I think there's 2 arguments here. One is, as you pointed out, binge drinking is bad for you. I think most people would agree.

The second argument, primarily in the second half of the article, is that creating the conditions to easily permit binge drinking is just a severe a problem.

>> It’s possible to consume alcohol in a safe manner... But at some margin, you are contributing to the idea that it’s normal to drink it. And we need to break down that norm.

In other words, every drink you order in public has a >1 R0 to make one of your buddies also order a drink. Conversely, every drink you don't get has <1 R0.

I'm sure we've all been in those situations at a bar where we say "I'll get (another) one if you get (another) one".

That's why he vouches for abstinence. Not for health, but to discourage a binge drinking culture that's quite pervasive, in the UK especially.

Most addiction specialists now subscribe to a definition of addiction that's something like, "repeated use in the face of adverse consequences" and I'd just say that in my life practically everyone I know who drinks has experienced adverse consequences from alcohol. These are frequently laughed off as rights of passage or minor embarrassments, but they include stuff like missing work with a hangover, driving when they shouldn't have, saying cruel things they wish they wouldn't have, getting in fights (physical or otherwise) they otherwise wouldn't have, behaving more aggressively than they normally would, behaving embarrassingly in public, skipping social events because they'd drank too much or were hungover, and on and on.

Again, even the people in my life who think of themselves as moderate drinkers without even the hint of a problem would have to acknowledge multiple incidents that fit the above criteria, if they were honest.

Because we live in a culture that tolerates alcohol we view a lot of this behavior as insignificant in a way that you wouldn't if somebody at a party were exhibiting signs of, say, cocaine intoxication. "Bob didn't come to work today because he used too much cocaine" sounds like a serious problem, but "Bob didn't come to work today because he's hungover" may elicit knowing laughs from the co-workers who were with him at the bar the night before.

Most people won't become fall-down drunks who lose their jobs and their spouses and everything else, but that's a pretty weak standard for harm.

Instead of just all-cause mortality, measure health and quality of life, as well. I know someone with a seizure disorder from drinking, and someone with heart problems from alcohol. It's yet to be determined whether or not alcohol will contribute to their deaths because they are still alive.

However, their quality of life is certainly lower than it was before alcohol. They require daily medications with side-effects, need to see expensive specialists, require expensive lab work to be run regularly, and have to worry about what happens should they go without their medication (ie suffer brain damage from seizing, have a heart attack, and/or die).

Imagine if instead the same number of people would consume heroine or LSD or other similar drugs at that level, as several people here are advocating for. Do you think that the human race would have any chance of survival?

LSD and other psychedelics actually have incredibly low harm potential. They're usually at the absolute very bottom of any harm chart.

In fact, mushrooms and LSD are the two least harmful recreational drugs per the Economist chart from 2010. Number 1 is alcohol and number 2 is heroin and crack. Meth is a pretty distant 4th. [1]

They're not addictive, in no small part because they're not really "fun" in the classic way cocaine is. They're interesting, but you're really not in a hurry to do them again. Further, the LD-50 is really, really, really high.

[1] https://www.economist.com/graphic-detail/2019/06/25/what-is-...

Sounds like a strawman argument to me. I don't see anyone advocating that people do heroin as much as they ingest alcohol.

LSD and other 5-HT2A agonists are self-limiting in that they induce a massive tolerance after a single dose, making subsequent doses either not work or give diminished effects that do not increase with increased doses. They also are not physically addictive like alcohol is, nor does LSD cause organ damage like alcohol does.

Beyond overdoses, opioids, other than ones like MPTP, don't cause physical harm to the body like alcohol does. The dangers of heroin come mostly from its criminalization, the criminalization of addiction and the lack of access to healthcare to treat addiction. For example, there are millions of people who take Suboxone, a long acting and powerful opioid that stays in the blood for 30+ days, without it causing organ damage or seizure disorders. Street heroin is dangerous because it is unregulated and often cut with fentanyl and stuff that should not be going into veins.

The issues surrounding heroin would be solved with a regulated supply of clean heroin, medical support to administer it correctly, addiction treatment and making all of those things accessible and affordable to the people who need it most. There are several examples of governments that provide all of these things, and they indeed cut down on heroin's mortality and the devastating effects of addiction.

