America Has a Drinking Problem

A little alcohol can boost creativity and strengthen social ties. But there’s nothing moderate, or convivial, about the way many Americans drink today.

Few things are more American than drinking heavily. But worrying about how heavily other Americans are drinking is one of them.

Few things are more American than drinking heavily. But worrying about how heavily other Americans are drinking is one of them.

The Mayflower landed at Plymouth Rock because, the crew feared, the Pilgrims were going through the beer too quickly. The ship had been headed for the mouth of the Hudson River, until its sailors (who, like most Europeans of that time, preferred beer to water) panicked at the possibility of running out before they got home, and threatened mutiny. And so the Pilgrims were kicked ashore, short of their intended destination and beerless. William Bradford complained bitterly about the latter in his diary that winter, which is really saying something when you consider what trouble the group was in. (Barely half would survive until spring.) Before long, they were not only making their own beer but also importing wine and liquor. Still, within a couple of generations, Puritans like Cotton Mather were warning that a “flood of RUM” could “overwhelm all good Order among us.”

George Washington first won elected office, in 1758, by getting voters soused. (He is said to have given them 144 gallons of alcohol, enough to win him 307 votes and a seat in Virginia’s House of Burgesses.) During the Revolutionary War, he used the same tactic to keep troops happy, and he later became one of the country’s leading whiskey distillers. But he nonetheless took to moralizing when it came to other people’s drinking, which in 1789 he called “the ruin of half the workmen in this Country.

Hypocritical though he was, Washington had a point. The new country was on a bender, and its drinking would only increase in the years that followed. By 1830, the average American adult was consuming about three times the amount we drink today. An obsession with alcohol’s harms understandably followed, starting the country on the long road to Prohibition.

What’s distinctly American about this story is not alcohol’s prominent place in our history (that’s true of many societies), but the zeal with which we’ve swung between extremes. Americans tend to drink in more dysfunctional ways than people in other societies, only to become judgmental about nearly any drinking at all. Again and again, an era of overindulgence begets an era of renunciation: Binge, abstain. Binge, abstain.

Right now we are lurching into another of our periodic crises over drinking, and both tendencies are on display at once. Since the turn of the millennium, alcohol consumption has risen steadily, in a reversal of its long decline throughout the 1980s and ’90s. Before the pandemic, some aspects of this shift seemed sort of fun, as long as you didn’t think about them too hard. In the 20th century, you might have been able to buy wine at the supermarket, but you couldn’t drink it in the supermarket. Now some grocery stores have wine bars, beer on tap, signs inviting you to “shop ’n’ sip,” and carts with cup holders.

Actual bars have decreased in number, but drinking is acceptable in all sorts of other places it didn’t used to be: Salons and boutiques dole out cheap cava in plastic cups. Movie theaters serve alcohol, Starbucks serves alcohol, zoos serve alcohol. Moms carry coffee mugs that say things like this might be wine, though for discreet day-drinking, the better move may be one of the new hard seltzers, a watered-down malt liquor dressed up—for precisely this purpose—as a natural soda.

Even before COVID-19 arrived on our shores, the consequences of all this were catching up with us. From 1999 to 2017, the number of alcohol-related deaths in the U.S. doubled, to more than 70,000 a year—making alcohol one of the leading drivers of the decline in American life expectancy. These numbers are likely to get worse: During the pandemic, frequency of drinking rose, as did sales of hard liquor. By this February, nearly a quarter of Americans said they’d drunk more over the past year as a means of coping with stress.

Explaining these trends is hard; they defy so many recent expectations. Not long ago, Millennials were touted as the driest generation—they didn’t drink much as teenagers, they were “sober curious,” they were so admirably focused on being well—and yet here they are day-drinking White Claw and dying of cirrhosis at record rates. Nor does any of this appear to be an inevitable response to 21st-century life: Other countries with deeply entrenched drinking problems, among them Britain and Russia, have seen alcohol use drop in recent years.

Media coverage, meanwhile, has swung from cheerfully overselling the (now disputed) health benefits of wine to screeching that no amount of alcohol is safe, ever; it might give you cancer and it will certainly make you die before your time. But even those who are listening appear to be responding in erratic and contradictory ways. Some of my own friends—mostly 30- or 40-something women, a group with a particularly sharp uptick in drinking—regularly declare that they’re taking an extended break from drinking, only to fall off the wagon immediately. One went from extolling the benefits of Dry January in one breath to telling me a funny story about hangover-cure IV bags in the next. A number of us share the same (wonderful) doctor, and after our annual physicals, we compare notes about the ever nudgier questions she asks about alcohol. “Maybe save wine for the weekend?” she suggests with a cheer so forced she might as well be saying, “Maybe you don’t need to drive nails into your skull every day?”

