Reusing empty bottles can also significantly reduce emissions — <a href="https://doi.org/10.1016/j.jclepro.2018.11.206">more so than lowering bottle weight</a> — and <a href="https://circulareconomy.europa.eu/platform/en/good-practices/rewine-reusing-wine-bottles">some countries</a> are making significant progress in this regard. </p>
<p><a href="https://wineindustryadvisor.com/2022/05/16/beyond-the-standard-bottle-wineries-are-embracing-greener-packaging#:%7E:text=Between%2050%20and%2068%20percent,also%20the%20issue%20of%20recycling.">Alternatives to glass bottles</a> with lower carbon footprints do exist, including bottles made from polyethylene terephthalate (PET), paper bottles, boxed wine, wine on tap and aluminium cans. Unfortunately, <a href="https://doi.org/10.3390%2Ffoods11081106">customers can be hesitant</a> to buy wine in these alternative formats, <a href="https://doi.org/10.1016/j.jclepro.2023.139502">perceiving it to be of lower quality</a>. Thus, consumer education is important. </p>
<p>While winegrowing using <a href="https://organiccouncil.ca/a-snapshot-of-the-organic-wine-industry-and-viticulture-in-canada/">organic</a> or <a href="https://doi.org/10.2147/IJWR.S69126">biodynamic</a> principles may in some cases promote greater sustainability, these account for only six per cent of vineyards.</p>
<p>Most wine producers employ more conventional grape growing methods, which in many cases are being adapted to create more sustainable practices. In the vineyard, these include using more disease and drought resistant grapes and <a href="https://www.decanter.com/learn/vine-rootstocks-getting-to-the-root-of-the-matter-445696/">rootstock</a>, which require fewer chemical sprays and less water.</p>
<p>On the wine production side, many wineries — including <a href="https://vineroutes.com/spotlight-on-sustainability-stratus-vineyards/">here</a> in <a href="https://www.flatrockcellars.com/about-us/sustainability/">Canada</a> — are investing in geothermal systems for heating and cooling needs in the winery, significantly reducing electricity use. These initiatives are supported by the International Organisation of Vine and Wine (OIV) — whose 50 member states produce <a href="https://www.oiv.int/who-we-are/presentation">87 per cent of global wine</a> — which recently <a href="https://www.oiv.int/public/medias/5766/oiv-cst-518-2016-en.pdf">adopted a policy</a> promoting general principles of sustainability across all production phases. </p>
<p>Other industry organizations such as <a href="https://www.iwcawine.org/about">International Wineries for Climate Action</a> are focused on ways to reduce GHG emissions to net zero by 2050, while the <a href="https://swroundtable.org/about-us/">Sustainable Wine Roundtable</a> is an independent group seeking to advance sustainability across the wine value chain and transfer that information to the consumer.</p>
<h2>Encouraging sustainability</h2>
<p>However, these efforts to improve sustainability have been uneven and inconsistent, <a href="https://doi.org/10.1016/j.jafr.2023.100681">confusing consumers</a> wanting to make an informed decision when purchasing wine. </p>
<p>Recent research from our lab has shown relatively <a href="https://doi.org/10.1080/09571264.2023.2254249">limited consumer knowledge about sustainably produced wine</a>, but equally <a href="https://doi.org/10.1016/j.foodres.2023.113555">a willingness to engage in many behaviors</a> around the product, including buying more environmentally friendly wine, and paying more for both environmentally and socially responsible wines. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/come-pests-frost-or-fire-how-the-swiss-are-arming-their-wines-against-climate-change-202663">Come pests, frost or fire: How the Swiss are arming their wines against climate change</a>
</strong>
</em>
</p>
<hr>
<p>Interestingly, this is especially the case with <a href="https://doi.org/10.1016/j.foodres.2023.113555">younger wine consumers</a>, who value sustainability considerations more than older generations when <a href="https://openurl.ebsco.com/EPDB%3Agcd%3A13%3A2391661/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A136924269&crl=c">making purchase decisions generally</a>.</p>
<p>Consumers seek easy ways to identify sustainable wine, such as clear visual cues on labels and trustworthy sustainability certifications. These considerations need to be priorities for the global wine industry as it seeks to respond to consumer demand, and address existential challenges to its long-term viability.</p><img src="https://counter.theconversation.com/content/220195/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The wine industry has a major sustainability problem. Informed consumer choice can help drive real change.Gary Pickering, Professor, Biological Sciences and Psychology, Brock UniversityKerrie Pickering, Research Associate, Environmental Sustainability Research Centre, Brock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2141502023-12-25T21:07:48Z2023-12-25T21:07:48ZWhy does alcohol make my poo go weird?<figure><img src="https://images.theconversation.com/files/549730/original/file-20230922-22-sscc3z.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C5765%2C3814&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As we enter the festive season it’s a good time to think about what all those celebratory alcoholic drinks can do to your gut. </p>
<p>Alcohol can interfere with the time it takes for food to go through your gut (also known as the “transit time”). In particular, it can affect the muscles of the stomach and the small bowel (also known as the small intestine). </p>
<p>So, how and why does alcohol make your poos goes weird? Here’s what you need to know.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/got-gastro-heres-why-eating-bananas-helps-but-drinking-flat-lemonade-might-not-198293">Got gastro? Here's why eating bananas helps but drinking flat lemonade might not</a>
</strong>
</em>
</p>
<hr>
<h2>Diarrhoea and the ‘transit time’</h2>
<p>Alcohol’s effect on stomach transit time depends on the alcohol concentration. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/27527893/">In general</a>, alcoholic beverages such as whisky and vodka with high alcohol concentrations (above 15%) slow down the movement of food in the stomach.</p>
<p>Beverages with comparatively low alcohol concentrations (such as wine and beer) <a href="https://pubmed.ncbi.nlm.nih.gov/27527893/">speed up the movement</a> of food in the stomach.</p>
<p>These changes in gut transit explain why some people can get a sensation of fullness and abdominal discomfort when they drink vodka or whisky. </p>
<p>How long someone has been drinking a lot of alcohol can affect small bowel transit.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man clutches his stomach while a glass of red wine sits on a table nearby." src="https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557036/original/file-20231101-27-y1owj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alcohol can affect the time it takes for food to go through your gut.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/glass-wine-on-wooden-desk-front-1233427003">Shutterstock</a></span>
</figcaption>
</figure>
<p>We know from <a href="https://academic.oup.com/alcalc/article/36/4/304/188709">experiments</a> with rats that chronic use of alcohol accelerates the transit of food through the stomach and small bowel. </p>
<p>This shortened transit time through the small bowel also happens when humans drink a lot of alcohol, and is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826790/">linked to diarrhoea</a>. </p>
<p>Alcohol can also <a href="https://pubmed.ncbi.nlm.nih.gov/1475618/">reduce the absorption</a> of carbohydrates, proteins and fats in the duodenum (the first part of the small bowel). </p>
<p>Alcohol can lead to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826790/">reduced absorption of xylose</a> (a type of sugar). This means diarrhoea is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826790">more likely to occur</a> in drinkers who also consume a lot of sugary foods such as sweets and sweetened juices. </p>
<p>Chronic alcohol use is also linked to:</p>
<ul>
<li><p><a href="https://www.sciencedirect.com/science/article/abs/pii/S0002916523399131">lactose intolerance</a></p></li>
<li><p><a href="https://pubmed.ncbi.nlm.nih.gov/6698486/">overgrowth</a> of small bowel bacteria and </p></li>
<li><p>reduced absorption of fats from the <a href="https://pubmed.ncbi.nlm.nih.gov/32511812/">pancreas not producing</a> enough digestive enzymes. </p></li>
</ul>
<p>This means chronic alcohol use may lead to diarrhoea and loose stools. </p>
<h2>How might a night of heavy drinking affect your poos?</h2>
<p>When rats are <a href="https://academic.oup.com/alcalc/article/36/4/304/188709">exposed to high doses</a> of alcohol over a short period of time, it results in small bowel transit delay.</p>
<p>This suggests acute alcohol intake (such as an episode of binge drinking) is more likely to lead to constipation than diarrhoea. </p>
<p>This is backed up by <a href="https://pubmed.ncbi.nlm.nih.gov/35393390/">recent research</a> studying the effects of alcohol in 507 university students. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A chart displays the different types of poos as categorised by the Bristol Stool Chart." src="https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557035/original/file-20231101-21-y1owj2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Bristol Stool Chart classifies poo into different groups.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/bristol-stool-chart-tool-faeces-type-1758939173">Shutterstock</a></span>
</figcaption>
</figure>
<p>These students had their stools collected and analysed, and were asked to fill out a stool form questionnaire known as the <a href="https://www.continence.org.au/bristol-stool-chart">Bristol Stool Chart</a>. </p>
<p>The research found a heavy drinking episode was associated with harder, firm bowel motions.</p>
<p>In particular, those who consumed more alcohol had more Type 1 stools, which are separate hard lumps that look or feel a bit like nuts.</p>
<p>The researchers believed this acute alcohol intake results in small bowel transit delay; the food stayed for longer in the intestines, meaning more water was absorbed from the stool back into the body. This led to drier, harder stools. </p>
<p>Interestingly, the researchers also found there was more of a type of bacteria known as “<a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/actinobacteria">Actinobacteria</a>” in heavy drinkers than in non-drinkers. </p>
<p>This suggests bacteria may have a role to play in stool <a href="https://pubmed.ncbi.nlm.nih.gov/26069274/">consistency</a>. </p>
<p>But binge drinking doesn’t always lead to constipation. Binge drinking in patients with irritable bowel syndrom (IBS), for example, clearly <a href="https://pubmed.ncbi.nlm.nih.gov/23295280/">leads to</a> diarrhoea, nausea and abdominal pain. </p>
<h2>What can I do about all this?</h2>
<p>If you’re suffering from unwanted bowel motion changes after drinking, the most effective way to address this is to limit your alcohol intake.</p>
<p>Some alcoholic beverages may affect your bowel motions more than others. If you notice a pattern of troubling poos after drinking certain drinks, it may be sensible to cut back on those beverages. </p>
<p>If you tend to get diarrhoea after drinking, avoid mixing alcohol with caffeinated drinks. Caffeine is known to <a href="https://pubmed.ncbi.nlm.nih.gov/9581985/">stimulate contractions</a> of the colon and so could worsen diarrhoea. </p>
<p>If constipation after drinking is the problem, then staying hydrated is important. Drinking plenty of water before drinking alcohol (and having water in between drinks and after the party is over) can help reduce dehydration and constipation. </p>
<p>You should also eat before drinking alcohol, particularly protein and fibre-rich foods. </p>
<p>Food in the stomach can <a href="https://mcwell.nd.edu/your-well-being/physical-well-being/alcohol/absorption-rate-factors/#:%7E:text=Having%20food%20in%20your%20stomach,the%20amount%20of%20alcohol%20consumed">slow the absorption</a> of alcohol and may help <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683774/">protect</a> against the negative effects of alcohol on the gut lining. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A person pours water into a cup, which is sitting next to a wine glass filled with white wine." src="https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557040/original/file-20231101-21-bn23t6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you’re drinking alcohol, have plenty of water, too.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-pours-water-into-glass-next-758548675">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Is it anything to worry about?</h2>
<p>Changes in bowel motions after drinking are usually short term and, for the most part, resolve themselves pretty efficiently. </p>
<p>But if symptoms such as diarrhoea persist beyond a couple of days after stopping alcohol, it may signify other concerning issues such as an underlying gut disorder like inflammatory bowel disease. </p>
