License State News May 17, 2019

NY: 186 alcohol sellers charged in underage drinking JMEMBER UPDATE crackdown To view the member newsletter, sign in using International News your member login, at https://www.nabca.org/member-newsletter. Canada: Ontario moving closer to reforming alcohol sales, The newsletter will include member benefits, surveys, important reminders, upcoming events special adviser to release recommendations and so on. United Kingdom: 5% of doctors are alcohol dependent, If you have any questions concerning your research says organization’s member benefits, please contact Dawn Rigaud at 703.578.4200.

Public Health News NABCA HIGHLIGHTS Cannabis legalization not tied to higher health care The Public Health Considerations of Fetal utilization Alcohol Spectrum Disorders (White Paper) Native American Nations & State Alcohol Industry News Policies: An Analysis (White Paper) Alcohol Technology in the World of Tomorrow Online marketplace warnings for retailers - (White Paper) Brewers Climb Capitol Hill To Advocate For Small And The Control State Agency Info Sheets. Please Independent Brewers view website for more information. NABCA Survey Database (members only) Education News Upcoming NABCA Meetings Majority of campus alcohol policies fail to receive 'most Statistical Data Reports effective' rating from experts Daily News www.NABCA.org Control States See Trading Up In Key Categories, Growth For E-Commerce How Much Alcohol Can You Drink Safely?

NABCA Daily News Update (5/17/2019) 2

LICENSE STATE NEWS NY: 186 alcohol sellers charged in underage drinking crackdown WBNG May 16, 2019 ALBANY, N.Y. (AP) — More than 180 establishments holding New York state liquor licenses have been charged with serving minors during last month’s statewide crackdown on underage drinking. That’s according to state officials who say April’s monthlong enforcement effort resulted in charges being filed against 186 out of the 851 bars, restaurants, liquor stores and grocery stores in 46 counties that were visited by underage decoys working with investigators. The compliance checks were conducted by the State Liquor Authority, the state Department of Motor Vehicles and local law enforcement agencies. Democratic Gov. Andrew Cuomo announced the start of the statewide sweeps in early April. He says it was the state’s latest effort to catch people using fake identifications to buy alcohol and to hold businesses accountable for illegal sales. The decoys were able to purchase alcohol at 186 businesses listed here. The 665 businesses which refused to sell to underage decoys are listed here.