What most of us want to know, coming out of the pandemic, is this: Am I drinking too much? And: How much are other people drinking? And: Is alcohol actually that bad?

The answer to all these questions turns, to a surprising extent, not only on how much you drink, but on how and where and with whom you do it. But before we get to that, we need to consider a more basic question, one we rarely stop to ask: Why do we drink in the first place? By we, I mean Americans in 2021, but I also mean human beings for the past several millennia.

Let’s get this out of the way: Part of the answer is “Because it is fun.” Drinking releases endorphins, the natural opiates that are also triggered by, among other things, eating and sex. Another part of the answer is “Because we can.” Natural selection has endowed humans with the ability to drink most other mammals under the table. Many species have enzymes that break alcohol down and allow the body to excrete it, avoiding death by poisoning. But about 10 million years ago, a genetic mutation left our ancestors with a souped-up enzyme that increased alcohol metabolism 40-fold.

This mutation occurred around the time that a major climate disruption transformed the landscape of eastern Africa, eventually leading to widespread extinction. In the intervening scramble for food, the leading theory goes, our predecessors resorted to eating fermented fruit off the rain-forest floor. Those animals that liked the smell and taste of alcohol, and were good at metabolizing it, were rewarded with calories. In the evolutionary hunger games, the drunk apes beat the sober ones.

But even presuming that this story of natural selection is right, it doesn’t explain why, 10 million years later, I like wine so much. “It should puzzle us more than it does,” Edward Slingerland writes in his wide-ranging and provocative new book, Drunk: How We Sipped, Danced, and Stumbled Our Way to Civilization, “that one of the greatest foci of human ingenuity and concentrated effort over the past millennia has been the problem of how to get drunk.” The damage done by alcohol is profound: impaired cognition and motor skills, belligerence, injury, and vulnerability to all sorts of predation in the short run; damaged livers and brains, dysfunction, addiction, and early death as years of heavy drinking pile up. As the importance of alcohol as a caloric stopgap diminished, why didn’t evolution eventually lead us away from drinking—say, by favoring genotypes associated with hating alcohol’s taste? That it didn’t suggests that alcohol’s harms were, over the long haul, outweighed by some serious advantages.

Versions of this idea have recently bubbled up at academic conferences and in scholarly journals and anthologies (largely to the credit of the British anthropologist Robin Dunbar). Drunk helpfully synthesizes the literature, then underlines its most radical implication: Humans aren’t merely built to get buzzed—getting buzzed helped humans build civilization. Slingerland is not unmindful of alcohol’s dark side, and his exploration of when and why its harms outweigh its benefits will unsettle some American drinkers. Still, he describes the book as “a holistic defense of alcohol.” And he announces, early on, that “it might actually be good for us to tie one on now and then.”

Slingerland is a professor at the University of British Columbia who, for most of his career, has specialized in ancient Chinese religion and philosophy. In a conversation this spring, I remarked that it seemed odd that he had just devoted several years of his life to a subject so far outside his wheelhouse. He replied that alcohol isn’t quite the departure from his specialty that it might seem; as he has recently come to see things, intoxication and religion are parallel puzzles, interesting for very similar reasons. As far back as his graduate work at Stanford in the 1990s, he’d found it bizarre that across all cultures and time periods, humans went to such extraordinary (and frequently painful and expensive) lengths to please invisible beings.

In 2012, Slingerland and several scholars in other fields won a big grant to study religion from an evolutionary perspective. In the years since, they have argued that religion helped humans cooperate on a much larger scale than they had as hunter-gatherers. Belief in moralistic, punitive gods, for example, might have discouraged behaviors (stealing, say, or murder) that make it hard to peacefully coexist. In turn, groups with such beliefs would have had greater solidarity, allowing them to outcompete or absorb other groups.

Around the same time, Slingerland published a social-science-heavy self-help book called Trying Not to Try. In it, he argued that the ancient Taoist concept of wu-wei (akin to what we now call “flow”) could help with both the demands of modern life and the more eternal challenge of dealing with other people. Intoxicants, he pointed out in passing, offer a chemical shortcut to wu-wei—by suppressing our conscious mind, they can unleash creativity and also make us more sociable.

At a talk he later gave on wu-wei at Google, Slingerland made much the same point about intoxication. During the Q&A, someone in the audience told him about the Ballmer Peak—the notion, named after the former Microsoft CEO Steve Ballmer, that alcohol can affect programming ability. Drink a certain amount, and it gets better. Drink too much, and it goes to hell. Some programmers have been rumored to hook themselves up to alcohol-filled IV drips in hopes of hovering at the curve’s apex for an extended time.

