Moderate Consumption of Alcohol

A while ago I had a Twitter exchange about this...  I don't know, blog post, article, column, whatever, by Stanton Peele.  I didn't handle it very gracefully at the time, but now I'll try to explain where I'm coming from.

My basic problem with the piece is that the writer is whistling past the graveyard in any number of ways.  To write so blithely about the benefits of alcohol reminds me of the classic What If? in which Randall Munroe walks through the many advantages of the sun going out, before finally noting the major downside:  "We would all freeze and die."

It's really the tone that gets me, the trolling, tendentious, college-debate-style dickishness.  Why doesn't our society do more to trumpet the health benefits of alcohol?  I don't know, Stanton Peele, it's a real fucking mystery!

Peele starts by recounting the death of Bob Welch, a teetotaler, at the age of 57.  Peele then suggests that the evidence is that the cause of Welch's premature death was his abstention from alcohol, and asks why we are so reluctant to draw this conclusion when the evidence is so strong.

Now look, I have no problem with publicizing the positive health effects of alcohol.  But there's something odd about Peele's piece.  Before we get there, though, let's pull a couple of passages from Wikipedia.  First, from the page on Jason Molina (citations and links removed):

On September 19, 2011, a message from the musician's family was posted on the Secretly Canadian Records website, titled "Where Is Jason Molina?", which said that over the past two years, Molina had visited rehab facilities and hospitals in England, Chicago, Indianapolis, and New Orleans for an unnamed condition. His family wrote that at the time, he was "currently working on a farm in West Virginia raising goats and chickens for the next year or so, and is looking forward to making great music again." The note also stated that the last several years had been "a very trying time for Jason, his friends, and his family. Although no one can be sure what the future holds, we feel very encouraged by the recent steps Jason has taken on the road towards becoming healthy and productive once again." The post ended by asking fans to donate to a PayPal account that would fund Molina's recuperation.

On May 5, 2012, a post titled "a note from jason" was posted on the Magnolia Electric Co. website, explaining certain aspects of his situation for the first time. Saying that it had been "a long hospital year", Molina expressed gratitude and appreciation for the monetary and emotional support he had received from fans and friends. He gave a brief update on his condition, saying, "Treatment is good, getting to deal with a lot of things that even the music didn't want to. I have not given up because you, my friends have not given up on me." The note concludes on an optimistic tone, saying that there were a few music projects on the "distant radar screen."

 . . . .

Molina died on March 16, 2013, in Indianapolis as a result of alcohol abuse-related organ failure. He was 39. Henry Owings, a friend of the musician, published an article on his online music magazine Chunklet that said Molina had struggled with alcoholism for most of the decade leading up to his death. Owings also wrote that Molina had "cashed out on Saturday night in Indianapolis with nothing but a cell phone in his pocket."

And from the page on Townes Van Zandt (again, I've removed citations and links - and note that this passage picks up after Van Zandt has injured himself falling down a flight of stairs):

Determined to finish the album that he had scheduled to record with Shelley and Two Dollar Guitar, Van Zandt arrived at the Memphis studio being pushed in a wheelchair by road manager Harold Eggers. Shelley canceled the sessions due to the songwriter's erratic behavior and drunkenness. Van Zandt finally agreed to hospitalization, but not before returning to Nashville. By the time he had consented to receive medical care, eight days passed since the injury. On December 31, X-rays revealed that Van Zandt had an impacted left femoral neck fracture in his hip, and several corrective surgeries were performed. Jeanene informed the surgeon that one of Townes' previous rehab doctors had told her detoxing could kill him. The medical staff tried to explain to her that detoxing a "late-term alcoholic" at home would be ill-advised, but he would have a better chance at recovering under hospital supervision. She did not heed these warnings, and instead checked Townes out of the hospital against medical advice. Understanding that he would most likely drink immediately after leaving the hospital, the physicians refused to prescribe him any painkillers.

By the time Van Zandt was checked out of the hospital early the next morning, he had begun to show signs of DTs. Jeanene rushed him to her car, where she gave him a flask of vodka to ward off the withdrawal delirium. She would later report that after getting back to his home in Smyrna, Tennessee, and giving him alcohol, he was "lucid, in a real good mood, calling his friends on the phone." Jim Calvin shared a marijuana joint with him, and he was also given about four Tylenol PM tablets.

While Jeanene was on the phone with Susanna Clark, their son Will noticed that Townes had stopped breathing and "looked dead." He alerted his mother, who attempted to perform CPR, "screaming his name between breaths."

Now I want to be clear, Peele didn't suggest that alcohol is always and everywhere a healthy thing to consume.  For instance, women with the BRCA 1 or 2 mutations (which are related to breast cancer), or who are otherwise at heightened risk for breast cancer, might reasonably abstain from alcohol.  Also, "Frequent, heavy binge drinking is unhealthy. But then you knew that already, didn't you? If you don't distinguish binge drinking from daily moderate drinking, that would be due to America's addiction-phobia, which causes them to interpret any daily drinking as addictive."

Maybe.  Maybe "addition-phobia" is the reason for our failure to distinguish between moderate drinking and binge drinking.  But I can't help pointing out that it is precisely the inability of many people to do one without the other that causes alcohol to be such a destructive force in their lives.

I understand that Peele is a polemicist, and as such doesn't have to concern himself with questions like, "On net, does alcohol consumption in the United States contribute to or detract from public health?"  Or:  "What is the actual stopping place for people who drink more than the ideal amount?"  In this connection, note that alcohol consumption forms a hockey-stick pattern, with the top decile consuming on average 73.85 drinks per week, vastly more than the other 90% combined.  The idea that public policy might be oriented toward keeping people out of that decile, rather than pushing them up to the eighth decile (6.25 drinks per week on average), apparently hasn't occurred to Peele.

Again, I don't have a problem with what you might say are his "literal" claims.  People absolutely should consider drinking in moderation if they can handle it, and should take into account genetic factors like BRCA 1 and 2 (and the genes related to "Asian flush," which Peele doesn't mention).  But this suggestion that alcohol consumption is a "health behavior," that when teetotalers die young we should call them out for their bad health decisions, that it makes sense to discuss the pros and cons of alcohol while barely mentioning alcoholism...  this is repugnant to me.  Probably the most telling thing about the piece is something that Peele mentions but doesn't dwell on, which is that Bob Welch, the teetotaler who died at the age of 57 (5 years older than Townes Van Zandt and 18 years older than Jason Molina), abstained from alcohol because he felt that he had a "disease."  So in other words, Welch diagnosed himself with alcoholism and successfully quit drinking, a path that neither Molina nor Van Zandt was able to follow.  And this—Welch's sobriety!—is the behavior that Peele thinks should be labeled "unhealthy."  This is what Peele chose to use as a cautionary tale.  Presumably if Molina and Van Zandt had gotten sober, Peele would have used them as cautionary tales, too.

Fuck Stanton Peele.