dry January that's where it's January with only just a little bit of remou right did you write that joke I I didn't write the joke it kind of just occurred to me have either of you ever done dry January I have never done dry January but I'm not going to lie none of my januaries is particularly wet I have tried dry January and I think that it's a very good experience and very good exercise for people to do I do the like you know glass of champagne toast right at New Year's and you got to
you got to spit it out right at midnight um I I go for dry January but I end up more doing damp [Music] January this is impromptu from Washington Post opinions a show that brings you conversations about the news we can't stop thinking about I'm Drew goens author of the today's opinions newsletter and this week we're talking about the US surgeon general's advisory about drinking and how it can lead to an increased risk of cancer recent National Health Data shows that the majority of American adults reported having had a drink in the last month and
it doesn't take a survey to see how entwined drinking is in American culture but is it really bad to hit up a happy hour every week couple times a week and in a world where it feels like everything can cause cancer is reducing how much we drink a priority for people who get some pleasure or Joy from drinking is it worth taking the risk I'm joined today by two of my my colleagues to talk through all this and more hey Drew hey Molly nice to talk with you and to everyone um I'm Lena W I'm
a contributing opinions columnist at the Washington Post I'm also a physician um and someone who thinks about alcohol and alcohol use and as you were saying drew the pleasure of of drinking combined with what risks there might be I'm Molly Roberts I'm an opinion writer at the post I'm not a scientist and I am a light Drinker thank you guys let's start with the personal so when you saw this advisory from Vivic Murphy this is America's this is the Surgeon General this is America's top doctor did it have any effect on you and how you
think about your own behavior around alcohol would you did it make you want to modify anything well for me no um and that's because the evidence that was presented is not new to me although I think the reason why Dr berthy presented this was it seems like um according to a study that he cites that most Americans are not aware of the link between alcohol and cancer I think people are aware that heavy drinking is associated with negative Health outcomes like liver disease and heart disease and cancer but I don't think they know that there
is a length that's seen even at moderate levels of drinking when it comes to at least seven different types of cancer and I think that it is important to uh for people to understand this in thinking about risks because there are lots of activities that we engage in in our lives that have risk but how we consider it really depends on each person so for example one of the studies SE cited by The Surge in general is that the risk of developing breast cancer over a woman's lifespan is about 11 out of 100 for people
who drink not at all or very little but for those who drink one alcoholic beverage a day the absolute risk goes up to 13 out of 100 for two drinks a day it's 15 out of 100 and so for some people they might say look I have a significant family history of breast cancer I I do everything else in my life to reduce that risk of breast cancer I want to reduce my my risk um further by cutting my drinking from two drinks to one drink or or something like that I I think that that
would be very reasonable but I also think that there are plenty of other people who will say look I there are lots of things that contribute to cancer risk actually um alcohol is the third preventable cause the first two are tobacco and obesity and then there are lots of things under there for example lack of exercise um ultr processed food I mean some people might say I try to maximize other things in my life that are helpful behaviors when it comes to cancer risk I can afford to take this one thing that brings pleasure yeah
I'll confess that I was one of the people who is surprised uh to see this I'm in that slightly more than half of Americans who did not see this Associated risk top of mind um and I'm also not 100% ready to modify my behavior immediately like I this is new information to me I I learned this last week and I need to take some time to you know take stock what is the benefit that I get from alcohol I you know I'm I consider myself a moderate Drinker do I want to drop down to that
level of one or fewer drinks per day I I I don't know yet Molly was this new information for you it definitely was new information for me I don't think it's going to change the amount I drink because very luckily for me I drink one or two drinks a week in fact the way it's likeliest to change my behavior is to prevent me from forming a habit in the future you know I'd been told and I'm sure that Lena's familiar with this debate that it would be good for me to drink a glass of red
wine with dinner maybe every day and I'd thought oh I really ought to drink more with dinner so perhaps I won't be doing that now yeah research shows that you know younger people in particular I'm going to I'm going to throw our elves in that bucket Molly flatter ourselves we're both in our early 30s research shows that young people are are headed away from drinking they're drinking less than previous generations I mean this dry January it I mean it's very popular online with young people we see sales of non-alcoholic beers Rising you know these canned