His hosts later took him over to the “whiskey room,” a lounge with a foosball table and what Slingerland described to me as “a blow-your-mind collection of single-malt Scotches.” The lounge was there, they said, to provide liquid inspiration to coders who had hit a creative wall. Engineers could pour themselves a Scotch, sink into a beanbag chair, and chat with whoever else happened to be around. They said doing so helped them to get mentally unstuck, to collaborate, to notice new connections. At that moment, something clicked for Slingerland too: “I started to think, Alcohol is really this very useful cultural tool.” Both its social lubrications and its creativity-enhancing aspects might play real roles in human society, he mused, and might possibly have been involved in its formation.

He belatedly realized how much the arrival of a pub a few years earlier on the UBC campus had transformed his professional life. “We started meeting there on Fridays, on our way home,” he told me. “Psychologists, economists, archaeologists—we had nothing in common—shooting the shit over some beers.” The drinks provided just enough disinhibition to get conversation flowing. A fascinating set of exchanges about religion unfolded. Without them, Slingerland doubts that he would have begun exploring religion’s evolutionary functions, much less have written Drunk.

Which came first, the bread or the beer? For a long time, most archaeologists assumed that hunger for bread was the thing that got people to settle down and cooperate and have themselves an agricultural revolution. In this version of events, the discovery of brewing came later—an unexpected bonus. But lately, more scholars have started to take seriously the possibility that beer brought us together. (Though beer may not be quite the word. Prehistoric alcohol would have been more like a fermented soup of whatever was growing nearby.)

For the past 25 years, archaeologists have been working to uncover the ruins of Göbekli Tepe, a temple in eastern Turkey. It dates to about 10,000 B.C.—making it about twice as old as Stonehenge. It is made of enormous slabs of rock that would have required hundreds of people to haul from a nearby quarry. As far as archaeologists can tell, no one lived there. No one farmed there. What people did there was party. “The remains of what appear to be brewing vats, combined with images of festivals and dancing, suggest that people were gathering in groups, fermenting grain or grapes,” Slingerland writes, “and then getting truly hammered.”

Over the decades, scientists have proposed many theories as to why we still drink alcohol, despite its harms and despite millions of years having passed since our ancestors’ drunken scavenging. Some suggest that it must have had some interim purpose it’s since outlived. (For example, maybe it was safer to drink than untreated water—fermentation kills pathogens.) Slingerland questions most of these explanations. Boiling water is simpler than making beer, for instance.

Göbekli Tepe—and other archaeological finds indicating very early alcohol use—gets us closer to a satisfying explanation. The site’s architecture lets us visualize, vividly, the magnetic role that alcohol might have played for prehistoric peoples. As Slingerland imagines it, the promise of food and drink would have lured hunter-gatherers from all directions, in numbers great enough to move gigantic pillars. Once built, both the temple and the revels it was home to would have lent organizers authority, and participants a sense of community. “Periodic alcohol-fueled feasts,” he writes, “served as a kind of ‘glue’ holding together the culture that created Göbekli Tepe.”
Things were likely more complicated than that. Coercion, not just inebriated cooperation, probably played a part in the construction of early architectural sites, and in the maintenance of order in early societies. Still, cohesion would have been essential, and this is the core of Slingerland’s argument: Bonding is necessary to human society, and alcohol has been an essential means of our bonding. Compare us with our competitive, fractious chimpanzee cousins. Placing hundreds of unrelated chimps in close quarters for several hours would result in “blood and dismembered body parts,” Slingerland notes—not a party with dancing, and definitely not collaborative stone-lugging. Human civilization requires “individual and collective creativity, intensive cooperation, a tolerance for strangers and crowds, and a degree of openness and trust that is entirely unmatched among our closest primate relatives.” It requires us not only to put up with one another, but to become allies and friends.

As to how alcohol assists with that process, Slingerland focuses mostly on its suppression of prefrontal-cortex activity, and how resulting disinhibition may allow us to reach a more playful, trusting, childlike state. Other important social benefits may derive from endorphins, which have a key role in social bonding. Like many things that bring humans together—laughter, dancing, singing, storytelling, sex, religious rituals—drinking triggers their release. Slingerland observes a virtuous circle here: Alcohol doesn’t merely unleash a flood of endorphins that promote bonding; by reducing our inhibitions, it nudges us to do other things that trigger endorphins and bonding.

Over time, groups that drank together would have cohered and flourished, dominating smaller groups—much like the ones that prayed together. Moments of slightly buzzed creativity and subsequent innovation might have given them further advantage still. In the end, the theory goes, the drunk tribes beat the sober ones.

But this rosy story about how alcohol made more friendships and advanced civilization comes with two enormous asterisks: All of that was before the advent of liquor, and before humans started regularly drinking alone.