<p>Researchers have also <a href="https://pubmed.ncbi.nlm.nih.gov/37563425/">linked</a> alcohol consumption to the development of irritable bowel syndrome. </p>
<p>If problems persist or if there are alarming symptoms such as blood in your stool, seek medical advice from a general practitioner.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/214150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Vincent Ho does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some alcoholic beverages may affect your bowel motions more than others.Vincent Ho, Associate Professor and clinical academic gastroenterologist, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2183442023-12-21T23:19:57Z2023-12-21T23:19:57ZGot period pain or cramps? What to eat and avoid, according to science<figure><img src="https://images.theconversation.com/files/566750/original/file-20231219-27-7x7oaq.jpg?ixlib=rb-1.1.0&rect=1%2C1%2C1276%2C848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-suffering-from-a-stomach-pain-5938362/">Sora Shimazaki/Pexels</a></span></figcaption></figure><p>Painful periods are common. More than half of people who menstruate have some pain for up to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">three days a month</a>, typically throbbing or cramping in the lower abdomen. </p>
<p>Digestive changes – such as vomiting, gas, bloating, diarrhoea and a “bubbling gut” – are also <a href="https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-018-0538-8">common</a> around the time of menstruation. </p>
<p>There are many <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8943241/">treatments</a> for period pain (known medically as dysmenorrhoea). Not all these treatments are well-tolerated or work for everyone.</p>
<p>We’re learning more about food’s role in influencing <a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">inflammation</a> in our body. So, could eating or avoiding certain foods <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5963185/">help</a> with painful periods? Here’s what we know based on high-quality research.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-sharp-butt-pains-to-period-poos-5-lesser-known-menstrual-cycle-symptoms-191352">From sharp butt pains to period poos: 5 lesser-known menstrual cycle symptoms</a>
</strong>
</em>
</p>
<hr>
<h2>Foods that may relieve period pain or cramps</h2>
<p><strong>Foods containing omega-3 fatty acids</strong></p>
<p>Foods rich in omega-3 fatty acids include chia seeds, walnuts, flaxseeds, salmon, herring, sardines, mackerel, oysters and edamame beans. Omega-3 fatty acids are naturally present in oils including fish, cod liver, algal, krill, flaxseed (linseed), soybean and canola oils.</p>
<p>Omega-3 fatty acids <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257651/">affect</a> how our cells function and the signalling pathways associated with inflammation and pain. </p>
<p>Earlier this year, researchers published a <a href="https://pubmed.ncbi.nlm.nih.gov/37545015/#:%7E:text=Meta%2Danalysis%20(n%20%3D%208,0.51)%20at%20reducing%20dysmenorrhoea%20pain.">meta-analysis</a> where they combined and analysed all data available on the impact of omega-3 fatty acids on period pain. They found diets high in omega-3 fatty acids (including supplements of 300-1,800 milligrams a day) over two to three months may reduce pain, and pain medication use, in people with painful periods.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Open sardine can, parsley, cut lemon on wooden table." src="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566754/original/file-20231219-15-vu9xne.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sardines and other oily fish are rich in omega-3 fatty acids.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/open-can-sardines-preserves-oil-on-1636046179">BearFotos/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-fish-oil-supplements-as-healthy-as-we-think-and-is-eating-fish-better-212250">Are fish oil supplements as healthy as we think? And is eating fish better?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Foods high in vitamin D</strong></p>
<p>Foods high in vitamin D include trout, salmon, tuna and mackerel, as well as fish liver oils. Small amounts are also found in beef liver, egg yolk and cheese. Mushrooms contain varying levels of vitamin D, and you can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/">boost</a> this by exposing them to direct midday sunlight for 15-120 minutes. </p>
<p>The body can make vitamin D when it gets sunlight exposure and you can also get vitamin D from supplements.</p>
<p>Vitamin D <a href="https://pubmed.ncbi.nlm.nih.gov/24262718/">may help</a> reduce the factors that cause inflammation in the uterus. This includes levels of hormone-like molecules called prostaglandins. </p>
<p>A 2023 <a href="https://www.mdpi.com/2072-6643/15/13/2830#B11-nutrients-15-02830">meta-analysis</a> showed women who received weekly doses of vitamin D greater than 50,000 IU (or international units) had relief from period pain, regardless of how long and how often women took the vitamin.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-be-getting-my-vitamin-d-levels-checked-211268">Should I be getting my vitamin D levels checked?</a>
</strong>
</em>
</p>
<hr>
<p><strong>Foods high in vitamin E</strong></p>
<p>Foods rich in vitamin E include seeds (particularly sunflower seeds), nuts (particularly almonds, hazelnuts and peanuts) and spinach, broccoli, kiwifruit, mango and tomato. </p>
<p>There is some evidence vitamin E supplements reduce period pain. In a well-conducted <a href="https://pubmed.ncbi.nlm.nih.gov/15777446/">trial</a> run over the course of four periods, women took vitamin E supplements (90 milligrams, twice a day) for five days, beginning two days before the expected start of the period. This significantly reduced the severity and duration of period pain. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman tipping out nut mix into palm of hand" src="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566756/original/file-20231220-17-d2da5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Seeds and nuts are rich in vitamin E.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-holding-jar-nuts-dried-fruits-1112521214">NazarBazar/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-painful-periods-could-it-be-endometriosis-101026">I have painful periods, could it be endometriosis?</a>
</strong>
</em>
</p>
<hr>
<h2>Foods that may worsen period pain or cramps</h2>
<p><strong>Highly processed foods</strong></p>
<p>Highly processed foods include energy-dense, nutrient-poor foods such as takeaways, chips, biscuits, doughnuts, processed meats and soft drinks. </p>
<p>Research findings on the impact of a diet high in processed foods on period pain vary. A 2019 <a href="https://karger.com/goi/article/84/3/209/153726/Nutrition-as-a-Potential-Factor-of-Primary">review</a> found sugar consumption had little association with painful periods. </p>
<p>However, some observational studies (which do not involve an intervention) suggest women who eat more processed foods may have more intense period pain. For example, a <a href="https://pubmed.ncbi.nlm.nih.gov/19468949/">2009 study</a> found adolescent females who ate fast or processed foods for two days or more a week reported more period pain compared with those who did not. Therefore, eating less processed food may be something to consider. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/8-everyday-foods-you-might-not-realise-are-ultra-processed-and-how-to-spot-them-197993">8 everyday foods you might not realise are ultra processed – and how to spot them</a>
</strong>
</em>
</p>
<hr>
<p><strong>Caffeine</strong></p>
<p>Foods high in caffeine include coffee, energy drinks and some processed energy bars. Caffeine intake is <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwij7LmPxfSCAxV5d_UHHRnyDyUQFnoECBIQAQ&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4222008%2F&usg=AOvVaw2mEjyMadOB1D6geQgAwckc&opi=89978449">associated with</a> menstrual pain. </p>
<p>Although we don’t know the precise underlying mechanism, researchers think caffeine may narrow blood vessels, which limits blood flow, leading to stronger cramps.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Tired woman staring at bowl of breakfast, cereal and cup on kitchen table" src="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/566757/original/file-20231220-23-u1d2j2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Avoiding coffee may help your period pain.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-does-not-want-eat-her-151886987">Lolostock/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/nope-coffee-wont-give-you-extra-energy-itll-just-borrow-a-bit-that-youll-pay-for-later-197897">Nope, coffee won't give you extra energy. It'll just borrow a bit that you'll pay for later</a>
</strong>
</em>
</p>
<hr>
<p><strong>Alcohol</strong></p>
<p>Drinking alcohol is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4859868/">not</a> a recognised risk factor for painful periods. However, chronic heavy alcohol use reduces levels of <a href="https://academic.oup.com/alcalc/article/55/2/164/5734241">magnesium</a> in the blood. Magnesium is an important factor in relaxing muscles and supporting blood flow.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
</strong>
</em>
</p>
<hr>
<h2>A healthy, balanced diet is your best best</h2>
<p>Having a healthy, balanced diet is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071223/">one of the best ways</a> we can support our own health and prevent future chronic conditions. This can help reduce inflammation in our bodies, thought to be the main way diet can help people with painful periods.</p>
<p>If you are looking for tailored dietary advice or a menstrual health meal plan, speak with an <a href="https://member.dietitiansaustralia.org.au/Portal/Portal/Search-Directories/Find-a-Dietitian.aspx">accredited practising dietitian</a>.</p>
<p>It’s important to stress, however, that diet alone cannot treat all forms of menstrual pain. So if you are concerned about your painful periods, check in with your GP who can discuss your options.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/9-signs-you-have-inflammation-in-your-body-could-an-anti-inflammatory-diet-help-210468">9 signs you have inflammation in your body. Could an anti-inflammatory diet help?</a>
</strong>
</em>
</p>
<hr>
<p><em>This article has been updated to reflect the correct date of a review that found sugar consumption had little association with painful periods.</em></p><img src="https://counter.theconversation.com/content/218344/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lauren Ball works for The University of Queensland and receives funding from the National Health and Medical Research Council, Queensland Health and Mater Misericordia. She is a Director of Dietitians Australia, a Director of the Darling Downs and West Moreton Primary Health Network and an Associate Member of the Australian Academy of Health and Medical Sciences.</span></em></p><p class="fine-print"><em><span>Emily Burch is an Accredited Practising Dietitian and member of Dietitians Australia. She works for Southern Cross University. </span></em></p><p class="fine-print"><em><span>Pui Ting Wong is a PhD Candidate at The University Queensland (UQ) Centre for Community Health and Wellbeing, and receives the UQ Tuition Fee Offset and Stipend Scholarship. She is also an Accredited Practising Dietitian and a member of Dietitians Australia.</span></em></p>A cup of coffee might help you kick-start your day, but it may actually make painful periods worse. Here’s what else to avoid (and eat) if you have period pain.Lauren Ball, Professor of Community Health and Wellbeing, The University of QueenslandEmily Burch, Lecturer, Southern Cross UniversityPui Ting Wong, PhD Candidate, culinary education and adolescent mental health, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2187692023-12-18T13:21:18Z2023-12-18T13:21:18ZA bottle of scotch recently sold for $2.7 million – what’s behind such outrageous prices?<figure><img src="https://images.theconversation.com/files/565866/original/file-20231214-17-d6ucfb.jpg?ixlib=rb-1.1.0&rect=164%2C82%2C3965%2C2734&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">In November 2023, a bottle of Macallan Scotch whisky fetched the highest price of all time for a bottle of wine or spirits.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/sothebys-global-head-of-spirits-jonny-fowle-poses-with-a-news-photo/1733842929?adppopup=true">Wiktor Szymanowicz/Future Publishing via Getty Images</a></span></figcaption></figure><p>When a rare bottle of Scotch whisky <a href="https://www.smithsonianmag.com/smart-news/scotch-whisky-auction-record-180983299/">sold for US$2.7 million</a> in November 2023, I was stunned, but I wasn’t surprised.</p>
<p>The whiskey market has been booming for some time.</p>
<p>Bourbon brands like Pappy Van Winkle from Buffalo Trace distillery <a href="https://www.thebourbonflight.com/why-is-pappy-van-winkle-so-expensive/">are selling for astronomical prices in the secondary market</a>. <a href="https://www.foodandwine.com/cocktails-spirits/japanese-whisky-prices">Japanese whiskies</a>, which have become popular over the past decade, <a href="https://www.vinovest.co/blog/expensive-japanese-whiskey">now fetch prices up to 50 times higher what they did a decade ago</a>.</p>
