The A Word

By Tom Farley

In my years in public health, I can probably count on one hand the number of times someone has asked me about the health risks of alcohol. It’s a whopping problem for which we have a national blind spot.


Although alcohol is a potent liver toxin, it’s not just about your liver. Alcohol increases blood pressure, and through that, increases the risk of a stroke. It increases the risk of some cancers, including breast cancer. When pregnant women drink, it can permanently damage the brains of their infants (Fetal Alcohol Syndrome).

And alcohol is toxic to the brain in adults, too. Acutely, alcohol makes men more aggressive and everyone less inhibited and more clumsy – a potent combination that leads not just to car crashes but nearly every other kind of injury, from accidental drownings to suicides. Chronically, alcohol is a drug that - just like heroin and cocaine - can be addictive. In fact, for all of the havoc caused by heroin and cocaine, alcohol is by far the most common drug of addiction. (Look around at the chronically homeless people you see. Yes, many are using heroin, but many more are addicted to alcohol.) The CDC estimates that, all told, alcohol is responsible for just less than 90,000 deaths a year – small compared to tobacco but huge compared to, say, war.

Alcohol’s effect on behavior feeds many social problems, too. Heavy drinkers are more likely to have family problems and be unemployed. Alcohol is involved in much domestic abuse and child abuse, with life-long consequences to the children. Between violence and car crashes, there are many victims of alcohol that don’t drink.

The one health effect of alcohol that everyone seems to know is that it is good for your heart. Yes, if you drink one drink a day, it probably is. But if you drink five drinks in an evening, it’s definitely bad, not just for your heart but for the rest of you, too.

Nearly one in four people over the age of 12 goes over that limit in a typical month (called “binge drinkers”), and one in 15 (16.5 million people) goes over that limit five or more times a month (called “heavy drinkers”).

If the alcohol-caused wreckage is so pervasive, why the conspiracy of silence? Maybe because most of us drink. Or maybe because the alcohol industry markets so aggressively.

In 2013, the top seven alcohol companies spent some $4.6 billion on advertising, on television, the internet, billboards, and even buses and subways that take children to school. To lure young people, the companies spend heavily on sponsorship of sports teams. The companies give incentives to stores to sell their booze, put their logos on caps and T-shirts, and pay for product placement in movies. All of that makes us feel that drinking is natural, normal, an essential part of the good life – and therefore wrong to speak against.

We’ll never get rid of alcohol or eliminate the harms it causes, but there are many things we can do to limit the damage. To start, we can counter-advertise. That is, we can use the same media channels to warn people about the health risks of alcohol that the alcohol companies are now using to persuade people to drink more. It may nudge some binge drinkers to cut back, or some young people not to start binging in the first place. It may build support for policies that protect people from aggressive marketing. At the very least, it will break our national conspiracy of silence.