Thursday, July 04, 2013

Drink

School's out, or something, but everyone has thoughts on drinking these days.

-Rita defends Cristina Nehring's "defense of drunks," which is also kind of a defense of social drinking, which I wasn't aware needed defending (maybe in Utah, but elsewhere?). I see where Rita's going with this, but I'm not sure it makes sense to place smoking (tobacco) and drinking in the same category. Is anyone really making the argument that we-as-a-society would be better off without alcohol? I mean, and being taken seriously while doing so? Or claiming that someone who enjoys wine with dinner should really switch to taking a psychotropic drug with who knows how many side effects, ones that for all we know include making it so that children you may have ten years down the line will emerge not as children but as miniature llamas?

That, and these drugs exist not only to turn Darias into Quinns, Constanzas into Seinfelds. They also address severe mental illness, in a way that, it would seem, the forms of self-medication that look chic in an old movie or a Sartorialist post do not. Any denunciation of "pills" must contend with the evidence that these drugs have saved/vastly improved however many lives.

And! Society (with the law slowly following along) does seem to be moving towards a greater acceptance of recreational (that is, non-medical) pot use. So maybe this is less about our rejection of a glorious Golden Age, and more about society weighing the cost vs. benefit of cigarettes in particular. I mean, take Dan Savage, harbinger of The New Morality if anyone is. Then check out where he stands on these issues. (Or I'll save you the trouble. He's anti-tobacco and anti-meth, but quite enthusiastically pro use-not-abuse of just about everything else.)

And finally, is it accurate to talk about how we-as-a-society have made this shift? Isn't it possible that we-as-a-society continue to socialize-and-indulge till a certain age, and then such things as 'pregnancy' and 'being kinda old' turn many into versions of Rob Lowe's health-crazed character from "Parks and Rec"? So it feels like society has changed, but it's just that we're ancient? Which brings us to...

-Tracy Moore declares 28 the age at which the mature hangover appears. Which, yes. Last year I experienced the one-martini hangover. This year I may have moved onto the one-beer hangover. While I didn't have the absolute most decadent college experience ever (UChicago and all that), this is nevertheless... new.

-OK, so there's one non-Mormon-or-Muslim opponent of social drinking, and that would be Emily "Prudence" Yoffe. A letter-writer, a woman, drinks 2-3 glasses of wine over many hours, with dinner. We don't know a) this woman's size, b) this woman's age wrt 28, or c) how she's defining a "glass." Is a "glass" a barrel? A thimble? (Oh, the thimble-of-wine hangover. Is that what awaits once I'm 30?)

Assuming by "glass" she means "glass," and she's not then driving or operating heavy machinery, or pregnant, then it kind of does take a doctor to say how much this matters for her personally. As someone who's not a doctor, let alone this woman's doctor, and as someone who eats 1,000x the recommended portion size of pasta a day, I don't feel in a position to be all, 'that's more than I drink, therefore alcoholism!' It sounds like a lot to me, if it's really every single day, but so what if it does?

As for her concerned fiancé, well, she has a choice. Either she uses him as a catalyst for a certain life-stage reduction in drinking, or maybe these are yet another pair of incompatible-yet-engaged individuals, and were it not for the incompatible-yet-mysteriously-engaged, there would be no advice columns. (Advice columns - I may well consume 2-3 of those a day.)

11 comments:

caryatis said...

“Rita defends Cristina Nehring's "defense of drunks," which is also kind of a defense of social drinking...”

Is it? I thought it was a defense of heavy drinking. Or at least drinking as self-medication, which I would think would have to be above the level of wine-with-dinner.

The point seems to be that drinking and psychotropic drugs both have good and bad effects, but people don’t see that because the former is considered a dangerous (potential) addiction, and the latter is “medicine.” Drinking for the taste is socially acceptable, but if you were to tell people that you drink, say, to deal with your anxiety, you’d get a lot of disapproval.