cocktails that are non-alcoholic Lena I want to go to you first do you think this is a function of people becoming more aware of the health risks or is it just a cultural shift that's much needed or is it is it both of those things happening at the same time what do you make of that well I'm still considering the fact that I'm no longer considered the young person in this conversation so um now I wrote we're all young to me young at heart um I wrote a column last year looking at Trends and it's
interesting um because when you look at the trends it does look like and you're accurate in saying true that alcohol used among young people has been trending down and in fact appears to be replaced by marijuana use because at the same time that you see the trends going down for alcohol we're also seeing regular cannabis use going up and in fact we're now getting to the point where people who use cannabis on a daily basis is higher than the number of people who drink alcohol every day um across demographics which is really interesting but what's
also interesting is that it does not appear that the decreased alcohol use among young people is sustained over the course of their lifetimes oh interesting also men are drinking less but women are drinking more and where that appears to really take into uh into effect are in the 30 to 45 year-old group there have been a number of studies done recently looking at professional women and the increased drinking in this group both excessive drinking um so drinking more than a drink per day um on a regular basis for for women but also B drinking going
out for an evening and drinking four drinks in that evening or five drinks for for um for for men but that bin drinking in this professional women's group is increasing but I will say with the surgeon general's advisory one thing that stood out to me is when you look at the risks for individuals what the greatest risk is not seen in moderate drinkers right it's in people who drink excessively it's for bin drinkers because you have all that alcohol hitting you all at once um and it's in people with alcohol dependence who have who have
signs of addiction to alcohol and people who are drinking in order to cover up something else like loneliness or depression or trauma or anxiety or something else and so I I think it's a good attention grabbing headline to say hey look at alcohol and cancer but I think if we really want to make an impact on public health we should be focusing on the people who are B drinking 61 61 million Americans reported bin drinking in the last month right that's the group that I would really focus our attention to not the people who are
drinking a glass of wine with their dinner at night read the marijuana thing I learned a new term while trying to read up for this which was California sober I think that's what perhaps the kids are saying when they're substituting marijuana for drinking I wouldn't know I'm not actually that young compared to the Gen zers but it's definitely true it's worse I imagine to substitute with plenty of substances that aren't alcohol but I also wonder and I have no real idea whether this would be something that would be likely to happen but this is related
to the binge drinking thought if people limit their alcohol consumption during the week say if they tell themselves so I'm not going to have a beer when I come home but then they go into the weekend thinking I've been so healthy this isn't that many drinks per week and they have five six seven beers would is that worse than if they had so that is potentially concerning yes in fact this is it's interesting because um in response to some of my columns last year I had readers write in with exactly the question is it better
that uh to have a drink every night or is it better to just go nuts one weekend day but then save up during the week so so to speak and the answer here is really unequivocal it is much worse to bin drink bin drinking is associated with what you might expect with a higher rate of injuries for example car accidents Burns drowning Falls right so not but not only that you're also alcohol is a toxin and the metabolites produced when your body processes alcohol those are toxins too so normally our body can get rid of
these toxins but if you are hit by a giant bolus of it all at once it's much harder for the body to deal with and so heavy drinking excessive drinking bin drinking that's associated with all kinds of problems like pancreatitis inflammation of the pancreas heart arrhythmias heart failure it is much better to drink if you have to drink five days or five drinks a week space it out over 5 days don't drink it all in one instance there's this really interesting idea that I'm seeing emerge which is that like drinking or like mind-altering pleasure generally
is this like zero some thing right for so many people it seems like I'm either going to have my drinks throughout the week or I'm really going to make up for it on the weekend if I cut out drinking here I am trying out weed right and on the weed point I did want to ask you know Molly kind of asserted it's worse is is that true is is this an out of the frying pan and Into the Fire situation I think it depends on the individual uh for young people we know that cannabis is
not good for the developing brain and brain development can occur in people's 20s as well and so I think if we're talking about teenagers who otherwise would try a beer here and there who are now turning to smoking marijuana every day that's really bad right I mean drunk driving is also very bad um and it's more likely that somebody could end up having a terrible accident out of drunk Dri from drunk driving but also cannabis is it Alters your judgment and perception too and so that's also not great so I I think the idea though
