The old TV western Gunsmoke lasted for 20 years, and it is highly likely the Long Branch Saloon was in all 635 episodes. The real 1870s Long Branch Saloon in Dodge City, Kansas, in addition to hard liquor and cold beer, served lemonade. And one of the owners wasn't satisfied with a mere honky-tonk piano. He was a musician, and he made sure there was a five-piece band. Today we would call the area an entertainment district.
Alcohol has always been a big part of America. Millions of us drink no alcohol and do just fine without it. There are also millions of us for whom alcohol is a deadly disease, people who can be helped by effective treatment. Most of us are somewhere in a big middle. We drink alcohol and have some fun doing it; while we sometimes drink too much, we are not alcohol-dependent.
But there are challenges related to alcohol we must confront for Arkansas to become the healthy place we want it to be. First, 88,000 Americans die each year due to alcohol, deaths that would not have occurred but for the alcohol. Almost a third of deaths caused by motor vehicle accidents are related to alcohol. Separate from the number of deaths are the millions of Americans battling chronic disease and injuries caused by alcohol such as cancers, liver disease, heart disease, memory loss, and violence. The number of deaths is about twice as many as die from opioid overdoses.
Second, the data describing American drinking patterns is moving in the wrong direction. A 2017 study published by JAMA Psychiatry reported that, from 2002 to 2013, the number of Americans drinking increased substantially. More importantly, the amount of binge drinking increased, as did the amount of problem drinking.
"Binge drinking" is defined for men as drinking more than five drinks in a sitting, and more than four drinks for women. "Problem drinking" included alcohol intake that caused significant and recurrent problems, and alcohol intake that developed into dependency. According to the Centers for Disease Control and Prevention, one in six adults binge drinks at least four times a month. Risky behaviors and the risks of disease and death go up with an increased number of drinks. Surprisingly, the increases in alcohol intake were especially true for women, minorities, and older adults.
Third, the last few years have seen increased medical attention regarding what is a safe level of drinking. The United Kingdom lowered its recommended level of safe drinking comparable to no more than six beers or glasses of wine a week for men and women, a recommendation lower than most other countries. Two studies published this year in Lancet reinforced the view that previous recommended levels for safe drinking should be lower, and the most recent one concluded that there is no amount of drinking that is good for you, although the increased risk is small with just one drink per day.
We are all individuals, each with a distinct response to what we take in to our bodies, and because of those differences, such studies are complicated. But perhaps one way to look at it is this: if the current medical debate is about whether the recommended line for men should be drawn after one drink or two, and the current recommended line for women is one drink, do I really want to be having three, four or even more?
So what can you do? First, be aware of the health benefits of keeping alcohol intake under control: less calories, better sleep, less alcohol-induced stress and symptoms of depression, fewer hangovers, lower risk for certain chronic diseases, and safer driving.
Second, don't be afraid to discuss alcohol with your doctor. Third, consider going completely alcohol-free for a month or so. You will learn a bit about what life is like without any alcohol, and you may well find when you resume alcohol that your overall number of drinks is reduced. Fourth, some of your friends may welcome a social life with less alcohol. Offer non-alcohol drinks as part of your menu to your friends.
Fifth, look for ways to have the fun with not quite so much alcohol. You can alternate a soft drink with an alcohol drink. Some taverns have small glasses. Tell the bartender to go easy on the alcohol in your mixed drink. Sixth, accurately count your drinks. If your wine glass is never empty because it is being frequently refilled, your two glasses of wine may in fact have been three or four. Finally, be a good role model for the kids around you.
Alcohol is part of American culture, but what part it plays for each of us is up to us.
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Dr. Vic Snyder is the corporate medical director for external affairs at Arkansas Blue Cross Blue Shield.
Editorial on 10/22/2018