Is Alcohol the New Tobacco?

60 years ago, the US Surgeon General, Dr. Luther Terry, released a report linking tobacco smoking to cancer and heart disease. This research based document was the first clue for many people, including physicians, that their habit of smoking was doing them harm.  This information has filtered and clouded and taken in and expanded over the past 60 years as a meme for dangerous behavior.  No more cigarettes in college classrooms, Braves games, or hospitals. A slow change at first, but still wending its way through vaping and cigar bars and hookahs and oral substitutes. Does anyone feel okay about using tobacco now? Is there still romance in “…when a lovely flame dies, smoke gets in your eyes”?

Is Alcohol on the Same Trajectory as Tobacco?

I wonder if a similar cultural change is beginning with regard to alcohol, and in 60 years, we will be surprised to look back at “partying,” tailgating, relaxing after work or before sleep, celebrating, wine tasting, and a version of the good life-Cheers!.  The CDC and The American Cancer Society both say research shows all alcoholic beverages are linked with cancer- most commonly breast cancer, mouth and throat cancer, esophagus-colon-rectal cancer, and others. The World Health Organization (WHO) says there is no safe amount of alcohol to use daily. All forms of alcohol, including wine and beer, are linked to high blood pressure, heart disease, liver disease, weakened immune system, anxiety, and depression.

We psychiatrists have not been much committed to noting the above risks of using alcohol, except for fetal alcohol syndrome. I do warn patients planning to become pregnant that it is best to have none of this toxic substance in their bloodstream at the moment of conception-when the sperm meets the egg.  Most of us are not abstainers from alcohol, except in the context of driving cars and practicing medicine.  We realize that people are positive about alcohol, derive pleasure from using it, that it often adds fun to life, that human beings like to get high, and that it’s no fun to seem to want to take the fun out of life.  There is a kind of moral hazard to all this: we sort of know that we will continue to drink alcohol, and there will not be an immediate consequence (I will not get cancer tomorrow). Also, almost everyone I know will continue to use alcohol, and they will encourage me not to worry about the risks.  That’s how it was when we had the first warnings about tobacco before slow changes occurred.

AUD (Alcohol Use Disorder)

Psychiatrists have been more concerned with a different problem: AUD (Alcohol Use Disorder), which is when alcohol use interferes with life functioning, interfering with goals, work, or relationships, and takes up a lot of space (craving, obtaining, dangerous use, cutting back, recuperating).  Fortunately, we do have medications that can clearly help people control and reduce alcohol use, including naltrexone, topiramate, acamprosate, and now the newest group, the GLP-1 agonists (Ozempic, Mounjaro, Wegovy, etc.), which some clinics are using as baseline treatment. People using GLP-1 (glucagon like protein-receptor) medications for weight/diabetes also have lower risks of addiction for various substances.

If alcohol is the new tobacco, will it take 60 years to get to the taboo status that tobacco has now?  Each moment is a turning point, a new direction. Life is a garden of forking paths, and after a few forks, we are often way off the path.  Our expectations and predictions are so often incorrect, and most of them turn out to be wrong.

What other “new tobaccos” are coming? Animal meat? Gasoline engines? Plastics? College? Psychiatrists?

Contact us at Psychiatry Opinion if you have any questions or concerns