Alcohol is the most popular psychoactive substance in the world, and this has been true for millennia. It is also one of the most damaging and dangerous substances known to humans,  second only to the harmful effects inflicted on the human body by tobacco smoking.  At the same time,  the judicious and moderate use of alcohol has been widely reported as clearly effective at preventing or delaying aging, heart disease, and stroke and other cardiovascular manifestations of disease. 

Drinking red wine has been correlated with all sorts of health benefits, such that the likely “French-effect” chemicals, resveratrol and resveratrol-related pharmaceuticals,  are likely to be evaluated in clinical trials soon.  It is now clear that in males,  alcohol has significant positive effects,  and in women the beneficial effects of alcohol are tempered by the increased risk for breast cancer.  Alcohol also reduces social inhibitions and anxiety and produces an overall feeling of well-being. It is an important element in social, political, and religious rituals, at which, without it, most participants would find the ceremony essentially meaningless.  For example, what is a Catholic mass without wine? Yet the use of alcohol is proscribed by many prominent faiths, most notably Islam,  arguably the fastest-growing religion in the world.

Alcohol is a legal substance,  and one that is easily obtained, often even by those who are lawfully forbidden from its use,  such as individuals in the United States who are younger than the age of 21. It is this group, the underage population,  which concerns many experts,  particularly high school or college students who drink. Developmentally,  the teenage brain is not ready for alcohol,  and binge-drinking episodes appear to sow the seeds for later alcohol abuse and early alcoholism.

Teen and college drinking is a major problem. Young adults who drink risk accidents, injury,  and death and also many dire consequences, including contracting sexually transmitted diseases,  initiating unplanned pregnancies, and suffering from violence engendered by inhibitions that are markedly decreased by alcohol. In the worst case, young people who binge drink die of alcohol poisoning or they drive drunk and kill or harm others.

There are some who support the lowering of the drinking age to 18 years,  arguing that an 18-year-old can vote and go to war,  and,  thus, it is only fair that an 18-year-old should be able to consume alcohol too.  However,  the minimum drinking age restriction has saved thousands of lives since its inception,  and rescinding it would not be consistent with Hippocrates’ admonition to “First, do no harm.”

Of course,  the limitation of 21 years does not prevent all young people from drinking, but deaths due to drinking and driving have decreased so much over the past decade that in many states, drugged driving exceeds or contributes to the majority of arrests for driving under the influence.

The law helps by serving as a mental barrier for many people,  just as many (but not all)  adults refrained from drinking during Prohibition in the 1920s because alcohol was illegal.  This reduced drinking from the very high level that preceded that period.

A major problem with alcohol arises when people become addicted to (or “dependent on”) this substance;  at that point,  the problem of alcoholism is extremely difficult to treat.  Prior to the onset of alcoholism,  however,  when the individual has begun abusing alcohol but has not yet become addicted, an early drinking problem is often treatable with what is referred to as a brief intervention with a trusted physician.

Many studies have confirmed this fact, yet some physicians are uncomfortable talking freely about alcohol and drugs with their patients.  In general,  physicians are used to the doctor-patient relationship being very truthful. So it is not a surprise that they are uncomfortable asking questions that provoke defensive responses and to which many patients routinely lie or deny or minimize. Yet, asking their patients about their use of alcohol,  providing an office-based brief intervention,  or even challenging unhealthy use when it is identified can help patients reduce their abuse or dependence.