<p>And in July 2022, a single Ardbeg whisky barrel, aged since 1975, with enough liquid for about 500 bottles, <a href="https://www.theguardian.com/uk-news/2022/jul/09/cask-scotch-whisky-world-record-sale-ardbeg-distillery">sold at auction for around $19 million</a>. In 1997, the entire Ardbeg distillery had been purchased by Glenmorangie Distillery <a href="https://www.heraldscotland.com/news/12074010.glenmorangie-pays-7m-for-ardbeg-distillery/">for roughly $11 million</a>.</p>
<p>How could a single cask of Scotch whisky sell for nearly twice the value of an entire distillery purchased just over two decades earlier?</p>
<p><a href="https://scholar.google.com/citations?user=nghJ8UEAAAAJ&hl=en">I’ve been studying specialty markets</a> for a decade, and I see at least two stories to unpack. </p>
<p>One is economic, where items in low supply, like rare bottles or barrels, sell for high prices. And prices in the whiskey market have been rising rapidly <a href="https://nobleandcompany.com/whisky-intelligence-2023/">over the last two decades</a>, fueled in part by investors. Some investors see luxury collectibles, such as high-end whiskey bottles or casks, <a href="https://www.businessexpert.co.uk/investing/whisky-investments/">as an alternative to other assets</a> like stocks and bonds. (There are, however, signs that the luxury market <a href="https://whiskymag.com/articles/where-does-the-whisky-cask-investment-market-stand-in-2023/">is softening</a> due to oversupply.)</p>
<p>But a second, overlooked – and arguably more interesting – explanation is social. It revolves around <a href="https://press.princeton.edu/books/hardcover/9780691165493/masters-of-craft">the increasing focus on the purported authenticity of craft products</a> – especially ones like Scotch whisky, which trade on their heritage as much as their flavor.</p>
<h2>A ‘brown spirit’ boom</h2>
<p>The history of whiskey is one of booms and busts.</p>
<p>Whiskey has been produced in Scotland and Ireland <a href="https://scotchwhisky.com/magazine/latest-news/26580/earliest-whisky-still-mention-found/">since at least the late 1400s</a>. The spirit spread to the rest of Europe in the mid-to-late 1700s. The late 1800s and early 1900s were boom years, especially for Irish whiskey. The period also witnessed innovations such as aging the spirit in oak barrels, which enhances its flavor. (Scotch, Japanese, Canadian and Indian whisky is spelled without the “e,” and Irish and American whiskey is spelled with the “e.” Whiskey is the general category label.)</p>
<p>In the U.S., Prohibition <a href="https://theconversation.com/the-prohibition-era-origins-of-the-modern-craft-cocktail-movement-109623">moved distilling underground</a> until it made a midcentury comeback. Famously, the advent of “white spirits” like vodka and gin <a href="https://www.wineenthusiast.com/culture/spirits/pappy-van-winkle-expensive/">pushed down prices</a> of “brown spirits” like whiskey starting in the 1970s. This led to what Scotch distillers call the “<a href="https://www.whiskyinvestdirect.com/whisky-news/whisky-loch-092320221">whisky loch</a>,” or “lake” – the accumulation of large stores of matured whisky and the resulting shuttering of many whisky producers.</p>
<p>But whiskey has made a comeback since 2000. Prices of some bottles, including highly prized single-malt whiskies produced at a single distillery, have risen <a href="https://www.knightfrank.com/research/article/2020-04-16-knight-frank-luxury-investment-index-update-rare-whisky">by almost 600% over the last decade</a>. American bourbon has also seen a spike in interest – and prices – <a href="https://robbreport.com/food-drink/spirits/bourbon-rye-price-increase-1234790092/">since at least 2016</a>.</p>
<p>Long perceived as an inferior knockoff of Scotch whisky, Japanese whiskies have also experienced price surges. The House of Suntory, the oldest Japanese distiller, <a href="https://asia.nikkei.com/Business/Food-Beverage/Japanese-whisky-continues-to-get-pricier-amid-solid-popularity">recently announced</a> its own substantial price increases in the primary market, in some cases <a href="https://japantoday.com/category/business/suntory-announces-massive-price-spike-for-its-whisky-some-types-more-than-double-in-price">by as much as 100%</a>. And India, long the largest consumer of Scotch whisky, is also seeing its distilleries produce their own single-malt whiskies and <a href="https://www.theiwsr.com/the-volatility-of-indian-whisky-markets/">gradually move up-market</a>.</p>
<p>While these increases have largely been confined <a href="https://www.ft.com/content/541735f0-cacd-4a45-aaa6-f80933889a27">to the higher end of the market</a>, prices of affordable bottles have gone up, too.</p>
<figure class="align-center ">
<img alt="Man with white gloves arranges bottles of amber-colored whisky on a table." src="https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565870/original/file-20231214-15-tnmarg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Japanese whiskies have become more popular in the 21st century.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/jonny-fowle-sothebys-global-head-of-spirits-unveils-a-news-photo/1793160447?adppopup=true">Tristan Fewings/Getty Images</a></span>
</figcaption>
</figure>
<h2>Craving real connections</h2>
<p>Not long after the sale of the 1926 Macallan for $2.7 million, Merriam-Webster named “<a href="https://theconversation.com/merriam-websters-word-of-the-year-authentic-reflects-growing-concerns-over-ais-ability-to-deceive-and-dehumanize-217171">authentic</a>” its 2023 word of the year.</p>
<p>The term’s popularity can be attributed to advances in artificial intelligence – and, with it, misinformation. But much of the focus on authenticity is also the result of <a href="https://www.harpercollins.com/products/the-substance-of-style-virginia-postrel">the longing for more in-person connections</a> in an increasingly virtual world. People want authentic experiences – <a href="https://doi.org/10.1287/orsc.2018.1253">or what look like authentic experiences</a>. And that includes the products that they buy.</p>
<p>Authenticity is a notoriously <a href="https://doi.org/10.1177/1089268019829469">difficult concept to define</a>. <a href="https://doi.org/10.5465/annals.2017.0047">But it tends to revolve</a> around following a set of internal or external standards. That might mean following your values or your heart in order to cultivate your best, most real or most authentic self. When it comes to products – think vintage cars, artisanal foods or craft beer – it could mean those products must meet certain criteria to be considered authentic. For example, <a href="https://eh.net/encyclopedia/a-concise-history-of-americas-brewing-industry/">according to standards defined by the microbrewery movement</a>, in order for craft beer to be considered authentic, it must be produced in-house in small batches.</p>
<p>These sorts of distinctions can be difficult for the average consumer to grasp, and authenticity can be easy to fake. The beer brand Samuel Adams, for instance, attempts to signal its authenticity by associating itself with the people, places and events of the American Revolution. But <a href="https://doi.org/10.1287/mnsc.2016.2517">the brewery also got in trouble</a> for marketing itself as a craft beer without making its beer in-house.</p>
<h2>Putting a price on authenticity</h2>
<p>Intangible qualities make whiskey special – aspects such as the aroma, or “nose”; its complexity; and its lingering flavor, or “finish.” </p>
<p>But to boost whiskey’s value, purveyors of high-end whiskey convey the product’s heritage.</p>
<p>A whiskey’s unique locale – what wine enthusiasts call “<a href="https://www.jjbuckley.com/wine-knowledge/blog/defining-what-terroir-is-for-wine/1022">terroir</a>” – matters greatly to its perceived authenticity.</p>
<figure class="align-center ">
<img alt="Flush young man wearing green suit jacket sniffs a glass of whiskey." src="https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=461&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=461&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=461&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=579&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=579&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565320/original/file-20231212-20-egifje.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=579&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">King Charles III – then the Prince of Wales – sniffs a glass of whisky during a 1994 visit to a distillery on the Scottish island of Islay.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/prince-of-wales-sniffs-a-glass-of-whisky-during-a-visit-to-news-photo/830078022?adppopup=true">Chris Bacon/PA Images via Getty Images</a></span>
</figcaption>
</figure>
<p>During and after the whisky loch, scotch producers realized they were sitting on large stocks of unsold whisky. Much of that whisky was produced and aged <a href="https://scotchwhisky.com/magazine/ask-the-professor/20868/why-was-scotch-whisky-better-in-the-1960s/">starting in the 1960s</a>, before the advent of automation, faster distilling and new ingredients. The desire to return to those more authentic, simpler times allowed distillers to rewrite the stories of those stores.</p>
<p>Scotch whisky has a long-standing reputation as more historically significant – and, therefore, more authentic. Despite research suggesting that <a href="https://flavourjournal.biomedcentral.com/articles/10.1186/s13411-017-0056-x">even most expert judges</a> can’t distinguish different categories of whisky, a Scotch whisky bottle can sell for as much as 100 times the price of a similarly aged – and similarly complex – Canadian whisky. </p>
<p><a href="https://doi.org/10.5465/amj.2020.0017">One recent study of Canadian whisky</a> showed how distilleries can even use their physical features and local character to enhance perceptions of their spirits’ authenticity. Bottles from older distilleries were deemed more authentic – and could sell for more. Those from newer, factorylike buildings had less appeal to consumers.</p>
<p>There’s a miragelike nature to all of this. A product can be considered authentic if everyone believes and acts like it is.</p>
<p>It should come as no surprise, then, that the history of whiskey is one of perception, not necessarily quality. And this perception helps drive its economic fortunes.</p>
<p>So the next time you search for a nice bottle of whiskey for yourself or as a gift, consider the story and history that’s amplifying its price.</p><img src="https://counter.theconversation.com/content/218769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hovig Tchalian does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The history of whiskey is one of perception, not necessarily quality.Hovig Tchalian, Assistant Professor of Entrepreneurship, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168342023-12-14T23:40:30Z2023-12-14T23:40:30ZChristmas drinks anyone? Why alcohol before bedtime leaves you awake at 3am, desperate for sleep<figure><img src="https://images.theconversation.com/files/564156/original/file-20231207-21-eolo35.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/new-year-christmas-celebration-champagne-front-1534963964">fornStudio/Shutterstock</a></span></figcaption></figure><p>You’ve come home after a long day at work, you have dinner, put the kids to bed, and then you have your usual nightcap before drifting off to sleep. Or, perhaps you’re at the pub for the work Christmas party, and you think you’ll just have one more drink before heading home.</p>
<p>That last drink might help you fall asleep easily. But your nightcap can also wreck a good night’s sleep. How could it do both?</p>
<p>Here’s what’s going on in your body when you drink alcohol just before bedtime. And if you want to drink at the Christmas party, we have some tips on how to protect your sleep.</p>
<hr>
<p>
<em>
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Read more:
<a href="https://theconversation.com/how-can-i-get-some-sleep-which-treatments-actually-work-212964">How can I get some sleep? Which treatments actually work?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens to my body when I drink?</h2>
<p>Soon after you drink, alcohol enters your bloodstream and travels to your brain.</p>
<p><a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1530-0277.1998.tb03695.x">There</a>, it affects chemical messengers known as neurotransmitters and <a href="https://pubmed.ncbi.nlm.nih.gov/2700603/">slows down communication</a> between nerve cells. </p>
<p>Certain <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4040959/">regions of the brain</a> are particularly vulnerable to the effects of alcohol. When alcohol interacts with cells in these regions, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826822/">overall effect</a> leads to those characteristic feelings of relaxation, lowered inhibitions, slurred speech, and may induce feelings of drowsiness and lethargy. </p>
<p>Alcohol can also have immediate effects on the heart and circulatory system. Blood vessels widen, resulting in a <a href="https://link.springer.com/article/10.1007/s11906-021-01160-7">drop in blood pressure</a>, which can make you feel dizzy or lightheaded.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-different-drinks-make-you-different-drunk-88247">Do different drinks make you different drunk?</a>
