Does the non-alcoholic craze just keep us drinking?
Everyone needs their vice. For me, its tacos. Tacos and a cheap can of beer. But each January, the tacos hit differently because the beer is gone. Ive been Dry Januarying for longer than I can remember, and will be the first to praise the hashtag. Over time, mine has extended to February, March, and now through most of the year until the Midwest grows cold and the parties feel cozy.The annual reset offers me a health tune up, and a cessation of habitand thats true for up to half of us who report that Dry January curtails drinking longer term. A glass of champagne or the occasional paloma gets swapped for seltzer and a splash of juiceor god forbid, tap water (*shivers*)and I cease reflexively grabbing something alcoholic to celebrate a hard days work.Whereas I used to quietly mainline homemade gingerade for the month while sidestepping the judgement of friends, the big brandification of sobriety means that my local liquor store eagerly emailed me on January 1 this year, inviting me back to try their Willy Wonka assortment of non alcoholic beers and spiritswhats been estimated as a $13 billion global market in 2023 and growing. NA drinks were once a mark of shame, but now theyre the popular kids, with enticing flavors, sharp labels, and a tempting, ever-so-sanctimonious halo effect of self-care in an era when we should know better.Any level of alcohol is bad for you, notes Daniel Roche, echoing warnings from the former Surgeon General. Roche is an assistant professor at the University of Maryland School of Medicine who studies alcohol and nicotine addiction. Going back 10 to 20 years, there was still some argument that there might be some benefits of alcohol, but now, any level of consumption is associated with almost every cancer.[Photo: Anheuser-Busch]At face value, the NA movement is a boon for health. But Ive also had the creeping suspicion that its too convenient. This is the first Dry January where Ive found myself chipping away at a 12-pack of (NA) Budweiser, its white and silver cans glinting in the light like vermeil clydesdales. Ive been enjoying the bite of hops chasing a rich al pastor, my palate convinced that Im drinking the real stuff, to the point Ive been asking myself if I should run back to the store to grab another pack.I havent had a drop of alcohol in weeks, but I still wonder: Am I really giving up drinking this month, if Im still drinking beer? Am I breaking any habit if Im reaching into a cardboard box labeled by Anheuser-Busch InBev?The answer is maybe. And maybe not. Through conversations with half a dozen addiction clinicians and researchers, experts firmly agreed that the proliferation of non-alcoholic beverages pose a net gain for public health. But they generally concurred that I may be onto something. There is little known about how non-alcoholic beverage affect our long-term relationships with drinking, and they could come with risks of their ownnamely, keeping us dependent on the rituals of alcohol at the opportunity of breaking up with it entirely.Were still sorting that out, says Kenneth Leonard, director of the Research Institute on Addictions at University at Buffalo, noting that anything that cues the sensations of alcohol might lead some to seek the real thing. It could certainly elicit some interest in returning and having an alcoholic beverage, and maybe saying, I can just have one, or maybe I can have a couple.Our changing treatment of addictionTo reiterate, the experts I talked to ranged from ever so positive to quite bullish on the proliferation of non-alcoholic products. While many shared light, curious concerns, they agreed that anyone from a light drinker (consuming 1 to 2 drinks a day) to a heavy drinker (who consumes 4 to 5) might benefit from trying them.The key reason for their support is that the medical communitys approach to addiction has shifted over time. Traditional programs like Alcholics Anonymous (which did not respond to comment) coach the complete cessation of drinkingwhich has often even included non alcoholic beers, in case they might trigger a relapse. But over the past few decades, clinicians have softened their approach in treating addiction from abstinence to whats known as harm reduction.I think in the clinical world that theres recognition that people are not going to change in ways they dont want to change, says Leonard. You have somebody come in for treatment for an alcohol use problem, and they say, I want to cut down on my drinking, you know, a clinician is not going to say, well, Im only going to treat you if youre committed to abstinence.Even though abstinence is the ideal long-term outcome to most clinicians, they acknowledge human nature, and will take what they can get. If an NA drink swaps out just one alcoholic drink, they are less concerned about the potential for unknown, long-term consequences than this singular net gainand having a patient take a first potential step in a greater path to recovery.The science has progressed at this point, says Joel Sprunger, a clinical psychologist in the addiction sciences division at the UC College of Medicine. If I can get somebody to go from drinking a 12-pack a night to six-pack a night, its still a lot, but its half. Being able to make that change can build momentumlets cut it in half again. Now Im going to go from six to three, and then from three to one, and then maybe I dont need it after a while.The science of habitsBreaking an addiction to ethanol is particularly difficult, but all new habits take time to form: an average of 66 days (though as many as 258), according to a landmark study published in 2009 that followed nearly 100 people as they charted new behaviors in drinking, eating, and activities like running.Phillippa Lally, who is now the Co-director of Habit Application & Theory Research Group at the University of Surrey, was the lead author on this study. And she is quick to caution, per her own research, that the single month of January wont be long enough for many people to break any habit. However, as for the effect of swapping a beer for an NA beer, she believes it could actually be beneficial to cut back consumption long term.You cant easily break a habit . . . particularly not just by consciously stopping yourself from doing it. It takes effort every time. So, you could exert this effort for the whole of January and then stop and you havent broken the habit, Lally writes via email. Substitution is a potentially useful approach to break a habit: Form a new habit that is stronger than the old one. Choosing a substitute that meets the same goals as the original habit is also a good idea, so a NA drink is a potentially good approach to that too, because it meets the goal of having a drink, potentially of being social, of the enjoyment of the flavor (presuming you do enjoy the flavor).In psychological theory, Lally is correct. In the actual practice of consuming alcohol, she might not be. A study from 2022 tracked beer purchases across 64,280 British households over three years. It asked the question that we are now: