Yet another argument over moderate drinking erupted in the New York Times on Friday. The occasion was an article about a pending change in the Dietary Guidelines for Americans, which currently indicate that a drink a day (two drinks for men) is healthier than no drink at all. The proposed change would reflect the new scientific consensus that the healthiest level of consumption is zero drinks a day and that people who drink should stop at one.

Written by health reporter Anahad O’Connor, the article is well-researched and informative, cogently explaining how scientists became convinced, then unconvinced, that moderate drinkers were healthier than non-drinkers. In the comments section, some readers confirmed the new scientific consensus by reporting that their own health had improved when they gave up alcohol. Some rejected the consensus by reporting that they—or people they knew—had maintained robust heath into old age through moderate drinking. I didn’t keep a gate count, but my impression was that the anecdotal evidence was more or less evenly split, the tone of the responses civil.

But there were also flashes of familiar anger against those who would revise the dietary guidelines, condemned as “puritans,” “killjoys,” “old ladies,” “prohibitionists,” and “neoprohibitionists.” There’s a book to be written about this language, some of which goes back beyond Prohibition and 19th-century temperance movements to 16th-century debates over drunkenness, but I’ll spare you and just make a few comments on my way to talking about why some people get so steamed up about this issue.

Let’s start with “puritans,” because that’s just simple historical ignorance. The Puritans on both sides of the Atlantic thought moderate drinking was not only good but godly; it was drunkenness they hated. In fact, to Puritans, the opposite of drunkenness was not abstinence but moderate drinking, so it’s actually the “moderate drinking is good for you” folks who should be called “puritans.” (I’ve posted more on Puritans and drunkenness here if you’re interested.)

“Killjoys” baffles me because I don’t understand how the “joy” of an activity can be “killed” by learning it’s less healthy than you thought. Personally, I enjoy cheesecake a little more knowing that it’s bad for me. I also have to say that, if you can’t enjoy drinking without believing it’s good for you, then you’re actually the Puritan in the room.

Old ladies? Jeez, where do I start? I don’t think I will because you either see it yourself or you’ll never see it no matter what I say.

Then there’s “prohibitionist,” with or without the prefix “neo” (usually with), a term that both baffles and annoys me. I can understand not knowing enough history to get the Puritan thing right, but I can’t understand being unable to distinguish between “let’s not claim health benefits for alcohol if no benefits exist” and “let’s ban the sale of alcohol,” which is like being unable to distinguish between puppies and grizzly bears. I don’t think that readers of the New York Times would confuse the the two if they were acting in good faith.

They’re not. Outside the comments section of the Times, most people who call other people “neoprohibitionists” turn out to be lobbyists or other representatives of the alcohol industry. See for yourself; Google “neoprohibitionist” and click through your search results. Even the ones that don’t point to industry web sites tend to be written by industry spokespeople; for example, what seems to be a news article from The Hill is actually an opinion piece by the managing director of the American Beverage Institute.

Some non-industry-flacks use the term “neoprohibitionist” as well, mainly bloggers celebrating a particular alcoholic beverage (Wine Curmudgeon, Zythophile) or the joys of drunkenness (Brutal Hammer). I have no way to divine their ties to the industry, but they all earn money from the sale of alcohol, alcohol advertising, and/or alcohol-related merchandise. (Brutal Hammer is currently flogging a “Locked Down & Loaded” tee shirt that I’ll talk about in an upcoming post on pandemic-related changes in drinking culture.)

Regardless of their affiliations, all these people use the term “neoprohibitionist” deceptively, erasing the difference between making a substance illegal and trying to reduce the harms it causes. Minimum unit pricing? Neoprohibitionist. Adding cancer risk to alcohol warning labels? Neoprohibitionist. Even changing the way doctors discuss alcohol with their patients is neoprohibitionist.

In fact, some see the malign influence of neoprohibitionism everywhere and become downright paranoid about it. Did people across the globe drink a little less in 2018 than they did in 2017? It can’t be that drinking levels sometimes go down as well as up; the only explanation is “neo-Prohibitionists’ scare tactics” such as insisting “all booze is evil.”

I must admit, there are remnants of prohibition in “dry” cities, counties, and reservations in parts of the south, as well as Alaska and South Dakota, but they’re diminishing, rather than increasing, in number. The people who support them we might call paleoprohibitionists, and they do actually want to ban alcohol. But the alcohol industry doesn’t care much about them (apart from occasionally trotting one out to show that prohibitionists exist) because they have no influence on people who drink. Neoprohibitionists are the reverse: they have influence but don’t want to ban alcohol, just to reduce its harms by urging people to drink a little less.

Which the alcohol industry also purports to do in its “responsible drinking” campaigns, by the way.

What angers me most about neoprohibitionism is that the US currently has a real, virulent form of prohibition that criminalizes substances demonstrably less harmful than alcohol. If neoprohibition “kills” people’s “joy,” drug prohibition kills people—and ruins futures, separates families, enables exploitation, and wastes tens of billions of dollars every year. Drug prohibition is the foundation of dangerous criminal networks and dangerous criminal justice networks; it legitimizes SWAT teams and no-knock warrants and breathtakingly harsh sentences for the equivalent of what Anheuser Busch InBev does every day.

Okay, back to the dietary guidelines.

So why does the alcohol industry work so hard to maintain the belief that a couple of drinks a day confer health benefits? Are there really so many customers who drink for that reason—and who would radically curtail their consumption because of a change in official guidelines?

Some might. More importantly, some wouldn’t develop the habit of a daily drink in the first place. Younger people already seem to be drinking less alcohol than previous generations, and no one really knows why—whether it’s due to health concerns, financial pressures, the legalization of cannabis, technology-driven shifts in the way Zoomers socialize, the emergence of “sober curious” online communities, or other factors.

