Dry January: is giving up booze beneficial?
It’s that time of the year where we traditionally make - and usually break - resolutions to eat less, drink less, lose weight, give up meat and take up exercise during the year ahead. And in the decade since 2013, thousands of people have also been signing up for “Dry January”. Last year 130,000 people in the UK elected to stop drinking alcohol for a month. So we thought this week we’d look at our long term love affair with the bottle, from how the practice of brewing began back in history, to the health harms and benefits of drinking today, and how scientists are now working on synthetic forms of booze with similar enjoyable effects but without the hangover.
In this episode
00:59 - The history of alcohol's social acceptance
The history of alcohol's social acceptance
Jane Peyton, School of Booze
Before we can look to the future of drinking, we must understand its past. Alcohol has been a staple of society for thousands of years, and is available in hundreds of forms, from beers to liquors to wines. But where does the origin of alcohol lie? And how has it remained socially acceptable when other drugs are illegal? Will Tingle spoke to Jane Peyton, principal of the School of Booze.
Jane - Alcohol has been around ever since there were sources of sugar that could be fermented, so if you think of fruit or roots or sap from trees. So the earliest alcoholic drinks wouldn't have actually been drinks. There would've been fermented fruit that had fallen off the tree onto the ground rotted and the animals would have eaten it. The hominids would've eaten it. So we're talking about in the last 100 million years, that's when fruit bearing trees came about.
Will - It's good to think that the first drunk animals were probably dinosaurs then.
Jane - <laugh>. You know what, I've never thought of that. But it could be if they were fruit eating. Absolutely.
Will - And it took a fair amount of time, but finally humans started to consume alcohol. At what point were these alcohols like beer and also wine, at what point did they become more popular?
Jane - Well, we have to look at the historical record of written records and in prehistory there were very few written records. So you look at archeological evidence, the archeologists find evidence of winemaking in the Caucasus. That's the earliest evidence of purposely making wine and having a wine industry around 6,000 years ago in the country of Georgia in the Caucasus. So if you look at the archeological evidence, you can date it back. That doesn't mean it started then. It only means that the evidence dates back to that time. So it would've been several hundred, maybe thousands of years before what we know of the date. When people started purposely making alcoholic drinks wine, for instance, beer in China 7,000 years ago. This archeological evidence of a drink made from rice, grapes, honey, and another fruit. So that was a combination that's like a cocktail actually. But we know for sure that by the time writing came about, cuneiform in what's now Iran and Iraq, we know that there are written records and evidence of people enjoying wine, high status people, drunk wine, beer was the drink for everybody. So beer and wine were the two drinks that we definitely know about because of the written evidence.
Will - Clearly alcohol has had a tremendous longevity amongst humans. If you were to speculate, what do you think is the reason behind alcohol's longevity as a socially acceptable or legal drug compared to other more contraband substances?
Jane - Alcohol is made from a food source. So every single alcoholic drink that we drink started as something that could be eaten as food. So therefore that food source was commonplace. It was in the home, it was in everybody's house. Everybody needed that food to turn it into alcohol as a way of preserving that food or getting enhanced nutrition from it. Fermentation enhances nutrition in food. It's called biological ennoblement. But there was another factor as well. And because it was a magical supernatural transformation from food to something that gave you this intoxicated buzz, this gentle buzz, there was a connection between this supernatural element and deities. So if you worshipped a God or a goddess, you often worshipped them by drinking alcohol and you'd get into an altered state and you could commune with your deity. So it became this socially acceptable and, in fact, mandatory thing to do. If you were a true disciple of your deity, you had to drink alcohol. Alcohol was considered to contain godly essence. So if you're talking about gods and deities and goddesses, then that's a very powerful motivator to drink alcohol. So it became this socially acceptable thing to do. You know, drunkenness was socially acceptable. In fact, it was expected. If you were at a festival to worship your deity, you had to get drunk, basically. Things like wine were restricted to high status people to the rulers. So they would give rules and they would give directives on who was allowed to drink wine. So therefore it became this thing that higher status people drank and so you were proud to drink it. So it becomes part of society. Something else really important as well as the religious element of it, is the alcohol in those days, I'm talking several thousand years ago when humans really started to industrialize the consumption of alcohol. In those days, the level of alcohol was fairly low. Distilled spirits didn't exist by the way. Wild yeast will ferment up to a certain level of alcohol. So you may be lucky to get up to 10%. Really lucky if you could get 10%. so you don't get completely obliterated like you would with some illegal drugs, some hallucinogenic drugs for instance, or nowadays it would be crack, something like that. So you don't get blasted, you just get gently intoxicated and it makes you feel good, but it also makes you sociable and that's really seductive. So you're doing it sociably. You're not just doing this internal intoxication like heroin would be, or hallucinogenic trip would be all about what's happening in your brain. With alcohol, it's all about what's happening in the group and what you're doing with your friends and just be really sociable. Alcohol is a social lubricant and it's been used as a tool for millennia, actually, to bond people together, to bring them together as a community. And it still is actually. You know, we don't think of that, but it really is when you go to a business networking event and most people will have a drink of alcohol and that makes you feel a bit relaxed, you're more likely to be sociable with the new business person who you're meeting. It helps you relax. So all these things together, they're the reasons why alcohol is the drug that we use legally and is the preferred drug.