</strong>
</em>
</p>
<hr>
<h2>What happens soon after a nightcap?</h2>
<p>Drinking alcohol before sleeping is like flipping a switch. At first, alcohol has a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6826822/">sedative effect</a> and you will probably feel <a href="https://pubmed.ncbi.nlm.nih.gov/23347102/">more relaxed</a> and <a href="https://www.nature.com/articles/s41598-020-62227-0#:%7E:text=In%20this%20large%2C%20population%20based,sleep%20(cross%20sectional%20analyses).">drift off easily</a>.</p>
<p>At this point, you still have a high level of alcohol in your blood. But don’t be fooled. As your body <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/">processes the alcohol</a>, and the night goes on, alcohol actually <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/acer.12621">disrupts your sleep</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man sitting on sofa, wearing pyjamas, holding glass of red wine, sparkling lights on floor" src="https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/564151/original/file-20231207-29-tofekf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A nightcap might help you drop off, but there’s worse to come.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-check-pyjamas-holding-glass-red-1901882026">dabyki.nadya/Shutterstock</a></span>
</figcaption>
</figure>
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<p>
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Read more:
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</strong>
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</p>
<hr>
<h2>And later that night?</h2>
<p>As your body processes the alcohol and your blood alcohol level drops, your brain rebounds from the drowsiness you would have felt earlier in the night. </p>
<p>This disturbs your sleep, and can wake you up <a href="https://journals.sagepub.com/doi/10.1300/J465v26n01_01">multiple times</a>, particularly in the second half of the night. You may also have
vivid and stressful <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821259/">dreams</a>.</p>
<p>This sleep disruption is mainly to the deep, “rapid eye movement” or REM sleep.</p>
<p>This type of sleep plays an important role in regulating your emotions and for your cognitive function. So not getting enough explains why you wake up feeling pretty lousy and groggy.</p>
<p>Drinking alcohol before bedtime also tends to mean you <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2775419/?source=post_page---------------------------">sleep less overall</a>, meaning important rest and recharge time is cut short.</p>
<p>There are also <a href="https://pubmed.ncbi.nlm.nih.gov/31234199/">long-term impacts</a> of alcohol on sleep. Moderate and heavy drinkers consistently have <a href="https://academic.oup.com/sleepadvances/article/3/1/zpac023/6632721">poor sleep quality</a> and more <a href="https://www.nature.com/articles/s41598-020-62227-0#:%7E:text=In%20this%20large%2C%20population%20based,sleep%20(cross%20sectional%20analyses).">sleep disturbances</a> over time.</p>
<hr>
<p>
<em>
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Read more:
<a href="https://theconversation.com/adele-called-herself-a-borderline-alcoholic-but-is-that-a-real-thing-215987">Adele called herself a 'borderline alcoholic'. But is that a real thing?</a>
</strong>
</em>
</p>
<hr>
<h2>How about the Christmas party then?</h2>
<p>If you plan to drink this holiday season, here are some tips to minimise the effect of alcohol on your sleep:</p>
<ul>
<li><p><strong>swap every other drink</strong>. Try swapping every second drink for a non-alcoholic drink. The more alcohol you drink, <a href="https://academic.oup.com/sleep/article/44/1/zsaa135/5871424?casa_token=okbJAuf8TXUAAAAA:ye_q-DACToxvj8H3IVaiKrjNkDhHZnl-LKJdds3iteaKyzJFuHUzitlRv45DqxNO-FraDRAlQMV53z8">the more</a> sleep disruption you can expect. Reducing how much you drink in any one sitting can minimise the effect on your sleep</p></li>
<li><p><strong>avoid drinking alcohol close to bedtime</strong>. If you give your body a chance to process the alcohol before you go to sleep, your sleep will be less disrupted</p></li>
<li><p><strong>eat while you drink</strong>. Drinking on an empty stomach is going to worsen the effects of alcohol as the alcohol will be absorbed <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-3010.2006.00588.x?casa_token=TQiCqcbasYAAAAAA:GbEvnTT82aB3_sPfmJLOQXIV3ivjnbZdIoP2_XZBa8IDZ0YLaPxNfE6DMHLgH7obnpA22VDsM4vyGZV4dQ">faster</a>. So try to eat something while you’re drinking</p></li>
<li><p><strong>ditch the espresso martinis and other caffeinated drinks</strong>. <a href="https://www.sciencedirect.com/science/article/pii/S1087079207000937?casa_token=NJsobF-C-vwAAAAA:opzPjrglPdZTwXEo7rHil5vm0a1K3KmXw9vp0Het-eRHZEWbfRAA40vgicU3Z5kC8x7uEJF39C8">Caffeine</a> can make it hard to get to sleep, and hard to stay asleep</p></li>
<li><p><strong>be careful if you have sleep apnoea</strong>. People who have sleep apnoea (when their upper airway is repeatedly blocked during sleep) can be even more impacted by drinking alcohol. That’s because alcohol can act as a muscle relaxant, <a href="https://academic.oup.com/sleep/article/5/4/318/2753287">leading to</a> more snoring, and lower oxygen levels in the blood. If you have sleep apnoea, limiting how much alcohol you drink is the best way to avoid these effects</p></li>
<li><p><strong>drink plenty of water</strong>. Staying hydrated will help you <a href="https://academic.oup.com/sleep/article/42/2/zsy210/5155420">sleep better</a> and will hopefully stave off the worst of tomorrow’s hangover.</p></li>
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Read more:
<a href="https://theconversation.com/what-causes-hangovers-blackouts-and-hangxiety-everything-you-need-to-know-about-alcohol-these-holidays-127995">What causes hangovers, blackouts and 'hangxiety'? Everything you need to know about alcohol these holidays</a>
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<img src="https://counter.theconversation.com/content/216834/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s what’s going on in your body when you drink alcohol just before bedtime. And if you want to drink at the Christmas party, we have some tips on how to protect your sleep.Madeline Sprajcer, Lecturer in Psychology, CQUniversity AustraliaCharlotte Gupta, Postdoctoral research fellow, CQUniversity AustraliaChris Irwin, Senior Lecturer in Nutrition and Dietetics, School of Health Sciences & Social Work, Griffith UniversityGrace Vincent, Senior Lecturer, Appleton Institute, CQUniversity AustraliaSaman Khalesi, Senior Lecturer and Discipline Lead in Nutrition, School of Health, Medical and Applied Sciences, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172032023-12-14T13:48:45Z2023-12-14T13:48:45ZHow much could the NHS save if people had healthier lifestyles? Hundreds of millions according to research<figure><img src="https://images.theconversation.com/files/565332/original/file-20231212-19-rf91na.jpg?ixlib=rb-1.1.0&rect=77%2C132%2C5106%2C3292&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-backpack-hiking-on-footpath-autumn-2377721871">encierro/Shutterstock</a></span></figcaption></figure><p>The NHS spends a lot of time and money looking after people who smoke, or drink too much or don’t do enough exercise. Hospital admissions and treatments are an expensive business. </p>
<p>So what would happen if these people were able to change their lifestyles, for example by switching to vaping, moderating alcohol intake and being more physically active? My research suggests that costs to the NHS could be significantly reduced. </p>
<p>One of <a href="https://www.magonlinelibrary.com/doi/abs/10.12968/bjhc.2023.0046">my studies</a> indicates that if half of England’s <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2022#smoking-prevalence-in-the-uk-by-sex-age-and-region">5 million smokers</a> switched to e-cigarettes or heated tobacco, the NHS would save more than £500 million a year. The shift away from cigarettes would lead to a decrease in cases of lung cancer, mouth cancer and heart disease. While the risks of vaping are still <a href="https://theconversation.com/how-bad-is-vaping-and-should-it-be-banned-197913">not entirely clear</a>, the damage caused by smoking has been firmly established.</p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1090944323000613">Another study</a> I carried out in Italy reinforces this conclusion. It suggests that if half of Italy’s smoking population transitioned to alternative products, that country’s public health service could save over €700 million (£600 million) a year.</p>
<p>The larger figure comes from a slightly different cost structure for Italy’s health service, and the fact that more people smoke in Italy than in England. That study also delves into potential savings related to reducing excessive alcohol consumption and promoting increased physical activity.</p>
<p>My research <a href="http://dati.istat.it/Index.aspx?QueryId=16778&lang=en">used statistics</a> which suggest that just under 3% of Italians are currently considered heavy drinkers. Overindulging in alcohol can lead to many <a href="https://www.thelancet.com/pdfs/journals/lanrhe/PIIS2665-9913(23)00073-5.pdf">health problems</a>, including liver damage, heart defects, increased blood pressure, and a heightened risk of certain types of cancer.</p>
<p>I found that if a single heavy drinker (someone who consumes over four units of alcohol a day) out of every 1,000 Italians reduced their consumption to the recommended guidelines (two units a day for men, one a day for women), this would result in an annual saving to the health service of €60 million (£52 million). </p>
<p>Another finding was that if one physically inactive person out of every 100 Italians started to take the recommended level of at least 150 minutes of moderate physical activity, the gain would be €223 million (£193 million) per year. </p>
<p>Almost 40% of Italians do no exercise, which increases the risk of cardiovascular diseases, type 2 diabetes and obesity. It also <a href="https://www.who.int/news/item/04-04-2002-physical-inactivity-a-leading-cause-of-disease-and-disability-warns-who">elevates the risk</a> of colon cancer, high blood pressure, osteoporosis, depression and anxiety. </p>
<p>So overall, as the Italian government – in common with many wealthy countries – struggles with healthcare funding, close to €1 billion could be saved every year in direct costs if a relatively small number of people made fairly straightforward changes. </p>
<h2>Save lives, save money</h2>
<p>A similar impact could be had on the NHS (which has an annual budget of £182 billion) by targeting smokers, heavy drinkers and those who take no exercise. </p>
<p>The economic impact could in fact be far greater than my calculations suggest. For the savings predicted by my research do not account for the loss in productivity due to time off work connected to illness, treatment and recovery. </p>
<figure class="align-center ">
<img alt="Bottles of water held up in celebration." src="https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565334/original/file-20231212-19-lbgug.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p>Some may argue that given the risky nature of cigarettes and alcohol, a more straightforward – and economically beneficial – approach would be to implement an outright ban. After all, if successful, it could potentially result in even greater savings of lives and resources. </p>
<p>But banning people from doing things they like, even if those things are harmful, <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">rarely works out well</a>. The idea of taking away the right to smoke or drink, or enforcing physical exercise would be a tough political sell. </p>
<p>Recognising that people are often inclined to engage in risky behaviour, the objective should be to reduce the excessive harm they cause themselves. A push towards encouraging and enabling people to smoke less, drink less and do more exercise would benefit them and significantly decrease the financial pressure on our healthcare systems.</p><img src="https://counter.theconversation.com/content/217203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Francesco Moscone is affiliated with University of Ca' Foscari Venice </span></em></p>Small changes, big savings.Francesco Moscone, Professor of Business Economics, Ca' Foscari University of Venice, Brunel University LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2186872023-12-13T13:33:06Z2023-12-13T13:33:06ZNonalcoholic beer: New techniques craft flavorful brews without the buzz<figure><img src="https://images.theconversation.com/files/565024/original/file-20231211-25-f1xwdr.jpg?ixlib=rb-1.1.0&rect=333%2C369%2C6999%2C4928&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Brewers today are delivering nonalcoholic beers that are a far cry from the sweet, watery options of the past.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/asian-brewer-filling-beer-in-glass-from-tank-at-royalty-free-image/1402489303">Pramote Polyamate/Moment via Getty Images</a></span></figcaption></figure><p>The holiday season for me includes socializing over drinks with friends and family. But all the celebrating tends to catch up with my waistline, and by New Year’s Day, it’s time to get back in shape. Besides vowing to hit the gym more, my approach involves a “<a href="https://doi.org/10.3399/bjgp16X683173">Dry January</a>.” But as someone who teaches brewing science, spends a lot of time around breweries and bars, and thoroughly loves beer, abstaining is no easy task.</p>
