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Does moderate alcohol use reduce mortality risk? Rafa Elias/Getty Images
  • A new study contradicts previous findings that link moderate alcohol consumption to health benefits and a longer life.
  • The researchers found that those who abstain from alcohol may have a higher mortality rate because of risky behaviors in which they engaged earlier in life.
  • The study also shows that people who abstain from alcohol and who have no other risk factors, such as smoking or poor self-reported health, are not statistically more likely to die at an early age than those with low to moderate alcohol intake.

Some recent studies have linked moderate alcohol consumption to health benefits, such as lower risk of cardiovascular disease. Other studies tout potential health benefits of drinking wine and tequila.

However, results of a new study from the University of Greifswald in Germany contradict the idea of drinking alcohol to protect health.

Earlier studies have shown an increased mortality risk in people who abstain from alcohol, compared with individuals who consume low to moderate alcohol amounts. However, the authors of the recent study chalk this up to risky behaviors that people abstaining from alcohol engaged in earlier in their lives.

The study appears in the journal PLOS Medicine.

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), in 2019, 85.6% of individuals in the United States aged 18 years or older reported that they had consumed an alcoholic beverage at one time in their life.

The NIAAA also reports that 14.5 million people in the U.S. aged 12 years or older are living with alcohol use disorder (AUD). According to the NIAAA, AUD is “characterized by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences.”

The NIAAA also notes that about 95,000 people in the U.S. die each year from alcohol-related causes. This makes alcohol the third largest preventable cause of death in the country.

Previous research suggests that people drinking alcohol in moderation live longer than those who do not consume it. Another, older study concludes that men who drink moderate amounts of alcohol have a higher life expectancy than individuals who drink alcohol occasionally or heavily.

Prof. Dr. Ulrich John and his team believe their research shows that the lower life expectancy for those who do not drink alcohol compared with those who do can be due to other high risk factors.

This contradicts the idea that consuming low to moderate amounts of alcohol confers health benefits.

“It is a problem […] that medical students and patients are given the advice that it might [improve] health if they drink low to moderate amounts of alcohol,” Dr. John told Medical News Today.

“For many years, epidemiological data seemed to reveal that low to moderate alcohol consumers live longer than alcohol abstainers. This was the scientific base for the attitude in medical care that alcohol consumption might support health, in particular cardiovascular health.”

“In the last few years, more and more shortcomings of the former research became known,” Dr. John continued. “So, we tried to prove what kind of subgroups are among the abstainers, subgroups perhaps with risk factors that might explain the seemingly higher likelihood to die early compared with low to moderate drinkers.”

During the study, Dr. John and his team examined data from a random sample of 4,028 German adults who had taken part in previous interviews. The original interviews included questions from a standardized AUD identification test and took place between 1996 and 1997. At the time, the participants were between the ages of 18 and 64 years.

The interview included questions about alcohol use over the 12 months preceding the interview, followed by questions regarding any risky behaviors the participants may have engaged in earlier in their lives, such as:

  • former dependence on alcohol or drugs
  • risky alcohol drinking
  • daily smoking

The participants also ranked their overall health using categories ranging from poor to excellent.

The researchers found that 447 (11.1%) participants had not consumed any alcohol in the 12 months before the interviews in 1996–1997. Of those, 405 (90.6%) used to drink alcohol, and 322 (72.04%) had engaged in at least one of the listed risky behaviors.

Of the 322 with one or more risk factors, 114 (35.4%) had experienced AUD. Also, 161 (50%) did not have alcohol-related risk, but they smoked daily.

Additionally, Dr. John and his team obtained data on whether the participants had died 20 years after the original interviews.

When examining the mortality rates of the study participants, the researchers observed that 119 (26.6%) of the 447 people abstaining from alcohol had passed away 20 years after the initial interview. Also, 248 (11.26%) of the 2,203 participants who drank low to moderate amounts of alcohol in the 12 months before the interview had also passed away by the 20-year mark.

However, the scientists found that both those who never drank alcohol and those who abstained in the 12 months prior to the study and had no previous risk factors did not have a higher rate of death than those who drank low to moderate amounts of alcohol.

The research team also observed a direct correlation between smoking tobacco and additional alcohol-related risk. They conclude that smoking may encourage alcohol use.

Dr. John and his team conclude that their results show that people abstaining from alcohol will not usually have a higher mortality risk than those who consume low to moderate amounts.

Any perceived increase in mortality risk is likely to be due to lifestyle factors preceding abstinence or because of smoking tobacco.

“Our findings add one piece to the growing evidence that low to moderate alcohol drinking should not be recommended for health reasons,” Dr. John said.

MNT also spoke with NIAAA Director Dr. George Koob about the research and what implications it may have on further recommendations concerning drinking alcohol for health benefits.

“There is no reason to recommend drinking alcohol for health benefits,” he said. “To minimize the risks of harm, we recommend that adults who choose to drink stay within the guidelines for moderate consumption in the Dietary Guidelines for Americans, which recommend up to one drink per day for women or two for men.”

“Keep in mind there are still some health risks associated with drinking at moderate levels, including an increase in the risk of breast cancer beginning at one drink per day for women. Decisions about drinking alcohol should be made knowing the risks involved.”

– Dr. George Koob

Moreover, Dr. John told MNT that the research may shed light on how former alcohol use can still impact a person’s health, regardless of whether they abstain later in life:

“Our study is one of the very few that asked for details [about the] former life of the abstainers, details that may be known risk factors for early death. Our study is perhaps the only one so far that includes a standardized diagnosis of former alcohol or drug dependence, i.e., a severe health disorder that may explain short time to death.”

Dr. Koob agreed: “Yes, the findings support the fact that chronic excessive alcohol use can take a toll on the body. The good news is that an individual’s health and overall quality of life can be improved greatly with extended abstinence.”

What about the next steps for this research? “Research in the future should address the problem that low to moderate alcohol consumption may increase the likelihood of death,” Dr. John answered. “Even low amounts of alcohol might add to the likelihood of female breast cancer or hypertension, both very severe and prevalent health disorders in many general populations.”