08:04 - Which groups does alcohol affect the most?
Which groups does alcohol affect the most?
Linda Bauld, University of Edinburgh
According to a recent UK government report, in England, among people aged 15 to 49 years, alcohol is the leading cause of ill-health, disability, and death. Alcohol misuse across the UK is a significant public health problem with major health, social and economic consequences, estimated at between £21 and £52 billion a year. Each year there are over 1 million admissions to hospital for alcohol-related conditions. Linda Bauld specialises in public health at the University of Edinburgh, and alcohol is one of the areas she looks at.
Linda - Alcohol is a serious issue, not just in our society but across the world. And in fact, 80% of UK adults drink alcohol. In many countries, it's far lower. The highest death rates from alcohol attributable mortality in the UK are amongst 50 to 64 year olds, women and men. And that's mostly because of the accumulated effects of alcohol over many years, drinking heavily. The figures you state though around young people, younger adults, are really important. And that's because young adults are less likely to die from other things that older people might die from. But also a small proportion of young adults may be drinking a lot and particularly drinking too much too quickly on a single occasion. And that can lead to accidents, misjudging, risky situations. Unfortunately, things like traffic accidents and mental health issues, importantly, and that's why you see this kind of mismatch. So the burden of harm is in older groups, but for younger people, for a small proportion, there are still serious risks.
Chris - That's age. What about across the social spectrum? Because obviously we know that different people lie on different parts of the social spectrum. Are the effects of alcohol particularly concentrated anywhere there?
Linda - Yeah, so we have something called the alcohol harm paradox. And what you see there is actually the more affluent you are, you're actually more likely to drink. So to give you an example, in the UK about 75% of the highest earners report drinking in the previous week compared to about 45% of the lowest earners. But when you look at death rates, for example male alcohol specific death rates are four times higher in the most deprived areas in England than the least deprived. And this is something that we don't fully understand, this harm paradox. We think it may be to do with a couple of things. The first thing may be this heavy episodic drinking that I may be pointed to for younger people. So there are particular harms if you do that repeatedly, but even on a single occasion there can be accidents and risks. And then the second feature may be just this interrelationship between the other things that people experience in more deprived areas and the alcohol on top of that. So something that scientists, there's a recent systematic review in Lancet Public Health around the harm paradox, still haven't fully understood.
Chris - What's the general trend though? Are alcohol related harms getting worse, staying about the same or are things improving?
Linda - So it's a mixed picture. Since about 2004, 2005, the amount of alcohol consumed in the UK, or the proportion of people reporting drinking ,has actually fallen. And that's particularly the case actually amongst younger drinkers. We have potentially a new generation of teetotal young people. And then you have other young people of a smaller proportion who are drinking a lot. So we haven't seen a huge rise in consumption. In fact, overall at the population level is going down. But when you look at the harmful drinkers there, you've got some very serious consequences. And particularly recently, Chris. So during the pandemic we've seen some of the highest level, in fact the highest recorded ever levels of direct alcohol causing deaths. So in 2020 there were around 9,000, just under 9,000, deaths from alcohol specific causes in the UK. An 18.6% increase compared with 2019. So something went on in the pandemic, which has slightly reversed some of the reductions we'd seen in recent years and that it may just have been due to the fact that heavy drinkers were at home. It was a very difficult time. They were drinking more, they'd maybe been drinking for many years and that period just caused real harm to them.