<p>Thankfully, I can still enjoy beer while cutting back on my alcohol intake and calories by switching to nonalcoholic beers.</p>
<p>To some people, nonalcoholic beer sounds like an oxymoron, but newer techniques are producing tasty, high-quality options in this growing beverage category.</p>
<p>A nonalcoholic beer is usually a malt beverage that is <a href="https://beerandbrewing.com/dictionary/5VGRSbEfTv/">more than 0.0% and less than 0.5%</a> alcohol by volume (ABV). Producing a beer this low in alcohol requires the brewer to use practices and equipment uncommon to the general brewing process and to consider additional food safety precautions.</p>
<h2>Brewing regular beer</h2>
<p>Regular beer has four main ingredients: malted barley, hops, yeast and water.</p>
<p>When brewing beer, brewers extract sugars from malted barley – barley grains that have been partially germinated and then dried to make available the starches in the grain and enzymes that break them down. The malted barley then goes into the mash. That’s where the enzymes in the grain wake up and get to work breaking down the starches into smaller sugars. This step results in a sweet wort.</p>
<p>The brewer then boils the sweet wort and adds hops to provide bitterness, aroma and flavors. The hopped wort is then cooled and transferred to fermentation vessels where the brewer adds yeast. The yeast breaks down the sugars in the wort, releasing carbon dioxide and ethanol. Ethanol is the alcohol that makes beer “alcoholic.”</p>
<p>At this point we have beer. Beer’s alcohol by volume ranges from 3% to 13%, with <a href="https://www.thespruceeats.com/alcohol-by-volume-353204#:%7E:text=Alcohol%20by%20volume%2C%20or%20ABV,4.0%20to%207.0%20percent%20ABV.">most styles falling between 4% and 7%</a>.</p>
<h2>The challenge of removing alcohol</h2>
<p>Some of the more traditional approaches to making nonalcoholic beer are skipping the fermentation step or diluting a regular beer. These techniques can produce beers that are too sweet or one-note, lacking in flavor characters that come from fermentation. Advances in two alternative techniques – controlled fermentation and de-alcholization – have led to improved nonalcoholic beer quality.</p>
<p>Controlling fermentation involves using either low temperatures to limit yeast activity, strains of yeast that are unable to break down certain sugars, or wort that is less fermentable. Remember, it’s the living yeast cells that add alcohol to the mix as they digest sugars in the wort. By keeping yeast from doing its thing, brewers prevent the typical amount of alcohol from getting into the beer in the first place.</p>
<p>Alternatively, there are a few <a href="https://nabeerclub.com/how-non-alcoholic-beer-is-made/">common techniques to de-alcoholize regular-strength beer</a>.</p>
<p>Both steam distillation and vacuum distillation <a href="https://doi.org/10.1016/B978-0-12-816938-4.00006-9">separate out the ethanol by heating the beer</a>. Alcohol has a lower boiling point than water, so it gets removed as steam while the water portion of the beer is left behind. One problem with steam distillation is that it also takes out volatile aroma molecules and give the beer a cooked flavor. Vacuum distillation, however, significantly lowers the temperature needed to evaporate ethanol. The gentler temperatures help the nonalcoholic beer retain aroma and minimize the impacts on flavor. </p>
<p>Membrane filtration usually relies on <a href="https://www.britannica.com/science/reverse-osmosis">reverse osmosis</a>. This process uses filters with small pores that allow alcohol and water molecules to pass through, but not the larger molecules – like sugars, hops acids and oils, and proteins – that provide flavor, aroma and body in the beer. Rather than the liquid flowing through the membrane head-on, reverse osmosis uses cross-flow filtration. The liquids flow parallel to the filter surface.</p>
<p>The brewer establishes a pressure differential so the side where the beer starts is at higher pressure than the other side of the filter. This pressure pushes the alcohol and water molecules through the membrane pores. The filtration process results in two liquid streams being collected: a concentrated syrupy beer liquid and an alcohol-water mix. The final step is adding water back to the beer concentrate. </p>
<p>Of the de-alcoholization options, most beer lovers agree that vacuum distillation and reverse osmosis produce the best results.</p>
<h2>Challenges for brewing nonalcoholic beer</h2>
<p>These techniques often require additional brewing equipment that can be cost prohibitive to many smaller craft breweries. </p>
<p>One significant downside associated with the production of nonalcoholic beer is that removal of alcohol creates a product that is not as shelf-stable. <a href="https://news.cornell.edu/stories/2023/12/nonalcoholic-beer-higher-risk-foodborne-pathogens">Alcohol normally acts as a preservative</a> – without it, the beer can be vulnerable to contamination by microbes that are dangerous or spoil the beer. Because some of the common methods to produce nonalcoholic beers can use less hops, produce beer with more sugars and increase pH, the resulting product can be even more susceptible to bacterial growth.</p>
<p>Brewers need to take additional steps such as pasteurization, sterile filtration or the addition of preservatives <a href="https://www.brewersassociation.org/educational-publications/non-alcohol-beer-a-review-and-key-considerations/">to make nonalcoholic beer safe</a>.</p>
<h2>Nonalcoholic beer is a growth market</h2>
<p>Regardless of the challenges and costs to produce safe nonalcoholic beer, the market is growing steadily. While nonalcoholic sales in the U.S. are comparatively small, currently representing around <a href="https://www.cnbc.com/2022/12/30/non-alcoholic-beer-set-to-continue-to-grow-in-2023.html">2% of total sales</a>, they experienced <a href="https://www.wsj.com/business/retail/non-alcoholic-beer-sales-alcohol-consumption-habits-aaa2e19c">31% average growth over the past four years</a> even as other alcoholic beverage market segments languished. In other global markets, nonalcoholic sales have performed even better.</p>
<p>A few factors explain greater interest in nonalcoholic beers.</p>
<p>First, there’s been a steady <a href="https://news.gallup.com/poll/509690/young-adults-drinking-less-prior-decades.aspx#:%7E:text=The%20decline%20in%20young%20adults,among%20both%20older%20age%20groups.">decline in alcohol consumption among younger generations</a>, along with a trend toward adopting more healthy lifestyles.</p>
<p>Second, nonalcoholic products have been <a href="https://punchdrink.com/articles/nonalcoholic-beer-golden-age/">successfully marketed</a> not only to nondrinkers but to regular beer consumers. Regular beer drinkers who enjoy the taste of beer and not the intoxicating aspect, like me, can guiltlessly enjoy a nonalcoholic beer, even during the workday. Marketing campaigns have also focused on nonalcoholic beer being a lower calorie alternative since it doesn’t contain <a href="https://www.nhs.uk/live-well/alcohol-advice/calories-in-alcohol/">calorie-dense alcohol</a>.</p>
<p>It also doesn’t hurt that the quality of nonalcoholic beer has significantly improved since its early days. Nonalcoholic today is not the watery, overly sweet or one-note product that it was in the past. Many recent technological advances in production help nonalcoholic beer maintain fermentation characteristics derived from the malts, hops and yeast, thus providing a more balanced and pleasant product that tastes like “real” beer.</p><img src="https://counter.theconversation.com/content/218687/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clark Danderson is a member of the Brewers Association. </span></em></p>Nonalcoholic beer may sound like an oxymoron, but newer techniques are producing tasty, high-quality options in this growing beverage category.Clark Danderson, Assistant Professor of Hospitality Management and Director of Brewing Science and Operations, Auburn UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2190032023-12-06T19:07:29Z2023-12-06T19:07:29ZWhat is needle spiking, and how can I protect myself?<figure><img src="https://images.theconversation.com/files/563813/original/file-20231206-15-s2excn.jpg?ixlib=rb-1.1.0&rect=6%2C0%2C4115%2C2747&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/trippy-night-image-people-dancing-outdoors-1861215565">Mircea Moira/Shutterstock</a></span></figcaption></figure><p>Last week two young Australian women <a href="https://www.abc.net.au/news/2023-11-30/travellers-warn-needle-spiking-overseas/103030942">spoke candidly</a> to the ABC about being sexually assaulted while on holidays. The alleged incidents occurred in Greece in 2022 and in Hawaii in 2019.</p>
<p>Both women described common symptoms of being drugged, including being unable to move or speak, blurred vision, lack of coordination and memory loss.</p>
<p>Both found a needle mark after they woke up and believe they were “needle spiked”.</p>
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Read more:
<a href="https://theconversation.com/what-is-drink-spiking-how-can-you-know-if-its-happened-to-you-and-how-can-it-be-prevented-160538">What is drink spiking? How can you know if it's happened to you, and how can it be prevented?</a>
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<h2>What is needle spiking?</h2>
<p>Needle spiking is when a person is injected with a drug without their consent. Reports of needle spiking started to emerge in the <a href="https://www.psychologytoday.com/au/blog/its-catching/202202/the-british-needle-spiking-panic">UK in 2021</a> but it’s now been reported around the world, including <a href="https://www.abc.net.au/news/2022-01-28/police-concerned-about-needle-spiking-at-echuca-newcastle/100787224">in Australia</a>.</p>
<p>Needle spiking is usually reported by people who have been at a crowded bar or party. It’s generally reported by women but <a href="https://www.abc.net.au/news/2023-06-07/needle-spiking-sydney-warning/102444708">some men</a> have also reported being needle spiked. </p>
<p>We don’t have data on how often needle spiking happens, but we think it’s <a href="https://journals.sagepub.com/doi/10.1177/00220426231197826">very rare</a>. There have been only a few reports of needle spiking in Australia but none of them have been able to be confirmed.</p>
<p>Often these types of incidents are not reported at all because often victims don’t remember what happened or there’s no way to identify the perpetrator.</p>
<p>We don’t know exactly what drugs might be used in needle spiking incidents, but they would likely be similar to drugs commonly used for drink spiking. These include colourless, odourless sedatives like Rohypnol, <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/GHB#bhc-content">GHB</a> and <a href="https://adf.org.au/drug-facts/ketamine/">ketamine</a>.</p>
<p>People who suspect they were needle spiked may have <a href="https://www.gmp.police.uk/advice/advice-and-information/spiking-advice/spiking/what-to-do-if-someone-has-spiked-you/#">blood or urine testing</a> afterwards. But there’s no real way to be sure any drugs detected in someone’s system were from a needle incident. And often <a href="https://www.psychologytoday.com/au/blog/its-catching/202202/the-british-needle-spiking-panic">no sedatives</a> are detected by the time testing happens.</p>
<h2>How does it happen?</h2>
<p>It’s very difficult to inject someone without them noticing, especially in a crowded venue where people are moving a lot. Needles need to be injected fairly carefully and it would take several seconds to get enough of a drug into the system to have an effect. It would also be almost impossible to inject enough of a drug to incapacitate someone through clothing.</p>
<p>So generally, a person would probably feel the prick of the needle and notice the drug going in. </p>
<p>It is theoretically possible to inject someone without them knowing, using a very thin needle. They may be less likely to notice if they’ve had a couple of drinks. But also it’s less likely you would find a needle mark with a very thin needle.</p>
<p>If needle spiking occurs, a more likely scenario may be that someone has their drink spiked, and the injection happens after they’re incapacitated from the drink spiking. This might be done to ensure someone stays sedated, but we don’t know the reasons for sure.</p>
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Read more:
<a href="https://theconversation.com/weekly-dose-ghb-a-party-drug-thats-easy-to-overdose-on-but-was-once-used-in-childbirth-73266">Weekly Dose: GHB, a party drug that's easy to overdose on but was once used in childbirth</a>
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<p>Drink spiking is much easier and is <a href="https://journals.sagepub.com/doi/10.1177/00220426231197826">probably much more common</a> than needle spiking, although we don’t have good data on the prevalence of drink spiking either.</p>