INTERNATIONAL NEWS Canada: Ontario moving closer to reforming alcohol sales, special adviser to release recommendations The Globe and Mail By Jeff Grayqueen's, Park Reporter May 16, 2019 A special adviser to the Ontario government is poised to release recommendations on potentially sweeping changes to the province’s alcohol regime, even as Premier Doug Ford remains at loggerheads with the industry- owned Beer Store over his promise to allow sales of beer and wine in corner stores. Former Alberta cabinet minister Ken Hughes, appointed to advise Finance Minister Vic Fedeli on loosening Ontario’s alcohol rules, told The Globe and Mail on Thursday that a special report on possible changes to the way Ontarians buy alcohol is “imminent” – and could be released within days or weeks. But he said it had not been finalized and would not reveal what it will propose. His impending report comes as other parts of the alcohol business have been urging Mr. Ford’s Progressive Conservative government to liberalize the industry well beyond the campaign promise on beer and wine. Lobbyists have been making the case for more radical changes, including letting private-sector standalone liquor retail chains compete with the Liquor Control Board of Ontario (LCBO). “When you are talking about modernizing the whole ecosystem, effectively, all the ways in which we distribute and sell alcohol beverages in Ontario, I think it’s fair to say that we’re listening to everybody," Mr. Hughes said, adding the government has made clear it will not sell off the LCBO. Meanwhile, the government is locked in an escalating battle with the big, foreign-owned breweries that control the quasi-monopoly Beer Store. Beer-industry sources have warned that opening up a deal signed by the previous Liberal government in order to put beer in corner stores could cost Ontario hundreds of millions of dollars in penalties, force beer prices to rise and threaten 7,000 Beer Store jobs. Mr. Hughes has dismissed the warnings as fearmongering. Legal experts say Mr. Ford could pass legislation overriding the contract, although the foreign-owned breweries could make claims for compensation under the NABCA Daily News Update (5/17/2019) 3 terms of trade deals. On Thursday, Mr. Hughes would not comment on talks with the Beer Store. A spokesman for the Beer Store could not be reached. Representatives of Edmonton-based Alcanna Inc., which operates more than 200 liquor retailers in Alberta, British Columbia and Alaska, has been meeting with Progressive Conservative MPPs and staffers to make its case for standalone private-sector liquor stores in Ontario. The company has hired lobbyist Melissa Lantsman of Hill+Knowlton Strategies, who headed Mr. Ford’s war room in last spring’s election campaign. Alcanna has several different liquor chains and just opened a branch of its marijuana arm, Nova Cannabis, in Toronto; it is already gearing up for expansion. Earlier this month, it announced it had secured $70-million in bank financing for its new cannabis business and for new stores under its high-end Wine and Beyond banner, including locations in Ontario “if the Ontario government’s reform of liquor retail so permits.” Company spokesman David Crapper said the government appears open-minded, but is concentrating on the Beer Store for now. He says he has met with staff and backbenchers, but not the Premier or Mr. Hughes. (Mr. Hughes was a partner in an Alberta alcohol retailer in the 1980s that was bought by Alcanna. He said he has not had a stake in the business for about a decade.) “We’re hopeful that the discussion could be broadened a little bit beyond what they’re talking about now,” Mr. Crapper said. “And we think that would be good for consumers.” Some critics say opening up liquor sales could mean a decline in the billions of dollars the Ontario government rakes in from the LCBO. But Mr. Crapper points to numbers that show the opposite is true in B.C., where government retailers remain a presence, as well as in Alberta. Most government revenue in both provinces still comes from controlling the wholesale side of the alcohol business, Mr. Crapper said, as private-sector players must still obtain their liquor through a government-controlled entity. Other lobbyists have also been bending the government’s ear. Jan Westcott, president and chief executive officer of the Association of Canadian Distillers, argues his members should be allowed to sell their whisky, vodka, gin or other hard liquor alongside beer and wine in corner, grocery and big-box stores. Asked about this idea, Mr. Hughes noted it was not something Mr. Ford’s government had promised. The Beer Store, primarily owned by the foreign brewing giants that control Labatt, Molson and Sleeman, launched ads this week that targeted the government’s corner-store plans, as did the union representing Beer Store workers. In response, the Retail Council of Canada and other industry associations that support Ontario’s liberalization push are set to launch a public-relations website aimed at countering the beer industry’s claims. Critics accuse Mr. Ford’s government of having an obsession with alcohol. With the long weekend approaching, Mr. Fedeli, Ontario’s Finance Minister, put out images on Twitter of beers from brewers answering his government’s call for “buck-a-beer.” The government is also loosening rules to allow tailgating and restaurants to serve alcohol at 9 a.m. Ontario NDP Leader Andrea Horwath said the government has no plans to address the side effects of increased drinking, and argued the changes could see the loss of unionized Beer Store jobs and see more alcohol end up in the hands of minors. “We don’t think it’s a priority," Ms. Horwath said. “We think the government should be focused on our education system, our health system. More access to booze is not a priority for New Democrats.”