Chris - Is there any level of intake which is judged to not be health harmful? I just remember Dame Sally Davies, when she was England's Chief Medical Officer, she went viral when she was saying, 'I asked myself before I pick up a glass of wine, do I want breast cancer or do I want to, to have that glass of wine?' I get what she was saying, that there is a health impact, but you're trading that off against something that you enjoy. Do we have any insights into where that risk benefit lies?
Linda - Yes, and I always think we're on safer territory, those of us in public health, when we talk about populations rather than our individual experiences. But as Jane was saying, you know, we've been consuming alcohol for thousands of years. Is there a safe level? Is there a safe drinking? Actually the answer is no. And in public health, we don't really use the term safe because if you look at cancer, which is an area I've done quite a bit of work in it, including in relation to alcohol, actually the gradient of harm starts from tiny levels of consumption for breast cancer, for example. And it gets higher the further you go. So we don't say safe, we say low risk. For some conditions, there's been evidence over the years that tiny amounts of alcohol might reduce your risk of developing and dying from heart disease, ischemic stroke, even diabetes, although that is really contested. So I think the fundamental thing for all of us is to think about, in terms of health, trying to do low risk drinking. So either not drinking at all, which as I say, 20% of adults in the UK don't. Or drinking at safer levels, low risk levels. And that is the CMOs, the chief medical officers guidelines, which are about 14 units a week, which I know to many people doesn't sound like a lot. That's about a bottle and a half of wine, about seven pints of lager. So that's really what we try to encourage people to stay within. But I realize we've just come out of the Christmas New Year's season and that's tricky. And that's why a lot of people decide, for example, in January to take a break from alcohol, which is a good thing for their health.
Chris - Indeed. Linda, thank you very much for the comprehensive summary. That is the University of Edinburgh's Linda Bauld, she's a public health specialist.
15:15 - What makes alcohol so addictive?
What makes alcohol so addictive?
Matt Field, University of Sheffield
Addiction is regrettably an unavoidable topic when it comes to alcohol. In the UK alone, there are an estimated 600,000 ‘dependent drinkers’ - that's people with an excessive, sometimes uncontrollable, desire to drink. So what drives the compulsion to drink? To talk about alcohol’s addictive nature, and what can be done to help it, is Matt Field from the University of Sheffield…
Matt - It's a social lubricant. It produces a pleasurable feeling of intoxication and relieves anxiety at least in the short term. So, it produces a lot of immediate beneficial consequences. In terms of what it does in the brain. It operates on the neurotransmitter GABA, which then has a number of downstream effects on other neurotransmitters and like all other addictive drugs. What it does is it influences the brain's reward circuit. And that circuit is involved in not only how we experience pleasure, but also how we learn about which behaviors are good behaviors and behaviors that we should repeat. So it influences our learning and our motivation. And what we ultimately learn is we learn that drinking alcohol is a behavior that we want to repeat, and that that desire to repeat the behavior can then be triggered by cues in the environment that we associate with alcohol.
Chris - We've all got those traits. We all have a brain that has those characteristics. You've not said anything about a person who's susceptible to this happening that's any different from anyone else in the human race. So what is it about people who succumb where this becomes excessive?
Matt - There's certainly some heritable risk factors for addiction, so for alcohol use disorder. So if you have a family history, then you're more vulnerable to it. Perhaps more importantly these adaptations in the brain are dose dependent. So they'll occur to everyone to an extent and that will be proportional to the amount that you drink. But the more that you drink, the more those adaptations in the way the brain works will kind of manifest themselves.
Chris - Do you find that addiction with alcohol works the same way as addiction to anything else, whether it's crack, cocaine or heroin? Is it the same process, the same endpoint a person has a physical dependency, just it's how they get there.
Matt - The medical manuals which characterize different mental disorders, including the addictions, actually the way that they describe addiction to alcohol is very similar, is almost identical to the features of other addictions such as cocaine and heroin and so on. And actually those physical changes that you talk about, things like tolerance and withdrawal, they're an important part of addiction to all kinds of drugs. But there are a host of other features which are shared across addiction as well, such as loss of control. So an inability to control, or a difficulty in controlling drug use. Strong cravings also like harmful effects that Linda was just talking about. Damage to your health, but also to relationships and so on. And also changes in behavior. So you spend more and more time using the drug and less time doing other things that you find pleasant.