<p>By far the most commonly used drug in drink spiking is <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/drink-spiking">alcohol</a>. Extra or stronger alcohol might be added to an alcoholic or non-alcoholic drink.</p>
<p>More rarely other drugs are used such as <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/benzodiazepines#:%7E:text=Benzodiazepines%20(or%20benzos)%20are%20depressant,sedatives%20(or%20sleeping%20pills)">benzodiazepines</a> (like Rohypnol), <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/GHB#bhc-content">GHB</a> or <a href="https://adf.org.au/drug-facts/ketamine/">ketamine</a>. These drugs have <a href="https://www.webmd.com/mental-health/addiction/date-rape-drugs">sedative effects</a> that can result in loss of consciousness, memory loss and sometimes hallucinations or feeling like you are outside your body.</p>
<p>There is minimal data about sexual assault after drink spiking as most incidents are not reported, but some data suggests around <a href="https://www.parliament.nsw.gov.au/la/papers/Pages/tabled-paper-details.aspx?pk=84446#:%7E:text=Drink%20spiking%20is%20sometimes%20referred,being%20reported%20to%20the%20police.">one-third</a> of drink spiking incidents end in sexual assault. </p>
<h2>What to do if think you’ve been spiked</h2>
<p>If you were injected with any of the substances mentioned above you would feel the effects nearly immediately. If your drink has been spiked, it takes longer for the substances to enter your system, so you might feel the effects with enough time to get help. </p>
<p>Some of the warning signs you may have been spiked include:</p>
<ul>
<li>feeling lightheaded</li>
<li>feeling sick or unusually tired</li>
<li>feeling drunk despite only having a very small amount of alcohol</li>
<li>feeling like you might faint or pass out, or you actually pass out</li>
<li>feeling confused when you wake up</li>
<li>being unable to remember what happened the previous night.</li>
</ul>
<p>If you think you’ve been drink or needle spiked, you should ask someone you trust to help get you to a safe place, or talk to venue staff or security if you’re at a licensed venue. </p>
<p>If you feel very unwell you should seek medical help, such as at an emergency department.</p>
<h2>How can you protect yourself?</h2>
<p>Stick to venues you know and that have a good reputation for safety. If you’re at a venue where you don’t feel comfortable, don’t stay.</p>
<p>Keep your drink close to you and don’t leave it unattended. Don’t share drinks with other people, especially if you don’t know them well, and buy your drinks yourself. If you’re offered a drink by someone you don’t know well, go to the bar with them and watch the bartender pour your drink.</p>
<p>If you think your drink tastes weird, or you start to feel strange or unwell, tell someone you trust straight away. Keep an eye on your friends and their drinks too.</p>
<hr>
<p><em>If you’ve been a victim of drink or needle spiking and want to talk to someone confidentially, you can call the National Alcohol and other Drug Hotline on 1800 250 015.</em></p>
<p><em>For information about sexual assault, or for counselling or referral, you can call The National Sexual Assault, Family and Domestic Violence Counselling Line – 1800 RESPECT (1800 737 732).</em></p><img src="https://counter.theconversation.com/content/219003/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee is CEO at Hello Sunday Morning and also works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p>Needle spiking is when a person is injected with a drug without their consent. Reports started to emerge in the UK in 2021 but this has now been reported around the world, including in Australia.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2178942023-11-19T18:59:38Z2023-11-19T18:59:38Z5 reasons why climate change may see more of us turn to alcohol and other drugs<p>Climate change will affect every aspect of our <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)01859-7/fulltext">health and wellbeing</a>. But its potential harms go beyond the body’s ability to handle extreme heat, important as this is. </p>
<p>Extreme weather events, such as floods, droughts, storms and wildfires, are becoming more frequent and severe. These affect our <a href="https://pubmed.ncbi.nlm.nih.gov/36165756/">mental health</a> in a multitude of <a href="https://www.nature.com/articles/s41558-018-0102-4">ways</a>.</p>
<p>Coping with climate change can be overwhelming. Sometimes, the best someone can do is to seek refuge in alcohol, tobacco, over-the-counter and prescription drugs, or other psychoactive substances. This is understandable, but dangerous, and can have serious consequences.</p>
<p>We outline <a href="https://journals.sagepub.com/doi/full/10.1177/17456916221132739">five ways</a> climate change could increase the risk of harmful substance use. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/climate-change-is-resulting-in-profound-immediate-and-worsening-health-impacts-over-120-researchers-say-151027">Climate change is resulting in profound, immediate and worsening health impacts, over 120 researchers say</a>
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</em>
</p>
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<h2>1. Mental health is harmed</h2>
<p>Perhaps the most obvious way climate change can be linked to harmful substance use is by damaging mental health. This <a href="https://onlinelibrary.wiley.com/doi/10.1111/dar.12448">increases the risk</a> of new or worsened substance use.</p>
<p>People with a mental disorder are <a href="https://www.hindawi.com/journals/psychiatry/2018/5697103/">at high risk</a> of also having a <a href="https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-11-25#:%7E:text=Prevalence%20of%20comorbidity%20in%20epidemiological%20studies&text=Among%20subjects%20with%20an%20alcohol,a%20comorbid%20SUD%20%5B39%5D.">substance-use disorder</a>. This often precedes their mental health problems. Climate change-related increases in the number and nature of extreme events, in turn, are escalating risks to mental health. </p>
<p>For example, extreme heat is linked to increased <a href="https://pubmed.ncbi.nlm.nih.gov/27727320/">distress</a> across the whole population. In extreme heat, more people go to the <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2789481">emergency department</a> for psychiatric problems, including for <a href="https://www.sciencedirect.com/science/article/abs/pii/S0048969720338249">alcohol</a> and <a href="https://www.nature.com/articles/s43856-023-00346-1">substance use</a> generally. This is even true for <a href="https://www.sciencedirect.com/science/article/pii/S0048969720325572">a single very hot day</a>.</p>
<p>Post-traumatic stress disorder, depression, anxiety and <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja13.10307">other mental health</a> problems are <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2019.00367/full">common</a> at the time of extreme weather events and can persist for months, even years afterwards, especially if people are exposed to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9116266/">multiple events</a>. This can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6101235/">increase</a> the likelihood of using substances as a way to cope. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/collective-trauma-is-real-and-could-hamper-australian-communities-bushfire-recovery-131555">Collective trauma is real, and could hamper Australian communities' bushfire recovery</a>
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<h2>2. Worry increases</h2>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1708626023217050009"}"></div></p>
<p>With <a href="https://climatecommunication.yale.edu/publications/climate-change-in-the-american-mind-beliefs-attitudes-december-2022/">increasing public awareness</a> of how climate change is endangering wellbeing, people are <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/wellbeing/articles/worriesaboutclimatechangegreatbritain/septembertooctober2022#:%7E:text=The%20level%20of%20worry%20about,lives%20right%20now%20(29%25).">increasingly worried</a> about what will happen if it remains unchecked. </p>
<p>Worrying isn’t the same as meeting the criteria for a mental disorder. But <a href="https://www.undp.org/publications/peoples-climate-vote">surveys</a> show climate change generates complex emotional responses, <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(21)00278-3/fulltext">especially in children</a>. As well as feelings of worry, there is anxiety, fear, guilt, anger, grief and helplessness. </p>
<p>Some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904966/">emotional states</a>, such as <a href="https://www.pnas.org/doi/full/10.1073/pnas.1909888116">sadness</a>, are linked with long-term tobacco use and also make substance use <a href="https://pubmed.ncbi.nlm.nih.gov/16011392/">relapse</a> more likely.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-am-i-supposed-to-do-about-all-this-really-bad-stuff-young-people-identify-7-superpowers-to-fight-climate-change-193620">'What am I supposed to do about all this really bad stuff?' Young people identify 7 'superpowers' to fight climate change</a>
</strong>
</em>
</p>
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<h2>3. Physical injuries hurt us in many ways</h2>
<p>Physical injuries caused by extreme weather events – such as smoke inhalation, burns and flood-related cuts and infections – increase the risk of harmful substance use. That’s partly because they <a href="https://pubmed.ncbi.nlm.nih.gov/20033251/">increase</a> the risk of psychological distress. If injuries cause long-term illness or disability, consequent feelings of hopelessness and depression can dispose some people to self-medicate with alcohol or other drugs. </p>
<p>Substance use itself can also generate long-term physiological harm, disabilities or other chronic health problems. These are <a href="https://www.tandfonline.com/doi/abs/10.3109/00952999609001655">linked with</a> higher rates of harmful substance use.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/extreme-weather-is-landing-more-australians-in-hospital-and-heat-is-the-biggest-culprit-216440">Extreme weather is landing more Australians in hospital – and heat is the biggest culprit</a>
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<h2>4. Our day-to-day lives change</h2>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1527519774233661440"}"></div></p>
<p>A single catastrophic event, such as a storm or flood, can devastate lives overnight and change the way we live. So, too, can the more subtle changes in climate and day-to-day weather. Both can disrupt behaviour and routines in ways that risk new or worsened substance use, for example, using stimulants to cope with fatigue. </p>
<p>Take, for example, hotter temperatures, which disrupt <a href="https://www.cell.com/one-earth/fulltext/S2590-3322(22)00209-3?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2590332222002093%3Fshowall%3Dtrue">sleep</a>, undermine <a href="https://jhr.uwpress.org/content/57/2/400">academic performance</a>, <a href="https://www.nature.com/articles/s41562-017-0097">reduce physical activity</a>, and promote <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(22)00173-5/fulltext">hostile language</a> and <a href="https://www.cambridge.org/core/elements/abs/climate-change-and-human-behavior/F64471FA47B8A6F5524E7DDDDE571D57">violent behaviour</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/did-you-look-forward-to-last-nights-bottle-of-wine-a-bit-too-much-ladies-youre-not-alone-109078">Did you look forward to last night's bottle of wine a bit too much? Ladies, you're not alone</a>
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</em>
</p>
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<h2>5. It destabilises communities</h2>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1722842936348455042"}"></div></p>
<p>Finally, climate change is destabilising the socioeconomic, natural, built and geopolitical <a href="https://www.nature.com/articles/s41558-018-0102-4">systems</a> on which human wellbeing – <a href="https://theconversation.com/climate-change-and-health-ipcc-reports-emerging-risks-emerging-consensus-24213">indeed survival</a> – depends. </p>
<p>Damaged infrastructure, agricultural losses, school closures, homelessness and displacement are significant <a href="https://www.nature.com/articles/s41558-018-0102-4">sources of psychosocial distress</a> that prompt acute (short-term) and chronic (long-term) stress responses.</p>
<p><a href="https://doi.org/10.1196/annals.1441.030">Stress</a>, in turn, can <a href="https://doi.org/10.1007/s002130100917">increase</a> the risk of <a href="https://link.springer.com/article/10.1007/s002130100917">harmful substance use</a> and make people more likely to relapse.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/teaching-our-children-from-books-not-the-sea-how-climate-change-is-eroding-human-rights-in-vanuatu-192016">'Teaching our children from books, not the sea': how climate change is eroding human rights in Vanuatu</a>
</strong>
</em>
</p>
<hr>
<h2>Why are we so concerned?</h2>