“Any denunciation of "pills" must contend with the evidence that these drugs have saved/vastly improved however many lives.”

...through the placebo effect. If you’re referring to antidepressants, the evidence that antidepressants work better than placebos is surprisingly thin, especially when tested against active placebos. And of course they have significant side effects--something like 40% of people (mostly women) on antidepressants suffer loss of libido. Plus tranquilizers and antipsychotics have truly scary side effects, and can be as addictive as alcohol.

“And finally, is it accurate to talk about how we-as-a-society have made this shift? Isn't it possible that we-as-a-society continue to socialize-and-indulge till a certain age, and then such things as 'pregnancy' and 'being kinda old' turn many into versions of Rob Lowe's health-crazed character from "Parks and Rec"? So it feels like society has changed, but it's just that we're ancient? “

Well, one objective change in society is that teenagers are less likely than ever to consume alcohol or smoke tobacco.

My impression is...and here I’m comparing not so much with my youth as with my impression of the 50s and 60s...drinking and smoking, like eating, has become problematized so to speak over the years. If you’re having a party, you can no longer assume that all of your guests will drink (smoke, eat cheese). If you go out to lunch on a work day, having one drink feels deviant.

I suppose some of it has to do with the incredibly harsh legal penalties for drunk driving, plus the rise of car culture. You can see this in Prudence’s reactions to drinking--not in the example you cited, but in others, she seems to assume that anyone who drinks will be driving home, and that may make her reaction more disapproving than it should be.

“It kind of does take a doctor to say how much this matters for her personally.”

Why shouldn’t the woman herself be able to decide how much this matters for her? The drinking doesn’t seem to be causing any problems, aside from conflict with a controlling and Puritanical boyfriend.

To be fair, Prudence does quote NIAAA*’s guidelines for “low-risk” drinking--7 drinks per week for women, 14 for men. However, since you asked, those are bullshit, because NIAAA consistently fails to consider the social, psychological, or physical benefits of drinking, and because, like probably all federally funded agencies studying drugs or alcohol, what science there is is politicized beyond belief. For ethical reasons, most of its research is done on animals, and a finding that infant primates or mice given alcohol have impaired brain development somehow becomes a recommendation that under no circumstances should 20-year-old humans drink.

I have listened to some of these NIAAA folks present their research, and I always find myself wondering whether they’ve ever really had a drink. They just seem to be on a different planet. It’s the toxicologist approach to alcohol, I guess, but where is the anthropologist or the psychologist’s view? Or the libertarian?

*National Institute for Alcohol Abuse and Alcoholism, part of NIH


Phoebe said...

Caryatis,

-Why I thought Nehring meant social drinking: the bit about clinking glasses. And I'm not sure anyone really believes "for the taste" is the only acceptable reason to drink. What if the taste could be replicated in an alcohol-free beverage? 'For the buzz' or 'for the social-lubrication' both seem reasonably acceptable. 'As medicine,' fine, less so.

-Who indeed are the people who think prescription drugs can't be addictive/dangerous? I thought there was supposed to be a prescription drug abuse crisis in this country?

-I always wonder with the teenager surveys. What teens do vs. what they admit to doing may not be the same. I've wondered this since I'd see whichever alleged rates (some small percentage doing whatever), then see what happens at a party (near-universal consumption of whatever, including the 'good kids').

Although maybe with the panoptical of smartphones and social media, the norm of teens doing everything and admitting nothing has shifted?

-By 'the woman's doctor,' I mean it's for her doctor to say if she's drinking too much by any kind of objective health measure. She's certainly free to disregard the doctor's advice. And those general standards are just that - general. A doctor might note that a woman is 12 feet tall and 400 pounds and recalibrate.

caryatis said...

"Who indeed are the people who think prescription drugs can't be addictive/dangerous? I thought there was supposed to be a prescription drug abuse crisis in this country?"