Chris - Is part of the problem that it takes a long time before you've accumulated enough damage that perhaps you notice or other people notice. Because I remember there was a documentary made for the BBC by Adrian Chiles, a broadcaster in the UK and he called it 'Drinkers Like Me. And he just described what most people would regard as a pretty normal lifestyle. But when he then went and did some medical tests and found actually there was evidence of damage already in his system and we were just hearing from Linda that alcohol does not have a safe level. It's always a bit damaging, but it's a trade off. Is it that it's socially acceptable, it's very available and you have to go a long way, way down the track before the obvious damage is visible to you or others. That as a result people often are far down that slippery slope before they suddenly realize perhaps they should reign it in.
Matt - That's right, and actually I've just finished reading Adrian Chiles' book, which is very informative. Yeah, that's absolutely right. I think a lot of people who are drinking more than is good for them. People tend to hang around with people who drink similar amounts to them. And so it's, it's always easy to find someone to think of someone who drinks more than you do. And a lot of people have this kind of stereotype of what an alcoholic looks like, you know the whiskey on the cornflakes type thing, and people, and it's really easy to convince yourself 'well I'm not like that so I'm not that bad.' Or such and such is worse than me. And so it's very easy to convince yourself that you're not doing yourself any harm when in fact you might be.
Chris - What are the danger signs for someone to look out for?
Matt - If you try to cut down and find it really difficult then that's probably quite a big red flag. Also, the way in which you start using alcohol. So if you find that you are primarily sort of drinking alone or drinking to manage a negative mood, those things tend to be associated with the development of a problematic relationship with alcohol. But the big one to watch out for is if you try to cut down and you struggle. And that's why something like Dry January can be quite helpful because people might think they'll be able to do it quite easily, but they may find it more difficult than they thought. And if that's you, then it's a good idea to ask for some help.
Chris - And just in the last 30 or 40 seconds, if either you yourself notice a problem perhaps trying to engage with dry January or among friends you notice some friends or colleagues that appear to be struggling, what should you do?
Matt - Well speak to your GP in the first place who will most likely be in a good position to refer you on to other services. But there's also lots of kind of self-help things which are very helpful. If you look on the NHS website, there's some good advice for what you can do to cut down and when you might need to seek specialist help. So those would be the first things I'd recommend.
Chris - Thank you Matt, very much for that very helpful, comprehensive overview. That's Matt Field. He's at the University of Sheffield.
20:50 - The future of alcoholic drinks
The future of alcoholic drinks
David Nutt, GABA Labs
In Star Trek they called it "synthehol" - an alcohol substitute that simulates the look and feel of alcohol, but for which - in the words of Commander Data - "the intoxicating effects are easily dismissed". And just like many of the prescient technologies made famous by Kirk and his successors, this is close to becoming a reality. Imperial College neuropharmacologist David Nutt at his company GABAlabs are working on alcohol replacements; one is entirely synthetic and refreshes all the same the parts of the body that many beers and other beverages can reach, but without the risk of an unpleasant hangover - it's called Alcarelle and we'll hear about that shortly; the other, called Sentia, is a carefully selected cocktail of herb extracts that hit many of the same brain pathways that booze does to produce a mild and short lived intoxicating effect. So how do they work?
David - So if you drink Sentia, it's been designed to taste like an attractive vermouth. And after a few minutes you begin to get the effect, a sense of some relaxation around the jaw. And then, the beginning of relaxation is inside your head, in your mind, you become more sociable, more convivial. You chat a little more. Look, if you're doing it socially, which is what we of course encourage people to do, because alcohol is the ultimate social drug. We start to look at people more and smile more, interact better.
Chris - How long will that persist for?
David - So with Sentia, the effect lasts for about 25 to 35 minutes.
Chris - How does it work?
So in the Sentia botanical drink, there are a number of food grade herbs, which we have selected specifically because they contain within them molecules which work on the GABA system. And the impact of this drink is, we believe, driven largely by a slight increase in the function of the GABA system, which produces this state of relaxation and sociality.