<p>Substance-use disorders are economically and socially <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30337-7/fulltext">very costly</a>. Risky substance use that doesn’t meet the criteria for a formal diagnosis <a href="https://digitalcommons.fiu.edu/srhreports/health/health/32/">can also harm</a>.</p>
<p>Aside from its direct physical harm, harmful substance use disrupts <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843305/">education</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234116/">employment</a>. It increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676144/">accidents</a> and <a href="https://www.tandfonline.com/doi/abs/10.1080/09595230600944479">crime</a>, and it undermines social relationships, intimate <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795906/#:%7E:text=Results%20indicated%20that%20alcohol%20use,drinkers%20with%20low%20relationship%20satisfaction.">partnerships</a> and <a href="https://www.cambridge.org/core/journals/development-and-psychopathology/article/abs/longitudinal-relations-between-parental-drinking-problems-family-functioning-and-child-adjustment/CE508589A9E799FD6DC9E23DF364FB8F">family functioning</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-does-ice-use-affect-families-and-what-can-they-do-41186">How does ice use affect families and what can they do?</a>
</strong>
</em>
</p>
<hr>
<h2>Politicians take note</h2>
<p>As we head towards the <a href="https://www.cop28.com">COP28 global climate talks</a> in Dubai, climate change is set to hit the headlines once more. Politicians know climate change is undermining human health and wellbeing. It’s well past time to insist they act.</p>
<p>As we have seen for populations as a whole, there are multiple possible ways for climate change to cause a rise in harmful substance use. This means multidimensional <a href="https://www.nature.com/articles/s41558-018-0102-4">prevention strategies</a> are needed. As well as addressing climate change more broadly, we need strategies including:</p>
<ul>
<li><p>supporting vulnerable individuals, especially <a href="https://journals.sagepub.com/doi/full/10.1177/21677026211040787">young people</a>, and marginalised commmunities, who are <a href="https://www.nature.com/articles/s41558-018-0102-4">hit hardest</a> by extreme weather-related events</p></li>
<li><p>focusing health-related policies more on broadscale health promotion, for example, healthier eating, active transport and community-led mental health support</p></li>
<li><p>investing in climate-resilient infrastructure, such as heat-proofing buildings and greening cities, to prevent more of the destabilising effects and stress we know contributes to mental health problems and harmful substance use.</p></li>
</ul>
<p>There is now <a href="https://news.un.org/en/story/2022/10/1129912">no credible pathway</a> to avoiding dangerous climate change. However, if <a href="https://carnegieendowment.org/2023/01/12/climate-protests-tracking-growing-unrest-pub-88778#:%7E:text=These%20are%20just%20a%20few,even%20more%20numerous%20and%20influential.">increasing rates</a> of climate protests are anything to go by, the world may finally be ready for radical change – and perhaps for reduced harmful substance use.</p><img src="https://counter.theconversation.com/content/217894/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen Louise Berry has received funding from various national research funding organisations and other sources. She is a director of management consulting firm, Altitude Consulting, and a member of the Australian Greens political party. </span></em></p><p class="fine-print"><em><span>Francis Vergunst does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Climate change is seeing more of us with mental health problems and harmful substance use. So we need to start planning now.Helen Louise Berry, Honorary Professor, Centre for Health Systems and Safety Research, Macquarie UniversityFrancis Vergunst, Associate Professor, Psychosocial Difficulties, University of OsloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2166282023-11-08T19:10:54Z2023-11-08T19:10:54ZIs drug testing in the workplace effective or necessary?<figure><img src="https://images.theconversation.com/files/558239/original/file-20231108-25-ssnwv6.jpg?ixlib=rb-1.1.0&rect=702%2C257%2C5228%2C3681&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Shutterstock</span> </figcaption></figure><p>Alcohol and other drug use is a major problem in Australian workplaces costing more than <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/impacts/economic-impacts#">A$4 billion</a> a year. Of this, $3.6 billion is due to absenteeism.</p>
<p>While testing is <a href="https://www.australiadrugtesting.com/when-you-can-drug-alcohol-test-your-employees/">legal</a> to ensure the health and safety of workers, companies must have explicit policies telling employees their objectives and the consequences of being drug affected at work.</p>
<p>Many workplaces, particularly in safety sensitive industries like building and construction, manufacturing, mining, transport and aviation, test regularly for alcohol and other drugs. Workers can be fired for <a href="https://www.fwc.gov.au/documents/decisionssigned/html/2013fwc2017.htm">refusing</a> to take part.</p>
<p>Both the <a href="https://www.parliament.nsw.gov.au/about/Documents/Independent%20Broderick%20Report.pdf">Broderick report</a> into bullying, harassment and sexual misconduct at the parliament of NSW in 2022 and the <a href="https://humanrights.gov.au/set-standard-2021">Jenkins report</a> into Commonwealth parliamentary workplaces in 2021 identified alcohol as a significant psychosocial risk in the workplace.</p>
<h2>How should testing be conducted?</h2>
<p>While workplace health and safety laws are largely uniform across the country, there are no specific provisions regarding how and in what way alcohol and other drug testing should be conducted.</p>
<p>Most workplaces that test do it either at random intervals and with no notice as workers enter high risk worksites if there is a suspicion of use, or if a safety incident occurs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/helping-drug-users-get-back-to-work-not-random-drug-testing-should-be-our-priority-77468">Helping drug users get back to work, not random drug testing, should be our priority</a>
</strong>
</em>
</p>
<hr>
<p>Testing usually involves breath tests for alcohol, similar to police roadside testing of drivers, or urine or saliva tests for other drugs. <a href="https://infostore.saiglobal.com/en-au/standards/as-nzs-4760-2019-1144217_saig_as_as_2711498/">Current</a> <a href="https://www.saiglobal.com/PDFTemp/Previews/OSH/AS/AS4000/4300/4308-2008.pdf">standards</a> require positive tests to undergo further testing in a laboratory to confirm the result.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Certificate signed by workers to say they agree with their workplace's drug and alcohol free policy" src="https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/558244/original/file-20231108-19-8znndt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A workplace must inform its employees if has an alcohol and other drugs testing policy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/search/alcohol-workplace?image_type=photo&page=2">Shutterstock</a></span>
</figcaption>
</figure>
<p>Alcohol testing is an effective way to detect someone who is unfit for work because they are intoxicated. The test involves measuring alcohol in the blood stream and correlating this with impairment.</p>
<h2>Even workplace testing is not foolproof</h2>
<p>The problem with testing for illicit and pharmaceutical drugs is that these tests don’t necessarily indicate intoxication.</p>
<p>Both urine and saliva tests have <a href="https://www.sydneycriminallawyers.com.au/blog/how-long-will-illicit-drugs-remain-detectable-in-my-system/">long detection windows</a>, so drugs can be detected hours, days or even months after the effects have worn off.</p>
<p>THC (Delta-9 tetrahydrocannabinol), the psychoactive component of cannabis, can be detected up to 30 hours after consumption in a saliva test and nearly a month after consumption in a urine test.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drink-problems-at-work-got-much-worse-during-the-pandemic-heres-how-employers-can-tackle-them-175467">Drink problems at work got much worse during the pandemic – here's how employers can tackle them</a>
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<p>The Victorian parliament is currently holding an <a href="https://new.parliament.vic.gov.au/workplacedrugtestinginquiry">inquiry</a> into the laws governing workplace drug testing, with a particular focus on whether current laws discriminate against medicinal cannabis users.</p>
<p>Under its <a href="https://new.parliament.vic.gov.au/4a5f0e/contentassets/b5cd021c07d040959123f0bc59c77616/terms-of-reference-attachments/terms-of-reference---inquiry-into-workplace-drug-testing.pdf">terms of reference</a>, the inquiry is considering whether testing may be improved to ensure due process and natural justice occurs in workplaces with these users.</p>
<h2>Is there evidence to support workplace drug testing?</h2>
<p>Drug testing is considered quite invasive so it needs strong evidence to justify its use. But there is very <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293184/">limited research</a> of <a href="https://www.frontiersin.org/articles/10.3389/fpubh.2022.1051119/full">good quality</a> available.</p>
<p>The evidence we do have is <a href="https://pubmed.ncbi.nlm.nih.gov/29582489/">mixed</a>. There is some indication testing can <a href="https://psycnet.apa.org/record/2015-28335-001">reduce risk of injury</a> but other research has found <a href="https://www.liebertpub.com/doi/abs/10.1089/jomh.2014.0008">no impact.</a></p>
<p>The highest quality evidence shows testing doesn’t reduce overall alcohol or other drug use. One study found of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293184/">11 evaluations</a> only two showed tests cut alcohol or other drug use rates.</p>
<h2>What makes good alcohol and other drug policy?</h2>
<p>So testing may be helpful for workplace safety in industries where there is a high risk of injury, but it’s not enough on its own to improve the health of the majority of the workforce.</p>
<p>For that to occur, testing needs to be part of a comprehensive workplace strategy. Fatigue, stress, and mental health problems can all impact on health and safety in similar ways to alcohol and other drugs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-jenkins-review-has-28-recommendations-to-fix-parliaments-toxic-culture-will-our-leaders-listen-172858">The Jenkins review has 28 recommendations to fix parliament's toxic culture – will our leaders listen?</a>
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<p>So there needs to be a broader consideration of “fitness for work” than just alcohol and other drug intoxication.</p>
<p>Also, much of the negative impact of alcohol and other drugs in the workplace is not in safety but in productivity and absenteeism rates.</p>
<p>A good alcohol and other drug policy reduces the damaging effect of usage, fatigue, stress and mental health issues by creating a healthy workplace culture where:</p>
<ul>
<li><p>wellbeing is valued and supported</p></li>
<li><p>workers receive early education and support</p></li>
<li><p>managers and team leaders are trained to identify workers at risk</p></li>
<li><p>clear referral options such as an identified employee assistance program (EAP) provider are available</p></li>
<li><p>there are return to work options for workers who have been impaired</p></li>
<li><p>there are clear expectations about what is and what is not acceptable to ensure fitness for work.</p></li>
</ul>
<p>Workplaces with effective drug and alcohol policies have happier, healthier and more productive staff and reduced absenteeism.</p>
<p><em>If you are worried about your own or someone else’s alcohol or other drug use, contact the National Alcohol and other Drug Hotline on 1800 250 015 for free, confidential advice.</em></p><img src="https://counter.theconversation.com/content/216628/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee is CEO at Hello Sunday Morning and also works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into alcohol and other drug prevention and treatment.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Testing workers for drug and alcohol use can reduce injuries but is less effective than a comprehensive approach to improving staff health.Jarryd Bartle, Associate Lecturer, RMIT UniversityNicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2158892023-10-26T12:31:10Z2023-10-26T12:31:10ZTo better understand addiction, students in this course take a close look at liquor in literature<figure><img src="https://images.theconversation.com/files/555246/original/file-20231023-15-kxsfnv.jpg?ixlib=rb-1.1.0&rect=23%2C31%2C5152%2C3383&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Characters in books can teach lessons about addiction.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/open-book-and-glass-of-white-wine-in-sunlight-royalty-free-image/1219727594?phrase=wine+literature&adppopup=true">Nataliia Shcherbyna via iStock/Getty Images Plus</a></span></figcaption></figure><figure class="align-right ">