Do low and no ABV beers reduce our drinking? In this study, alcohol alternatives were consumed in small overall amounts at a population level: regular beer outsold NA beer at a rate of 32:1. But what it found was striking, and you can see it for yourself on the timeline below. Once households started buying nablab (no and low alcohol beer), they did consume less alcohol overall. Nablab purchases offset 22.5% of regular beer drinkingand that shift in habit continued even a year later. But they also kept on buying normal beer, albeit not as much. (Its also worth noting that another study looking at no and low-alcohol beverages in Great Britain and Spain found little benefit in their consumption: These lighter options were linked to lower mortality rates, but at such low levels it was a moot intervention.)Graphic from Are Lower-Strength Beers Gateways to Higher-Strength Beers? Time Series Analyses of Household Purchases from 64,280 British Households, 20152018 by Eva Jan Llopis, Amy ODonnell, Eileen Kaner, Peter Anderson [Image: Oxford Academic]In other words, NA drinks appear to reduce consumption by someone who drinks, potentially long term, but they arent a proven gateway to full sobriety, either. People who started drinking NA beers were still drinking the same, diminished amount of alcohol from the first day they bought an NA beer to a year later. While the studys author did not respond to request for comment, Roche is bullish on the findings, and says he could imagine those nablab drinkers really could kick the habit longer term, but that we dont yet know. His take on NA drinks is optimistic but measured.I dont know that I would come out and say I fully support it, but also Im not strongly against it either, says Roche. I think, you know, having more options available to people as they make more informed decisions about the role that they want these beverages to play in their lives is a good thing. Indeed, one study found that simply by expanding the number of different NA options available next to alcohol increased their rate of purchase. So the proliferation of NA drinks itself likely means more of us will be drinking them.[Image: Ghia]Breaking the links between drinking and our identityYet I cant help but wonder if drinking these convincing mocktails or NA beers is only perpetuating our identity as drinkers. And thats a point that could make you stick with a habit you might otherwise try to kick completely.There is . . . a question of identity here, writes Lally. If people identify as doing dry January, then they are likely to drink again in February. Whereas if they identify as someone who no longer drinks, or drinks rarely, its more likely to stick, but that is likely harder to encourage people to. Could the same be true to someone who still cracks a beer with their tacos?An alternative approach, Lally notes, is to remove cues that lead us to drink, whatever they may be. If these are removed permanently then the change should stick, she continues. However, a lot of the cues are things we cant remove from our lives.Indeed, alcohol is closely associated with every major social activity for adultswhich is both cultural and the result of omnipresent marketing (see: the NFL). Whether were talking about dating, whether were talking about picnics or end of year parties or retirement parties or all those things, theres always celebrations, says Leonard. Theres wine, beer, champagne, all those opportunities. And so you have to sort of imagine, what would those events be with[out alcohol]. You know, maybe they would be fine.The researchers I spoke to agreed that throwing back a few NA drinks at a party was a healthy behaviorand it might even help you deal with social anxiety. If you strongly associate beer with being a social lubricant, well, studies show the placebo effects may come along with it. You may actually get chattier and jollier drinking NA beer. But I think eventually, thats going to peter out well without the drug on board, says Roche. And your association between celebration and consumption may naturally fizzle out, too.In traditional conditioning models of learning, you have a conditioned stimulus, which is beer, and you have an unconditioned stimulus, which is alcohol. The way you extinguish that is, you present the beer cue without the alcohol. And then that should weaken that learning of this really positive, associative factor [of a buzz], says Leonard. But we dont have the data on that.[Image: Athletic Brewing Co.]What else can we do after dry January?If youve read this far, then you might be wondering, what other actions either you or the industry at large can do to reduce the consumption of alcohol. In fact, we do have some data on just that.For the industry, one study has calculated that, if the producers were to reduce the ABV in drinks across the board by 10%an amount that would be largely unnoticeable in many contextswe could reduce overall mortality rates by up to 1.26%. For mass public health, reducing alcohol in alcoholic beverages could make the biggest immediate impact simply because people would drink less ethanol for the same volume of beverage. Similar research on tobacco has even demonstrated that, by swapping cigarettes for lower nicotine cigarettes for six weeks (in randomized double blind trials), people reduced their dependence on and craving for nicotine. Simply offering less of a drug seems to be a good way to get people to consume less of it: even making cups smaller can lead people to drink less at parties.As for individuals, drinking can be a tough habit to break without breaking up with your rituals and social circles associated with it. But if you want to make abstinence feel easier, one of the most effective things you can do is to make more plans for the morning. People who had activities like exercising or volunteering planned for the next day are about half as likely to drink the night before.My biggest takeaway from a couple decades of enjoying alcohol is that, deep down, Ive always known it wasnt good for meeven when studies conveniently teased that a glass or two of wine a day might lengthen your life. Reaching into the fridge for an NA beer feels sneakily similar. You can never have your cake and eat it too. Something always costs something.But I also recognize my concerns are probably vastly overblown, and in just a few years, culture is attempting to reframe and reconcile thousands of years of practices weve had around alcohol.Perhaps not every decision we make is perfect (and thank god or what fun would life be?)but when it comes to our physical health, theres almost always a better thing we can be drinking, and chances are, that glass of NA will do you more good than harm.Liana Reid, who kicked her own heroin addiction decades ago to become a professional interventionist, puts it all pretty bluntly. If were gonna save some lives, people can save some lives by switching to NA, she says. It wont have the same effect. They wont end up in another country or behind the wheel of a car killing somebody.
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