Ah, but people don't recognize that legally obtained prescription drugs, taken according to doctor's orders, can be dangerous too. Doesn't the author refer to anti-depressants and not, say, painkiller abuse?

And, yeah. I'm not sure how reliable the surveys are either. Although, doesn't it say something about the culture if teens are less likely to _say_ they drink, even if drinking rates haven't changed?

Britta said...

I was once talking about drinking with a med student, and he said that the binge drinking guidelines were kind of insane and that if you didn't have a problem with alcohol, you should definitely lie to your doctor about how much you drink, since almost any social drinker would be a binge drinker by those standards. (I think it's more than 2 drinks in one sitting for a woman, and more than 3 for a man.)

I think there is much more of a sense in the US that alcohol is completely unnecessary for life and could be cut out, and it's easier to do so than to make an informed decision around relative risk. I was reading Italian guidelines for pregnant women, and it's no more than 3 glasses of wine a week. When I was in Australia, it was "an occasional glass of wine or beer every once in awhile." I'm on an anti-depressant (though not an SSRI), and apparently it minimally increases seizure risk, as does alcohol. According to my psychiatrist, it means the risk of a seizure while consuming alcohol while on this drug is ever so slightly higher than next to nothing, but still negligible, so sometimes there's a warning against drinking while taking the medication. Every time I get a refill at the pharmacy however, they tell me that drinking is forbidden while taking the medication, with no explanation of why or acknowledgment that unless one has epilepsy, drinking alcohol doesn't really cause a problem.

Phoebe said...

Caryatis,

The article doesn't just mention anti-depressants: "Rather, they are dying, like Michael Jackson of an excess of anti-anxiety medications given to them by their doctors. They are dying, more recently, like Shulamith Firestone, the gorgeous feminist icon, of psychotropic-drug-enhanced loneliness in the privacy of their studio apartments in the middle of downtown Manhattan." All of which says pills in a more general sense. I guess I just can't think of where in our society there's this blind faith in psychotropic medications, let alone a belief that those drugs don't have side effects. I see why this would be worth arguing against if there were, but if anything, it might well be that people are more suspicious of them than necessary. I think Judith Warner wrote something about this as it relates to kids and ADHD drugs. That everyone thinks kids are overmedicated, but the larger reality is under-diagnosis.

Britta,

You may be right re: the States, but I suppose it depends where. I've never been on any of these apparently controversial prescription psychotropics, but I was briefly on a headache medicine that meant I couldn't drink. And the (American) doctor who prescribed it encouraged me to go off of it in part because she knew I was about to study in Paris and wanted to be sure I could drink wine. Which - good call!

What your comment also makes clear - and what seems absent from the conversation thus far - is that these things are not mutually exclusive. As in, actual people aren't going to be Team Prescribed Psychotropics or Team Wine.

Phoebe said...

Also, for Caryatis,

Yes, it does say something if kids indulge the same but admit to less. But what does it say? Could it be that kids have older parents, for whom decadent youth seems distant, and that creates the need for secrecy? The obvious would be that adults drink/smoke less than they used to. So, whereas it used to be that kids who did these things were assumed to be growing up too fast, it's now assumed that they're altogether breaking with social norms. And... I haven't looked into this, and it's been a very long time since I was at a party with the 19-and-under set.

caryatis said...

Just call me Team Wine.

Britta, yeah, I completely agree. I would never tell a doctor how much I really drink–split a bottle of wine with my boyfriend and suddenly I’m binging?

There’s also this bizarre belief in public health circles (forgive me if I’ve mentioned it before) that you just need to ask people about their substance use, and they will infallibly tell the truth. Even teenagers. Even with illegal drugs. It’s called SBIRT and SAMHSA is putting a lot of money into it and it’s fucking ridiculous.

I’ve also noticed that over-the-counter pain meds like ibuprofen, acetaminophen, aspirin or naproxen ALL say do not take if you have more than 3 alcoholic drinks per day. I believe there’s a real risk of hepatotoxicity here, but the labels give you no clue that, for instance, aspirin is safer than acetaminophen, and as far as I know there is no over-the-counter alternative for heavy drinkers.