Similar to the person I know with heart disease from alcohol, I know a former heroin addict who also has heart disease from their use. Their heart problem was not caused by heroin, but by the fact that they'd crush pills and inject them without properly filtering them, and the pill binders caused heart damage. A clean supply of heroin and access to addiction treatment would have prevented their heart problem.

Suboxone is the trademark name of a eponymous mix of the inhibitor Naloxone added to Buprenorphine.

Many formulations contain small enough amounts of Naloxone to permit a addict to take opiates without any significant adverse effects within a few hours.

The reason why people use the name synonymously is because Buprenorphine is a Mu Kappa Delta antagonist with sufficiently higher affinity to those receptors making it very much harder for other opiods to bind preferentially. Slow release formulation and slow linear bioavailability decline profiles suffice to do the rest of the job of making say heroin ineffective if the patient takes anything else.

I'm saying this so no one is under any impression that Suboxone is a safe drug for anyone to take (accidentally or otherwise) and off the top of my head a commonly used 8mg dose is roughly 100mg Morphine equivalent.

https://www.gloshospitals.nhs.uk/gps/treatment-guidelines/op...

Naloxone isn't orally active, so it isn't actually inhibiting anything for people who aren't abusing it. The opioid blocking effect comes from buprenorphine itself, as it is a partial agonist with a high binding affinity. It binds preferentially to the mu-opioid receptor compared to many opioids, and as a partial agonist, it has a weaker effect than some other opioids.

Nobody will advocate it, no, but there's a significant set of the population with self destructive tendencies. They're gonna use what they can get their hands on, and lots of whatever it is. I know a few folks who have taken tens of tabs of acid, and every single one was traumatized by the experience; some were incapacitated for months or years following.

I'm in favor of universal legalization, but it's definitely worth considering the impact to everybody, not just the people who use drugs responsibly

> Nobody will advocate it, no, but there's a significant set of the population with self destructive tendencies. They're gonna use what they can get their hands on, and lots of whatever it is. I know a few folks who have taken tens of tabs of acid, and every single one was traumatized by the experience; some were incapacitated for months or years following.

When I was in high school and college, kids would regularly get alcohol poisoning and need medical attention. Some of them would drink, drive and die. People like this will exist whether or not it's legal for them to consume whatever substance they're abusing.

> I'm in favor of universal legalization, but it's definitely worth considering the impact to everybody, not just the people who use drugs responsibly

Criminalization isn't going to stop these people, and even if their use leaves them unscathed, the justice system can impose lifelong negative consequences on them.

This is why I'm in favor of funding real drug education so people can make informed decisions, healthcare so people can get help if their use affects their heath, and legalization so that lives aren't ruined by legal consequences.

That's a fair assessment when it comes to addiction, but there's also binge drinking which has a fair number of detrimental effects and a decent rate of overdoses. I looked up the rate of incident and was actually surprised at the prevalence throughout age groups, to be honest.

https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

EDIT:

To be clear, I'm not an abolishonist. I do think, however, we should look at the actual potential harm of a substance when making laws. Alcohol is both physically addictive and habitual vs. marijuana or mushrooms. Alcohol and MDMA have overdose risk, where as marijuana and mushrooms do not. Marijuana and MDMA can pose serious psychological risks, especially in adolescents, where alcohol has a much lesser risk. These should all be reviewed in a scientific and dispassionate manner when defining laws, is all I'm suggesting.

> A lot of the points here talk specifically about the harms associated with binge drinking

Except that "binge drinking" is the norm for a lot of people.

Think about how much drinking surrounds sports events--it's really easy to fall into the trap of "having a couple extra"--and a stadium cup is often close to 2 drinks in quantity.

Suddenly, you're in the "7 drinks" range without even trying very hard.

It's a highly addictive substance which creates chemical dependence over time - for some, never, but a vast percentage of people are vulnerable to the gradual creep of addiction.

> but a vast percentage of people are vulnerable to the gradual creep of addiction.

Sorry, you're gonna have to back up this rather hefty statement with some facts. I've never seen any data to suggest that a "vast percentage" of people are at risk of becoming alcoholics.

> gonna have to back up this rather hefty statement

Thanks, you're quite right to challenge that, it's a belief based on past reading and should be backed up.

>> but a vast percentage of people are vulnerable to the gradual creep of addiction.

