I was about 4 years old when my Polish grandfather gave me a glass of whiskey. He drank whiskey throughout the day everyday and seemed content with that liquid diet. He urged me to drink from the glass, although I do not recall how he managed that, given that he spoke a language with which I was and always would be unfamiliar. I took a small sip and choked. There was nothing resembling a flavor: it was unadulterated fire. He seemed amused. I was not. We remained on good terms despite this misadventure until he died at 97 years of age, but I never again joined him in drink.
Despite this unsavory experience, I tried to develop a tolerance for alcoholic beverages. I failed. Even when medical journals insisted that a little wine everyday improved longevity, I was unable to test this hypothesis on myself. The smell of liquor nauseated me. One sip of wine, and I was stuporous. Rather than explaining my refusal to drink alcoholic beverages in social settings, I would dismiss the offer of a drink on religious grounds. Most people will not explore the religious bases for behavior. This was evident during the Covid epidemic when millions of people suddenly discovered they could be exempt from vaccination by simply claiming a faith that demanded their god and not science decided if they and the relatives exposed to them should struggle to breathe.
During my medical training, I learned that alcohol might not be the elixir of relaxation and pleasure depicted in advertising. Wear and tear caused by alcohol was most evident in people who drank to excess or who were in a real sense addicted to alcohol, a condition usually referred to as chronic alcoholism. In fact, many people develop chronic alcoholism at a surprisingly early age. In Boston, most of the serious drinkers I spoke to claimed they got hooked on alcohol by the time they were 14 years old. Apparently, my grandfather was not the first adult to urge a child to take up “schnapps.”
We worry that our children will die from a fentanyl or heroin overdose or get addicted to oxycodone, but we have become so desensitized to the damage done by alcohol that we routinely dismiss it as not worth worrying about. In fact, the complications of chronic alcoholism are so numerous and varied that even many physicians do not recognize treatable complications of alcohol abuse when they see them. There are the somewhat disabling but relatively benign problems, such as Dupuytren’s contracture of the hands. This has recently had considerable exposure in commercials that offer nonsurgical remedies for this palm deformity that can interfere with full extension of the fingers. At the other end of the spectrum is a frequently lethal condition called Wernicke’s encephalopathy.
Wernicke’s encephalopathy is a disorder of the brain that develops with chronic alcohol abuse and a poor diet. It involves an insufficient supply in the brain of the vitamin thiamine. Thiamine is vital in sugar metabolism. If an individual with a poor diet and chronic alcoholism is exposed to a sudden increase in the sugar in their blood, such as from an intravenous fluid with sugar, deep brain structures may die as thiamine is diverted away from them. Early signs of this condition include disturbed thinking, disturbed or absent eye movements, and the abrupt onset of gait problems. If thiamine is given at the outset, the patient will live. If it is delayed, the patient will die. What usually determines the outcome is the doctor’s familiarity with the condition.
There are numerous other consequences of chronic alcoholism, ranging from liver damage to delirium tremens [DTs]. Motor vehicles accidents must also be included in the side effects of alcohol abuse. The recent adoption of fobs as part of the ignition system for cars has inadvertently increased the ability of an intoxicated individual to start a car without assistance. Being too uncoordinated to place a key in the starter system provided little deterrence to drunk driving, but it may have prevented a few accidents. Why starter systems do not require the input of a simple code, such as that needed to access bank or credit card information, is a mystery. If the driver cannot enter an 8 character code, regardless of the reason, he or she should not be driving.
In 1920 the problems with alcoholic beverages led to Prohibition. This was as monumental a failure as the current War on Drugs. As with our national assault on drug trafficking, the Volstead Act made wealthy criminals more wealthy and took the carnage associated with turf wars to a new level of barbarism. The business of delivering alcohol to eager consumers in the 1920s and early 1930s became much more profitable when it was designated a crime. We know the prohibition of alcohol sales wreaked havoc across America. Despite this experience, we have adopted the same strategy to deal with our drug epidemic. But, I digress.
What can we do about our problem with alcohol use and abuse? Aside from making dangerous devices, like automobiles, less user friendly for the intoxicated, we could pursue the ban on advertising that helped reduce the level of cigarette smoking over the past several decades. In 1954, 45% of adults in the U.S. smoked cigarettes. After decades educating Americans to the dangers of cigarette smoking and campaigns to counter the glorification of cigarette smoking by the tobacco industry, cigarette smoking amongst adult Americans dropped to 15% in 2015.
Perhaps portraying people partying with the help of intoxicants is not educational. Perhaps identifying a grateful son as the one who brings his mother an expensive scotch whiskey is misleading. Widespread and redundant advertising has romanticized alcohol consumption, just as cigarette ads glorified smoking as sophisticated, relaxing, or bold (remember the Marlboro man). The obvious question is not what will be lost without billions of dollars spent promoting a health hazard but rather what is the redeeming value of this advertising? What is the cost to society for the ever more glamorous depictions of people consuming whiskey, wine and other alcoholic beverages? Banning alcohol sales during Prohibition had virtually no impact on the rates of liver failure, visual loss, ulcers, bleeding disorders, alcohol-related motor vehicle and industrial accidents, and other such consequences of alcohol abuse. We know not to waste time and money on such pointless exercises as interdiction. What proved useful in reducing tobacco consumption is easily applied to the allure of alcohol consumption. Rather than ads with a grateful mother toasting her son with a glass of whiskey, we might benefit more from her pouring the bottle down the drain.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.