Phoebe,

“The article doesn't just mention anti-depressants...”

My point is that the article is about duly prescribed psychotropics, like the Prozac, Xanax and Wellbutrin the author mentions, not about drugs of abuse.

“I guess I just can't think of where in our society there's this blind faith in psychotropic medications”

Really? Who (besides me and some maverick journalists) ever tells people about the side effects of these drugs, or the lack of proof of their effectiveness? I was shocked when I learned that, for instance, benzos are addictive and antipsychotics are addictive, brain-damaging, and cause psychosis and dementia when taken over long periods. Certainly no one bothered to tell me about the side effects when I went on Prozac at 7 or Zoloft at 10.

“It's been a very long time since I was at a party with the 19-and-under set...”

Ha, me too. Danah Boyd is as close as either of us are likely to get to real insight into Teenagers Today.

Miss Self-Important said...

Ahem, who's Rita?

Also, I'm 28 and have never had a hangover. But I'm currently having altitude sickness in Santa Fe, which the internet tells me is just like a really horrible hangover. That's why this is all I have to say about that.

Phoebe said...

Eep! "Rita" (no-last-name) has been linking to a certain Miss Self-Important's blog at WWPD since forever. Which has been known to confuse P and make her alternate between the first name and the pseudonym.

No hangover ever? Wow. I've never had altitude sickness, but if it is indeed like a hangover, yuck. Hope you're over it soon!

Miss Self-Important said...

Ok, recovered. Now, back to the points. Basically, I think Caryatis gets the Nehring article right - she's not talking about social drinking of the wine w/ dinner variety, but relatively hard drinking - done socially - of the bar fighting variety. That's why I linked it to our previous debate over smoking as self-medication, b/c this is pretty clearly drinking as self-medication. She does fail to mention that alcoholism is also undertaken in private, like pill-popping, but she's right that alcoholism tends far more towards sociability than pills.

Any denunciation of "pills" must contend with the evidence that these drugs have saved/vastly improved however many lives.
Her point here is that alcohol also improves lives, by bringing otherwise lonely people who crave human company together. The baseline is, what would your life be like if you were depressed or anxious and did nothing about it? Then how do drinking and taking anti-depressants compare? I would imagine the answer is actually something more like "differently for different people," but as I said, I wouldn't rule out the benefits of social addictions.

So maybe this is less about our rejection of a glorious Golden Age, and more about society weighing the cost vs. benefit of cigarettes in particular.
Well, alcohol too then. Alcohol has similar long-term health and danger-to-others costs. The problem with this cost-benefit calculus is that it's probably always going to be wrong. It assumes there are "safe" drugs out there - new substances which do all the good stuff that older substances used to do, but without all the bad effects, and that over time, we will discover or concoct more and more of them and so shed our dependency on older, unhealthy variants. This describes our educated-person assumptions about marijuana and psychotropic drugs. Marijuana is harmless if you smoke some high grade variant that's not laced with nuclear waste, and psychotropic drugs are, as Caryatis says, "medicine" and so targeted to a specific problem which they cure. But, I'm willing to bet that we're as wrong about the "safety" of these drugs as we were about the "safety" of tobacco in the 19th and early 20th centuries. If ever there was an iron rule of cost-benefit, it's probably that pleasure always costs something. It just may take us a few decades to realize what.

Phoebe said...

MSI,

Eh, I partly agree with you, if not with your/Caryatis's interpretation of that article. There was something Nehring said about how everything can be done to excess. And well, alcohol consumed in moderation is something not too many people are all that worked up about.

But I agree that the newer this-and-that are unknowns, and that there's something to be said for knowns. And that it's absurd to believe (although once again, I'm not sure how many do) that because current medical science recommends X for depression/anxiety, that's a route with no downside.