> Sorry, you're gonna have to back up this rather hefty statement with some facts. I've never seen any data to suggest that a "vast percentage" of people are at risk of becoming alcoholics.

"vulnerable to the gradual creep of addiction" and "at risk of becoming alcoholics" are not the same thing. A person might refrain from alcohol altogether because they believe, perhaps due to their family history, that if they drank on a regular basis they would become alcoholic. IOW, they feel they are vulnerable to the gradual creep of addiction. And they might be right. But as long they don't drink at all, they're not at risk of developing alcoholism.

The claim was a "vast percentage of people are vulnerable" to alcoholism. Their reply supports my interpretation of their comment.

This isn't about the propensity of an individual to develop alcoholism based on personal circumstances. This is a population-level claim with no data to back it up.

Frankly, I'm not even sure what you're arguing but it seems wholly disconnected from the OPs claim or my counterpoint.

Of the many things I've tried, cigarettes (likely the chemicals rather than the tobacco) was the most habit forming. I remember working a co-op term in Montreal in the winter and taking up the habit. At somewhere over a pack a week was habit forming. Less didn't seem to be.

I've drank lots, both socially and just at home for no reason. I enjoyed having many different beers around and consumed what was on-hand but never got to the point I made special trips to stock it. Similarly for wines or spirits (vodka, tequila, whiskey, wine).

Lately since there's little social occasions to drink, I've taken to consuming a bottle of red per week with/after meals. It seems to help with sleep (since I also have a couple cups of coffee throughout the day) than without.

Edit: Also recalling that it wasn't all that long ago, historically speaking, that Quebec still allowed smoking inside the office, and there was one woman who I worked with that had a rolling machine and a large ashtray that always needed emptying. It was like a weird trip in a time-machine.

> likely the chemicals rather than the tobacco

Everything is "chemicals".

> somewhere over a pack a week was habit forming

Try three packs a day

> I've drank lots,

Probably not, compared with someone (such as me) that does drink lots.

> I've taken to consuming a bottle of red per week ... I also have a couple cups of coffee throughout the day

Careful there!

My point is that different people have wildly different ideas about what is acceptable, damaging and addictive, and their ability to deal with it, in one way or another. I easily managed to give up cigarettes because my girlfriend said she would leave me if I didn't. She gave up alcohol (which she was a heavy user of) when she became pregnant (not by me), which is something I know I will never be able to do.

Yes absolutely. I didn't mean to imply that this was in any way universal. Coffee may be the second hardest thing for me. I've successfully given it up for a month or more a number of times, getting all the way through withdrawal symptoms where I generally feel happier and more energetic. So far I've always restarted consumption. Not out of a physical/psychological want but because it's so easy, mildly pleasant, and aids focus during work hours.

There's also the fact that they've only argued from the point of economic productivity.

As if that's all there is to life...

Those graphs are epidemiological studies. Saying “effect” implies that alcohol is a cause here, which is might be, but who knows!

Nutritional epidemiology is real questionable - it pretty much can tell you nonsense - like the fact that most items we cook with give us cancer [1]

[1] https://pubmed.ncbi.nlm.nih.gov/23193004/

But the next follow-up question to what you said would be, why should we focus on only the risk of death to determine harm? E.g., what happens if I exercise and drink a moderate amount of alcohol per week? I believe, AFAIK, I get worse results from that, and I would care about that wasted effort whether it raises my risk of death or not. I understand the logic of it, but I'm not super okay with saying that "causing no excess mortality" is somehow equivalent to "no effect". There are effects in statistics other than death, I think what you're saying means that mortality data alone is not enough to justify teetotalling.

As long as you don't become an addict.

I think most people start with 4 drinks per week. 12 years later is a different story.

Assuming this site has decent numbers, in the US around 5% of people >26 years old have an "alcohol use disorder". Presumably the majority of those are addition disorders. But that means that after 12 years 95% of them will still be fine.

https://americanaddictioncenters.org/rehab-guide/addiction-s...

Presumably an alcohol use disorder is quite bad. Is the benefit of drinking alcohol really enough to offset the fairly significant risk there?

So tens of millions of people?

Sounds like a public health crisis

Most non-abstinents are not alcoholics and that holds true even in countries with high rates of alcoholism.

Also "most people start with 4 drinks per week" is made up. Regardless of where you put "start".