I don’t imagine, however, that most people accustomed to drinking a glass or two of wine or the equivalent in beer or liquor every day will change their habits based on new dietary guidelines, assuming they even hear about them. I think most will contemplate the tiny increase in risk, contemplate the pleasure and sociability they gain from their daily tipple, and carry on as before, though perhaps a little less apt to take a third and fourth drink.

But say I’m wrong, and this glass-or-two-a-day cohort slashes its consumption in half. Though that sounds catastrophic for the alcohol industry, it actually represents a modest hit to the bottom line, about the same hit delivered by a 100-percent-successful campaign to wipe out underage drinking. The reason for such a modest hit is that most people don’t drink a glass or two a day, at least not in the US. According to the last comprehensive analysis of the available data on how Americans drink, thirty percent of us don’t drink alcohol at all, forty percent drink rarely (0.02 to 2.17 drinks per week), and only twenty percent drink in the manner sketched out by the guidelines. And, all together, they consume only 26 percent of the alcohol sold. So I think the real concern of the alcohol industry lies somewhere else.

To suggest where, let me offer a personal anecdote.

In my family of origin, we communicated . . . how shall I put this . . . indirectly. My father loathed friction of any kind, and my mother never developed a theory of mind,  so honest conversations, especially on difficult topics, didn’t happen.

Nevertheless, one day, my father wanted to make a point about my mother’s alcohol consumption, which officially hovered around four generous drinks a day, sometimes five, but might have been seven or eight if you counted swigs from the vodka bottle in the kitchen liquor cabinet or from one of the miniatures in her purse.  Plus three different tranquilizers, but that’s another blog post. My father made his point by leaving a letter from my mother’s cardiologist on the dining room table, a letter warning that she must quit drinking or she would likely suffer a cardiovascular event such as a heart attack or stroke. Lest my mother and other family members miss his point, my father had drawn brackets around the cardiologist’s warning in blue ink. The letter stayed in the same spot on the dining room table all day.

The next day, the letter was gone. In the same place, tilted at the same angle, was an article clipped from the National Enquirer. The article claimed that, according to the latest research, people who consumed two or three drinks a day had fewer heart attacks and strokes than people who didn’t drink at all. It was my mother’s reply, and, lest we miss her point, she had drawn blue brackets around the researchers’ conclusion. The article also stayed on the dining room table for a day.

I hope no one’s expecting drama, because that was the end of the “conversation.” My mother kept drinking at her previous rate and, not long afterward, had an ischemic stroke so disabling that she required constant care for the next 26 years. My father kept his mouth shut because, seemingly reputable scientists did extol the cardiovascular benefits of “moderate” drinking, not just in the National Enquirer, but in papers such as the New York Times.[1] And, from what he could see (he didn’t know about the extra swigs), my mother’s alcohol consumption was just a little beyond “moderate,” as was his.

This episode suggests the darker—and more lucrative—stakes of the “two drinks a day are good for you” myth. It provides cover for much heavier drinking.

It’s important to remember, every time you think about alcohol policy, that ten percent of Americans drink almost three-quarters of the alcohol sold at a rate averaging 73.85 drinks per week. In other words, that ten percent is where the money is.

Obviously, no one in that top decile adheres to even the most generous “drinking is good for you” guidelines, so why do the guidelines matter to this cohort of drinkers?

In some cases, they don’t. I paid them no heed because I never drank moderately; I either abstained completely or put the pedal to the metal. My mother, however, claimed—and, I think, believed—that the guidelines justified her consumption. An observer might say she must have realized she exceeded them by some distance, but, with the caveat that no one ever really knows what’s in another person’s head, I don’t think so. Based on comments she made over the years, I think she engaged in some mental gymnastics to justify her consumption, and they went like so.

If the ideal is two to three drinks, then three to four drinks is only a small deviation from the ideal, four to five drinks a slightly larger deviation, and five to six a somewhat larger deviation but still within shouting distance of the ideal. Factor in large glasses, generous pours, and a disinclination to count secret swigs, and she could still believe that her consumption was, not healthy, but health-adjacent.

Even with the “one to two a day” recommendations, I’ve heard people in recovery, especially women, describe this kind of thinking: if one or two glasses of wine are healthy, then three are almost healthy, right on the cusp of healthy, and, if I don’t drink every day, then I can drink a lot on the days I do drink and still be on that cusp. Add to that reasoning the fact that most people underestimate their alcohol consumption by fifty percent, and you end up with a lot of unrecognized heavy drinking.

There are less personal reasons for defending the old drinking guidelines as well. For example, the media use them to distract people from the harms caused by alcohol use disorders. It’s a reflex: over and over, news articles about alcohol addiction or alcohol-related violence or the disease burden of alcohol pivot midway through to focus on the benefits of moderate drinking. Tell me, when was the last time an article about opioid addiction pivoted midway through to explain how safe opioids are for most people and how well they work to manage pain?

Of less tangible value is that revising the guidelines diminishes alcohol’s status as a unique substance that that hovers between categories. It’s like a drug but not really, like a food but not really, like a health supplement but not really. Take away the cardiovascular benefits of a tipple a day, and alcohol becomes easier to classify as a drug, albeit one that tastes good and has calories–sort of like edible cannabis, now that I think about it. Alcohol industry lobbyists in the US have fought hard to maintain the categorically unique status of alcohol, so I expect some serious opposition to these new dietary guidelines, even though other countries have adopted similar guidelines without too much fuss.

We in the Worldwide Neoprohibitionist Cabal are ready for the fight!

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[1] I will say that it was only in my mother’s National Enquirer article that I ever saw three daily drinks recommended, which is probably why she clipped and saved that one. Two was much more common–and the number has been coming down since the late 1980s, which is when the NE article appeared.