that we can replace alcohol with cannabis and it's a safe quote unquote safe alternative is wrong I don't know how to compare the two exactly in terms of harmful effects but excessive of either is bad but replacement not a good idea yeah and it's not just cannabis right I mean maybe that's for more casual drinking casual settings but when it comes to the partying seen there are other substitutes big these days I assume we don't want a lot more more ketamine consumption compared want more ketamine consumption only for the horses Lena wi coming out with
a bold bold medical statement that we don't want more people taking camine I was going to ask you know what about the positive benefits of alcohol which uh we see like in terms of Social Capital like all of these friendships that you know developed the people who went up and asked out their future wife because they'd had a drink at the bar but then the the more I thought about that question the more I was like okay well if I had been doing this podcast 30 years ago 40 years ago would I have been saying
well what about all the positive benefits of smoking you know you you you met someone out on the smoke break do you think that a few decades from now Lena we're going to be in a place where we're thinking about alcohol the way that we used to think about smoking I don't think so but I also say this as someone whom enjoys alcohol not because it is mind altering but because I like the taste of alcohol um and specifically of wine my my husband and I both enjoy wine with some meals we got married on
a Vineyard we have friends who own Vineyards um I think it's different to think about alcohol as with smoking in the same way perhaps or in a similar way that we cannot think about sugary drinks sugar sweetened beverages the same way that we think about smoking to be fair I I do think that the idea Molly that you mentioned earlier that um that drinking alcohol drinking wine specifically is good for your heart and that you need to be drinking a glass of wine every night I think that is outdated there is there's such controversial data
surrounding alcohol and heart protection that I just don't think it's worth it right and whatever benefit you may get from one glass of wine a night even let's say that it gives you some small degree of cardio protection it's outweighed by the the potential cancer risk so I don't think you're going to meet a doctor these days who's like who I'll say to you hey if you want to improve your heart forg about your blood pressure medications or walking outside or whatever go drink go drink wine I don't think we should be talking about the
health benefits specifically of alcohol certainly but could it have social benefits could there be pleasure that one derives from drinking alcohol the way that you derive from eating cookies like cookies are not essential for your health but I also don't want to be telling my patients stop eating cakes and cookies if that's something that they really enjoy yeah I am now fully convinced that I don't need to have a glass of wine with dinner to improve my heart Health but I do think that accepting the occasional cocktail from my husband who loves to make his
little cocktails maybe better for my relationship for my emotional health so I do think there's a certain extent to which alcohol is just more interesting than cigarettes not just because it's a social lubricant but because like you said there is a real and vibrant culture around wine there is around cocktail making too well speaking of the the pleasure that we derive from drinking uh I do want to talk more about how we weigh the risks versus rewards of drinking and a lot of other things but first let's take a quick [Music] break I'm Alexander Petry
and I write a humor column for the Washington Post I think sometimes it helps to have somebody yelling at the news with you these days when people might be more inclined to tune out of the news if there's a way to make news consumption more pleasant hopefully I'm helping with that I consume unhealthy amounts of news thanks to our wonderful news side who are always bringing in stories I look at the paper I become indignant about things that are going on and then I try to figure out a way of writing about them that will
hopefully make my readers indignant too I think the most important thing subscribers do is support our actual journalism which is how I learn what's going on in the world and we have so many phenomenal writers whom I love to read because they're deeply well sourced and they know what's happening and I can learn what to be indignant about when you subscribe to The Washington Post you support this kind of Journalism and the people behind it that and coffee a lot of coffee I'm Alexander Petry and I'm one of the people behind the [Music] post welcome
back I'm Drew Owens and this is impromptu so I feel like I go through life and every 2 days I'm seeing something else that's a new carcinogen right we're being told about things that are going to harm us microplastics I I can hardly open the microwave these days and put something in it without being like I'm ciding my death sentence right now we were discussing the podcast beforehand and a colleague was overhearing she's jenz and she calls out I mean with all the fires how am I supposed to think about alcohol which is you know
an exaggeration not not entirely true but the state of the world and specifically just you know cancer risks too emanations from your gas stove all of these warnings are super overwhelming at least for me and they're really really easy to tune out um how do you think These Warnings accumulate psychologically Lena yeah it's an interesting question um I think it does become overwhelming to to people I see this in my patients as well um also in a patient encounter you have limited time to address issues with your with your patients and also you can't tell