This article appeared at TheAtlantic.com here .. 

https://theconversation.com/alcohol-addiction-could-the-brains-immune-system-be-the-key-to-understanding-and-treating-alcoholism

Alcohol abuse is a serious problem worldwide. In England alone, over 350,000 alcohol-related hospital admissions – and over 5,000 alcohol-related deaths – were reported in 2018. Long-term alcohol abuse can have many harmful effects on our body. But one of the organs most affected by alcohol is the brain. Even moderate consumption changes brain structure and leads to cognitive issues, such as declines in memory and problem-solving.

Alcohol use is habit forming and can eventually lead to alcoholism. And though there are many treatments available for alcoholism, research shows these interventions often fail – with less than 20% of patients remaining alcohol free after intervention. Like every addiction, alcoholism is a disease and not a choice, so finding the root cause of it will make treatment easier.

Although genetics and the environment you live in are known to play a role in developing alcoholism, these factors don’t tell us how dependence occurs.

However, past research has found hints that the brain’s immune system cells (known as microglia) may be involved in addiction, including to cocaine and tobacco). One study even found that alcohol exposure and withdrawal in rats increased microglia numbers in the brain, before any other signs of alcohol-induced decline.

Another two recent studies have investigated brain changes seen in people and animals with alcohol dependence. Each of these studies found a common culprit: inflamed microglia.

Microglia are the brain’s resident immune system cells. Their main role is to guard and maintain balance in the brain. When microglia detect a threat, they respond by becoming inflamed and attacking. Normally, they return to normal after the threat is gone, but sometimes when inflammation becomes uncontrollable – such as with Alzeimer’s disease – it can lead to brain degeneration.

Microglia and addiction

One recent study used mice to study the effect of alcohol dependence on the brain.

In the brains of male mice that had alcohol dependency, research found there were more microglia cells in the medial prefrontal cortex, a region associated with pain, decision making, and memory processes. Similar results have also previously been found in humans.

They then examined what effects microglia depletion had on alcohol dependent mice by looking at their alcohol seeking behaviour, and anxious behaviour during alcohol withdrawal. The researchers found both factors were lowered when the microglia cells were reduced in the brain.

They also saw gene changes with microglia depletion. Genes involved in inflammation and immune responses were expressed less after depletion. The expression of genes involved in alcohol consumption, and alcohol dependence also changed when microglia had decreased. They also found that microglia depletion weakens brain circuits involved in the development of dependence and relapse behaviour in rodents.

second study looking at both rodent and human brains also showed microglia is involved in alcohol dependence.

The researchers of this study used brain imaging, microglia depletion, and studies of post mortem brains, to examine changes that occur in alcohol dependence. For the brain imaging part, they used a variation of MRI scans, called DTI-MRI in humans and rats, focusing on a measure called mean diffusivity.

A microglia cell.
Microglia are involved in alcohol dependence. Juan Gaertner/ Shutterstock

As DTI-MRI is based on the diffusion of water in tissues, mean diffusivity essentially shows the amount of diffusion of water molecules in tissues, with more dense and structurally-intact tissues having lower mean diffusivity. Mean diffusivity has previously been shown to change in the brain in inflammatory and degenerative conditions (including Alzheimer’s Disease and even psychosis). The researchers therefore chose to look at mean diffusivity as neuroinflammation is also involved in alcoholism. The researchers wanted to examine whether changes in mean diffusivity would be found between alcoholics and non-alcoholics, which hasn’t been done before.

Indeed their findings showed that mean diffusivity is overall higher in the brain of alcohol dependent rats and humans. They also found additional changes in how certain neurotransmitters – including dopamine, which is involved in alcohol dependence – move and are distributed in the brain.

The researchers went on to examine the microglia in the brains of rats with alcohol dependence, and rats with previous dependence who had abstained from alcohol for a week. They found a decreased amount of microglia in specific brain regions of dependent rats (including the hippocampus, which is involved in memory, and the nucleus accumbens, which is involved in the reward system). The microglia in the brains of alcohol dependent rats were also in their inflamed form.

Although this study showed a decrease in microglia numbers – whereas the previous study saw an increase – this might be because the researchers looked at different brain regions and used different research methods and animal models. However, both studies give hints towards how microglia functions during alcohol consumption and dependence, may differ in different brain regions.

The researchers also found that depleting microglia from the brain, or inducing microglia’s inflammatory response, led to similar results to each other, as both increased the mean diffusivity. Changes in microglia’s form when inflamed were also similar to the ones they observed in dependent rats. They concluded that the changes in the brain areas they studied could be explained by an inflammatory reaction of microglia caused by alcohol.

One limitation of both studies’ findings is that they used both only male rodents and male humans. However, both studies exhibit how alcoholism is a complex disease that produces clear changes in the brain.

Examining how exactly microglia is involved, and being able to interfere with their responses, could lead to better understanding and detection of addiction to alcohol, and give a good stepping stone for future targeted interventions.

Originally posted at TheConversation.com