Chris - When you say the GABA system, this is the brain's inhibitory circuits that are also targeted by alcoholic boosts, their effects when you drink. So you are going for basically the same brain target, but you're getting there using different chemicals to do it?
David - That's correct. GABA is the main inhibitory system in the brain. We are targeting GABA because that's the primary target of low doses of alcohol. And the advantage of that is that we avoid targeting all the other transmitter systems that alcohol affects, particularly as you take bigger doses. So most of the problems with alcohol come because it starts to interact with other neurotransmitter systems.
Chris - And did we know that these herbs would have this effect or did you have to go through brute force and just find things that looked promising and then test them out?
David - So we started off looking for herbs, which had GABA containing molecules. But the other criteria were that they had to have been available for certainly decades. In fact, most of them have been around for hundreds of years and known to have calming effects. So there are herbs out there which have historically, traditionally been used for relaxation and calming. We targeted those and selected the ones where the effects could be generally predicted to be due to the GABA system.
Chris - And what data have you generated so far looking at the effect of this on the general public and whether it affects everyone the same amount to the same degree and what the safety profile of this is?
David - The safety profile, we believe to be as safe as the herbs. And as I say, all the herbs are approved either as foods or as food supplements. So we're fairly comfortable that these historically used herbs are safe. In terms of the magnitude of the effect, the effect is equivalent to perhaps a half a pint of beer, a small glass of wine. We don't want to get people very intoxicated and you can't get very intoxicated for two reasons. One is if you drank a whole bottle, the effect wouldn't be particularly greater because alcohol takes about an hour to get rid of a unit of alcohol. Whereas we get a much faster clearance. So we believe that even if you took a lot, you would have very little signs of impairment.
Chris - And presumably because there isn't that cumulative effect with dose, it's less likely that someone would become hooked on this.
David - Yes. We think that what we are doing, targeting the GABA system, minimizes, I can't say it completely eliminates, but we think it will minimize risk of dependence because we know that one of the key drivers for alcohol dependence and craving is turning on the dopamine system. And, and we have consciously chosen herbs, which we believe will not do that. So that's likely to reduce the craving that some people have for alcohol. And particularly that craving, which leads people to lose control when they start off intending just to have one or two drinks and going on a binge.
Chris - With the approach you've taken, you are to a certain extent, constrained by the hand that nature has dealt you. Could you do this a different way and say, well, we know what we want to achieve and we're gonna rationally design something that isn't alcohol but does have some of the same effects in the same way as you've done with the herbs, but you can get an even better effect or an even more tailored outcome that's even more desirable for what you want.
David - That's exactly what we're trying to do, Chris, yes. And we have invented small molecules which target subtypes of the GABA system with a deliberate ambition to do exactly what you say, to mimic the effects of alcohol in a much more specific way. The plan is to have, and I have a bottle of it here a synthetic molecule which we call Alcarelle. It's a direct pun on Candarel. Candarel was a molecule developed to give you the pleasure of sugar, the sweetness, without the calories. And Alcarelle is designed to mimic the pleasure of alcohol with much less in the way of harm. And also by the way, a lot less in terms of calories too. So Alcarelle will be an ingredient that we will license to drink companies, any drink company in the world will be able to make drinks which contain Alcarelle rather than ethanol. We see this as being an ingredient that can be used extensively as an alternative to Alcohol.
Chris - You said you've got a bottle of it sitting in front of you. Is this ready to go or is it a bit like if you were coming up with a pharmaceutical drug for Covid, for example, we know there are lots of trials that have to be done on lots of people and that takes lots of time and lots of money. Have you got to do that, or is the food and drink industry a bit different?
David - No, it has to go through food safety testing. I should say if it was a drug for Covid, it would be on the market already. Because if we had the same interest in governments reducing the harms of alcohol as they have shown they have for reducing the harms of Covid, there will be massive investment. There are three and a half million deaths a year globally from alcohol. It's not far off what we've had with Covid. But yes, we have to take Alcarelle through food safety testing and that testing will take between two and four years.
Chris - But you've tested it presumably on yourself if you've got a bottle of it sitting there?
David - Yes.
Chris - Is it good?
David - Well, it does what it will say on the bottle. That's true.
Chris - <laugh>. Well, I'll raise a glass to that. David, thank you very much for joining us, to tell us about it.
David - Thank you, Chris. It's been a pleasure.