<img alt="Text saying: Uncommon Courses, from The Conversation" src="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/topics/uncommon-courses-130908">Uncommon Courses</a> is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.</em> </p>
<h2>Title of course:</h2>
<p>Alcohol in American Literature</p>
<h2>What prompted the idea for the course?</h2>
<p>I got the idea for the course when I was writing a chapter on the temperance movement in American literature for my doctoral dissertation. I ended up reading a lot of fiction and poetry about alcohol and the anti-alcohol movement. I thought it would be fun to teach a class that <a href="https://www.academia.edu/12903259/_Temperance_Novels_and_Moral_Reform_in_Oxford_History_of_the_Novel_in_English_Oxford_UP_2014_">surveyed American literature through a booze-themed lens</a>. </p>
<p>Since alcohol affects and disables people regardless of gender, sexual orientation, race, ethnicity or class, it is easy to find literature about the impact of alcohol from many points of view. </p>
<h2>What does the course explore?</h2>
<p>I pair my course with a medical doctor who teaches a course on the <a href="https://www.verywellmind.com/addiction-4157312">biology of addiction</a>. In the biology course, students learn about the <a href="https://www.verywellmind.com/addiction-overview-4581803">biological and physiological effects</a> of diseases of addiction, <a href="https://www.verywellmind.com/substance-use-vs-substance-use-disorder-whats-the-difference-6385961">substance use and abuse</a>, dependency and recovery.</p>
<p>The core curriculum at John Carroll University requires students to take paired courses from different departments that are linked together. A colleague who teaches biology courses approached me about linking my alcohol class to her addiction class. Students must take both of our courses during the same semester. The combined courses give students both a scientific and literary view of addiction. </p>
<p>Students read fiction, poetry and drama about many aspects of alcohol and other addictive substances: celebrating them, struggling with them, even prohibiting and regulating them. Students compare the literary representations of substance and alcohol abuse with medical descriptions and impacts. For example, when my class reads Kristen Roupenian’s viral short story “<a href="https://www.newyorker.com/magazine/2017/12/11/cat-person">Cat Person,</a>” we talk about the role of alcohol in reducing inhibition when casually dating.</p>
<h2>What’s a critical lesson from the course?</h2>
<p>My goal is for students to come to a better understanding of how alcohol influences literature. They learn how some writers portray the way alcoholism further marginalizes minorities. For example, characters in <a href="https://fallsapart.com/">Sherman Alexie</a>’s “<a href="https://bookshop.org/p/books/the-lone-ranger-and-tonto-fistfight-in-heaven-20th-anniversary-edition-sherman-alexie/12459512?ean=9780802121998">The Lone Ranger and Tonto Fistfight in Heaven</a>” are enrolled members of the Spokane Tribe of Indians. They live on the reservation and have great difficulty finding or keeping a job. Many characters suffer from intergenerational trauma, poverty and a pervasive addiction to alcohol. </p>
<p>For their final project, students must pitch a movie that offers a compelling plot with relatable characters. The storyline must be backed up by a deep understanding of the science of disease and addiction. </p>
<h2>What materials does the course feature?</h2>
<p>• “<a href="https://tinhouse.com/book/night-of-the-living-rez/">Night of the Living Rez</a>,” by Morgan Talty, explores addiction and poverty among the Penobscot Nation.</p>
<p>• “<a href="https://www.hemingwayhome.com/store/p/the-sun-also-rises-softcover">The Sun Also Rises</a>,” by Ernest Hemingway, is a classic novel set in 1920s Paris about a set of heavy-drinking American ex-pats dealing with the trauma of World War I.</p>
<p>• We visit <a href="https://karamuhouse.org/">Karamu House</a>, the U.S.’s oldest continuing African American theater, to watch a performance of “<a href="https://www.dramatists.com/cgi-bin/db/single.asp?key=6301">Clyde’s</a>,” a popular play by Lynn Nottage that is set in a truck stop sandwich shop that employs the recently incarcerated.</p>
<h2>What will the course prepare students to do?</h2>
<p>Students can be better advocates for their own personal health, and the health of others, if they understand how addictive substances affect their minds and bodies. Pre-health students in particular get a general introduction to medical issues related to addiction and how American authors have long portrayed booze. </p>
<p>For example, Frances Watkins Harper’s “<a href="https://www.literaryladiesguide.com/full-texts-of-classic-works/the-two-offers-by-frances-watkins-harper/">The Two Offers</a>,” written in the 1850s, is believed to be the first short story ever published by an African American woman. It is a temperance story that encourages young women not to marry a drunkard, highlighting the antebellum Black community’s concerns about sobriety and domestic well-being, in addition to freedom.</p>
<p>The course hones students’ critical reading and writing skills while challenging them to think about the role of alcohol, substance abuse, sobriety and recovery in their lives and in American culture.</p><img src="https://counter.theconversation.com/content/215889/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Debra J. Rosenthal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This course beckons students to examine how alcoholic beverages are portrayed in books by American authors.Debra J. Rosenthal, Professor of English, John Carroll UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2154862023-10-24T10:55:14Z2023-10-24T10:55:14ZHow substance use services can better support LGBTQ+ people<figure><img src="https://images.theconversation.com/files/555281/original/file-20231023-29-56xt8z.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C9504%2C6331&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many LGBTQ+ people do not access drug and alcohol support services because they fear stigma and discrimination.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pride-rainbow-flag-balloon-flies-high-2312602051">Old Town Tourist/Shutterstock</a></span></figcaption></figure><p>LGBTQ+ people in the UK face significant barriers to accessing substance use services, due to a number of <a href="https://clok.uclan.ac.uk/9598/1/POTP%204th%20Year%20Report.pdf">factors</a>, including fear of discrimination and stigma. Our <a href="https://www.tandfonline.com/doi/full/10.1080/09687637.2023.2238118">research</a> has shed light on these barriers and offers ideas for better helping this community.</p>
<p>We asked 38 LGBTQ+ people about their experiences of using alcohol and other drugs, getting treatment and how they think support and treatment services could improve.</p>
<p>Some LGBTQ+ people face challenges like rejection, stigma and abuse that can negatively impact their self-esteem. Lacking other social outlets, commercial venues like pubs and clubs may become their only connection to community, potentially leading to substance use. </p>
<p>Participants noted challenges such as the normalisation of drinking and clubbing culture within the community. As one explained: “Being part of the LGBTQ+ community can, for some people, be stressful in itself. The club scene in some areas is very drug/alcohol fuelled and focused”.</p>
<p>Another participant also pointed out: “Historically I think recreational drugs have been associated with the queer community, especially among men, this could lead to people thinking that since ‘everyone takes drugs’ they should too”.</p>
<p>Many respondents did not access support services because they feared stigma, discrimination and barriers to treatment. Some also doubted the effectiveness of treatment services or had negative experiences seeking help in the past.</p>
<p>One participant told us: “I didn’t think I would get any help if I sought it because I didn’t get help for other things when I sought and needed it, and because I wasn’t as bad as some other people”.</p>
<p>An important aspect of this research was to listen to the voices of those with lived and living experience of substance use and engagement with drug treatment services. In doing so we identified five suggestions for improving LGBTQ+ engagement:</p>
<h2>1. Training</h2>
<p>Training staff on LGBTQ+ identities, experiences and needs could help to ensure that treatment services are more welcoming and sensitive. This may reduce fears of stigma or discrimination that deter LGBTQ+ people from accessing support.</p>
<h2>2. Recruitment</h2>
<p>Feeling uncomfortable talking about sex or gender identity was cited as something which prevented people from accessing services.</p>
<p>For example, one participant explained the difficulty of talking to heterosexual professionals about <a href="https://www.shwales.online/chemsex.html">chemsex</a>, which is the use of drugs before or during planned sexual activity to enhance, disinhibit or facilitate the experience. Chemsex typically takes place at parties or gatherings organised specifically for this purpose. </p>
<p>Treatment providers need to understand LGBTQ+ culture to help people to feel more comfortable discussing intimate issues like chemsex, which many heterosexual or straight professionals may be less familiar with.</p>
<p>Employing LGBTQ+ staff members from diverse backgrounds could also help make services feel more inclusive and supportive.</p>
<h2>3. Cultural competence</h2>
<p>While some people valued existing inclusive services, more than half of participants said they still faced barriers when trying to access them. Many of our participants suggested that having tailored LGBTQ+ services would be helpful. </p>
<p>But it would also help if existing treatment providers learned more about LGBTQ+ cultures. This is called “<a href="https://www.e-lfh.org.uk/programmes/cultural-competence/">cultural competence</a>”, which means being aware of your own cultural beliefs and values, and how they may differ from those of people from other cultures. It also means being open to learning about different cultures so you can understand and meet the needs of the community. </p>
<p>Group services designed for and by LGBTQ+ people could reduce the risk of feeling marginalised in mixed groups. An LGBTQ+ culturally competent provider would be educated about LGBTQ+ experiences, mindful of their own potential biases, and able to offer a welcoming space for open discussion without judgement or misunderstanding.</p>
<h2>4. Outreach</h2>
<p>Attending Pride events and community spaces could help to build trust and make better connections with LGBTQ+ people. This could also make services more visible, approachable and accessible to the people who need them.</p>
<h2>5. Advertising</h2>
<p>Visible signals of LGBTQ+ inclusion was also important to our respondents. Symbols like rainbow flags and explicitly stating “LGBTQ+ welcome” in promotional materials could help to communicate that services affirm LGBTQ+ identities and are safe spaces. </p>
<p>One person told us: “Generally, if they were vocally welcoming of LGBT people, it would maybe lessen any worry”.</p>
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<img alt="An LGBTQ+ flag hangs out of a bag" src="https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555280/original/file-20231023-15-tij0b7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Everyone deserves compassionate and inclusive care for substance use issues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/york-england-united-kingdom-june-3-2312590215">Old Town Tourist/Shutterstock</a></span>
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<p>We now need to work much harder to understand these complex issues with bigger and more diverse groups of LGBTQ+ participants.</p>
<p>All people deserve affirming, compassionate care for substance use issues. Thoughtfully engaging with LGBTQ+ communities and listening to their perspectives is crucial for providing equitable services. Implementing LGBTQ+ inclusive practices requires commitment but is entirely feasible.</p>
<p>Substance use services willing to learn, adapt and grow can successfully create welcoming environments for LGBTQ+ people. Small steps towards inclusion ultimately enable greater access to support for communities that have felt left out for far too long.</p><img src="https://counter.theconversation.com/content/215486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shannon Murray received funding from the University of South Wales' Knowledge Exchange Innovation Fund (KEIF) and was awarded funding through the Civic Action Fund for this research. Shannon works for the University of South Wales as a research assistant in the Substance Use Research Group (SURG) and is a doctoral student at Cardiff University researching gay and bi men's experiences of Intimate Partner Violence (IPV). </span></em></p>LGBTQ+ people face barriers to accessing substance use services, but research shows there are ways to make them more inclusive and supportive.Shannon Murray, Research assistant at the Substance Use Research Group and PhD Candidate, University of South WalesLicensed as Creative Commons – attribution, no derivatives.