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2024

We need to talk about alcohol

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It’s curious to me that of all the substances we have imbibed through our history as humans, the one that we have branded, celebrated and made available to all is alcohol. 

Its use and misuse is at the root of so much insomnia, depression, anxiety, fatty liver, abuse, self-harm, harm to others and disease. And yet — in a very clever PR campaign — we have glamourised this drinking ritual in the same way that Peter Stuyvesant made cigarettes and yachts sexy and demure. 

Did you know that the effects of alcohol are due to a toxin — a metabolic by-product that impairs brain function temporarily and hijacks your liver’s detoxification system? 

Several studies appraising the potential harm that can come from prescribed and illicit substances cite alcohol as number one or in the top five. One study, published in Frontiers in Psychiatry, listed alcohol just after crack, methamphetamines and heroin. 

You could argue that this is because it’s the most consumed drug in the world but the truth is that you never hear of anyone high on psilocybin or MDMA beating their wife. 

And the harder drugs that wreak havoc on the nervous system often require alcohol to tame their effects — crack and methamphetamines often go hand in hand with a drink! 

Only fine wines don’t play nicely with other inebriating friends. 

In 1918, the US placed a temporary prohibition on alcohol to protect grain for the war effort and reduce the obvious consequences that excess drinking can have on a society. 

Not long after, in 1933, this was lifted and what was born during this brief time of restriction was a gangster underworld that fed the belly of the thirsty masses. Perhaps the roots of excess were sown in that time. 

We all know that humans love to have what they are told they shouldn’t want. As far back as 1784, American civic leader Benjamin Rush called excessive alcohol consumption a disease that harmed the psyche and the body equally. 

In the 1920s, doctors and pharmacists were able to prescribe and dispense scripts for alcohol for medicinal purposes. This is a resonance of the opiate crisis we are facing today. 

In her paper The Lucrative Business of Prescribing Booze During Prohibition, Paula Mejia tells of prescribers who wrote in excess of 500 whisky prescriptions a day. 

This practice catapulted Walgreens, a popular American pharmacy chain, from 20 to 525 stores in that time.

What is now a $1.3 trillion a year global business is the leading cause of death in people aged 15 to 45 in the US. Alcohol results in 3.3 million deaths a year worldwide. 

It might seem obvious to change the way we imbibe and sell such a substance but economics are at the heart of a capitalist system. When will we see public health education about over-consumption?

One of the characteristics of modern Western life is the separation of people. It’s unusual these days for four generations to squabble and commune under one roof in the higher-LSM demographic. A desirable pursuit today is your own shiny perimeter — a white picket fence. 

I wonder if the intimacy lost here has anything to do with the need people have these days for social lubricants such as alcohol. I wholeheartedly believe that a lack of purpose and meaningful connection drives such pandemics. 

Social rituals such as tribal dance, connection to nature, choral song and ululation have been largely replaced by boozy lunches and dingy bars and shebeens.

Our bodies are so magnificent. We hold so much wisdom and information within, both historical and present. Imprints of past experiences and even intergenerational ones are embossed into our cells. 

What of the built-in intelligence of ecstatic dance and breath? Dr Stanislav Grof, a Czechoslovakian psychiatrist, with his wife Christina, described the use of breath to attain altered states of consciousness without poisons. 

After his exposure to the healing potential of LSD, he and Christina pioneered a technique used all over the world today called holotropic breathwork. It sounds like a left-of-field suggestion but could we be teaching this in high schools as a tool for connection to self and other?

More than 1 000 South Africans die in car crashes every month and more than half of these are thought to involve alcohol. Driving under the influence is a cultural norm here that needs to change. 

I’m not suggesting that it’s all bad — many of the blue zones in the world have a daily ritual that involves alcohol. What differentiates that ritual is the context, the extent, the set and the setting.

How can we change the dialogue we have around alcohol, sugar and not moving our bodies? What we’re seeing more and more are symptoms of a culture that cultivates overactive minds and lazy bodies. 

Humans have been looking for rests from reality for as long as there is evidence of us on this beautiful planet. And that’s okay — everyone deserves a respite from the sometimes gruelling reality of the human experience.

I’d like to argue, though, that we are getting our dopamine in all the wrong places — and that we can, collectively, rewrite the pleasure-seeking habits of humans by refocusing our attention on connection, using our bodies, as they were designed, for pleasurable (safe, consensual and sacred) intimacy, endurance and movement. 

Dr Skye Scott is a family GP, podcaster and co-owner of Health with Heart which offers holistic wellness to large corporations. Follow @drskyescott and @health_w_heart on Instagram, or visit www.healthwithheart.co.za. Health with Heart with Dr Skye podcast can be found on Spotify or Apple.