them to do everything because then they'll end up doing nothing right you you have to focus on what's the most important I would always ask people how much they are drinking and ends up being more than one drink a week I would ask them if they're saying five drinks a week or 10 drinks a week I would definitely ask them about spacing of the drinks um and then I would address this with them if it's actually excessive drinking um I would also ask them questions that assess for dependence so things like have they tried to
stop drinking are they un once they start are they unable to stop do they have trouble controlling the amount of alcohol that they're having and also when are they drinking is it only socially or are they drinking alone which could be a a red flag um are they trying to self-medicate essentially because there's something else that's really hurting them and then we can get at those things but I I give this this clinical example because we have only so much time we have only so much Focus that we have to choose what are the issues
that we really want to dedicate our attention to as clinicians or as individuals for ourselves and so for someone it might be they might not be aware of the risks of alcohol and for them cutting down from four drinks a day to one drink a day is not that big of a deal but would really improve their health so we could focus on that but for somebody else if they're only drinking let's say one one drink a day but they're not exercising at all and they're eating really fatty foods and having lots of soda I'm
not going to be talking about drinking alcohol as the thing that they need to cut back I'm going to focus on these other things and so I think maybe that's one way to think about it what's really the problem if it's if alcohol is a big problem and also what's low hanging fruit for all these other risks that are in your life right I mean it sounds like you're talking to your patients plenty about alcohol where where warrented for the people who are not going in and talking to their physician with any frequency and who
are more frequently encountering alcohol you know do you think the surgeon general's recommendation that we get a war warning label um making more clear the cancer risk is is an effective strategy I think that it could raise awareness for some people again people who have a genetic predisposition to certain cancers who who may not even be aware of how much they're drinking and so they tally it up and they say oh my goodness I'm actually at the high end maybe I can cut down a little bit to that point I also don't want for people
to be tuning out warnings by public health officials because if you say that everything is a problem then they start thinking well I can't even live my life just let me have some Pleasures left right and so I think that's the other concern If This Were Me choosing I don't think I would have chosen this as the issue that the Surgeon General would would part on I think there are lots of other I actually would put cannabis um up there because I think far fewer people even recognize the risks of cannabis use right um I
would I think the Surgeon General and his work on social connection has been so important and him calling out the problems of excessive use of of smartphones and social media by by young adults has been so important I don't want that work to be drowned out by by this Molly do you go through life worrying about your hierarchy of cancer risks funny that you ask I have assembled a list I I did not know what you had been writing in your notebook but I'm thrilled to hear that this is the answer non-stick cookware mattresses they
have flame retardants in them insecticides pesticides shower curtains leather chairs and wooden sofas Pro processed meat Dairy I don't know if those all have warning labels if they do I have been ignoring them my understanding is that there's a much firmer link between alcohol and particularly breast cancer but other cancers too than these things but if you just tell me generally oh those are all carcinogenic and they all have warning labels I'm going to kind of shrug at all of them I think unfortunately on the other hand if I am told in a more consider
way here are the big risks then I'm at least going to calibrate my risk depending on how dangerous it is so I'm not going to smoke cigarettes I'm not even going to have the occasional cheeky cigarette after a few too many drinks cuz that's double cancer risk I'm going to wear sunscreen so I suppose that's how I think about it Paragon of Health Molly Roberts giving us the worst cover if we didn't start the fire since I've got that list as we come to the end of conversation I wonder if you could just wrap up
for us Lena you know I'm going into life with this new information new to me from the Surgeon General how do I weigh the risks versus rewards of drinking I think understanding your relationship with alcohol and the role that alcohol plays in your life that's going to be the most important thing rather than just focusing on this one link between alcohol and cancer which is real and is important for people to know but I think that there is a lot more to life than simply avoidance of risk with that the rest of dry January beckin
and we have to wrap this up thank you both for joining me for this episode of impromptu thank you thanks [Music] true this episode was produced by Hadley Robinson edited by deir marusik Chris cantop and Allison Michaels and mixed by Emma Monger special thanks to Millie MRA and dearra burn thanks for listening to impromptu please send us your thoughts about alcohol today's conversation at impromptu washpost.com and if you're liking the show please be sure to leave us a review or comment on your favorite podcast app [Music]
