Moderate Drinking: Good or Bad?

The debate over the benefits and risks of moderate alcohol consumption has sparked intense discussions among scientists, regulators, and the alcohol industry. One of the most influential figures in this debate is psychologist and academic Tim Stockwell, who has contributed studies over the past two decades that have been used by advocates for greater regulation and control of alcohol consumption. Stockwell has played a key role in reducing drinking guidelines in the United Kingdom and has promoted minimum pricing policies in Canada, arguing that these measures help reduce excessive drinking and its harmful effects. However, one of his main missions has been to challenge the notion that moderate alcohol consumption has health benefits, which has drawn criticism from some quarters.

In a recent interview on the Drinks Insider podcast with journalist Felicity Carter, Stockwell addressed many of these issues. While he tried to avoid sounding overly dogmatic, not all listeners were convinced, especially regarding his stance on the positive effects of moderate drinking. Throughout his career, Stockwell has been determined to debunk the J-shaped curve, which suggests that abstainers have a higher risk of premature death than moderate drinkers, while heavy drinkers face the greatest risk. This type of research, particularly concerning heart disease, has supported the idea that moderate alcohol consumption can reduce the risk of coronary heart disease, which is seen as one of the reasons for the lower mortality among moderate drinkers.

Since he chaired the Kettil Bruun Society in 2006, a neo-temperance group that advocates for reducing global alcohol consumption, Stockwell has consistently worked to discredit the belief that alcohol in moderate amounts provides health benefits. One of his main theories is the "sick quitter" hypothesis, which argues that studies suggesting a lower risk among moderate drinkers might be biased by including people who have stopped drinking due to health problems, skewing the data in favor of moderate drinkers.

This hypothesis, first introduced in the 1980s, has been the subject of numerous studies that have largely debunked it. Researchers like renowned epidemiologist Richard Doll excluded former drinkers from their analyses and compared moderate drinkers to those who had never consumed alcohol. The results showed that moderate drinkers had a significantly lower risk of developing heart disease, confirming the validity of the J-shaped curve. In one of his final studies, Doll concluded that moderate alcohol consumption could reduce the risk of coronary heart disease by up to 28% and all-cause mortality by 12%.

Despite this evidence, Stockwell has held firm to his views and has presented a modified version of his original theory: the "sick abstainer hypothesis." According to this theory, people who have never drunk alcohol may be inherently less healthy or predisposed to illnesses that lead them to avoid drinking. This claim is difficult to support, as many people who abstain from alcohol do so for religious reasons, such as Muslims and Protestants, or simply because they dislike the taste. These individuals do not appear to have inherently less healthy lifestyles than the average person, and in some cases, such as among religious communities, their habits tend to be even healthier.

Stockwell has also argued that lower-income individuals, who generally have shorter life expectancies, are more likely to abstain from drinking. However, this factor, known as statistical confounding, can be easily adjusted in epidemiological studies, which regularly control for variables such as socioeconomic status, age, smoking, and other risk factors. In the case of abstainers who have had serious health problems since birth, it is unlikely that their numbers are significant enough to influence the results of studies involving hundreds of thousands of people.

Despite Stockwell's efforts, the sick abstainer hypothesis has not been able to withstand statistical scrutiny. Researchers like Doll have shown that even when controlling for these factors, the link between moderate alcohol consumption and a lower risk of heart disease remains strong. This causal relationship has been supported by over 40 years of epidemiological research, which has withstood various methodological revisions and adjustments. The debate is far from settled, but moderate alcohol consumption, especially concerning heart disease, continues to be a central issue in public health and alcohol policy formulation. Meanwhile, researchers are continuing to refine their studies to better understand the complexities of these findings and their impact on public health.