United Kingdom: 5% of doctors are alcohol dependent, research says Pulse By Anviksha Patel May 16, 2019 UK doctors are turning to alcohol, food, and drugs to cope with the pressures of their working environment, a new study has shown. NABCA Daily News Update (5/17/2019) 4

Researchers from University College London (UCL) and Birkbeck, University of London, found that over one in four doctors binge-drink and 5% meet the criteria for alcohol dependence. The study asked 417 doctors across the UK about their occupational distress and showed that job factors such as work-life imbalance and burnout increased the likelihood of substance misuse, insomnia, and binge-eating. This comes after a Pulse survey of over 800 GPs revealed one in seven turn to alcohol and drugs to cope with the stress of general practice. The research also suggested community-based doctors are ‘more at risk’ of feeling worse after binge-eating. This study showed over half of participants (53%) drank alcohol more than twice a week and 44% binge-drank, which was defined as consuming six or more drinks on one occasion. With regards to substances, 44% of doctors used drugs, but the study stated ‘almost all were non-illicit drugs’. Over-the-counter medications were most commonly used (35%), and prescription drug use was rare; 3% used opioids and 2% used benzodiazepines. Given that almost a fifth of respondents (18%) were GPs and the average age of participants was 47, the research suggested that community-based doctors are ‘more at risk’ of feeling worse after binge-eating but that doctors who've been in the profession longer were 'less likely to have unpleasant emotions after binge-eating. It stated: ‘Doctors who have longer experience working in medicine, and doctors who work in hospitals, are less likely to have unpleasant emotions after binge-eating, suggesting that community-based doctors are more at risk of finding that binge-eating makes them feel worse, rather than better.’ Dr Clare Gerada, medical director at Practitioner Health Programme, said: 'The prevalence of dependence in the general population is nearer 12%, so its actually showing what we felt for a long time, which is doctors have a far lower rate of alcohol dependence. That doesn’t mean that it’s not a problem. It’s not minimizing the problem, its actually putting it into context. 'It’s a stressful job being a doctor, they tend to come in young, and young people tend to binge drink. This is what we find in our service. Doctors don’t tend to have a typical alcohol dependence, but they tend to binge-drink when they’re off duty to overcome the stress of a really difficult job.' Dr. Asta Medisauskaite, lead author on the research, said: 'We found evidence that stress damages the health of doctors. We know from previous literature that doctors under stress are at risk of poor quality patient care. Our study provides the missing link for evidence that stress actually has severe health consequences for doctors, including regular alcohol use and binge-drinking. 'In terms of GPs, our study actually showed that hospital-based doctors have nearly twice the risk of drinking a large amount of alcohol on a typical day of drinking, and binge-drinking, compared to community-based doctors like GPs. Hospital doctors are also twice more likely to have sleep problems. 'Our research did show that community-based doctors like GPs are at higher risk of binge-eating, which is something that should be explored in further research.' Pulse’s recent workload survey revealed GPs are working beyond safe measures when it comes to patient safety. It also showed how GP partners work the longest hours and have more patient contacts than other GPs.

PUBLIC HEALTH NEWS Cannabis legalization not tied to higher health care utilization Medical Xpress May 16, 2019 (HealthDay)—Legalization of recreational cannabis is not associated with changes in health care utilization, as measured by length of stay or health care costs, according to a study published in the May issue of BMJ Open. NABCA Daily News Update (5/17/2019) 5

Francesca N. Delling, M.D., M.P.H., from the University of California in San Francisco, and colleagues used the Healthcare Cost and Utilisation Project inpatient databases (2010 to 2014) to compare changes in rates of health care utilization and diagnoses in Colorado, which was the first state to legalize recreational cannabis, versus New York and Oklahoma (control states). Analysis included 28 million individuals and over 16 million hospitalizations across the three states. The researchers found that compared with New York and Oklahoma, cannabis abuse hospitalizations increased in Colorado (risk ratios, 1.27 and 1.16, respectively) after legalization. There was a reduction in total admissions noted in Colorado, but only compared to Oklahoma (risk ratio, 0.97). Compared to the control states, length of stay and costs did not change significantly in Colorado. An increase in motor vehicle accidents, alcohol abuse, and overdose injury, as well as a reduction in chronic pain admissions were the postlegalization changes most consistent with previously published evidence. "Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy," the authors write. More information: Abstract/Full Text Journal information: BMJ Open

INDUSTRY NEWS Online marketplace warnings for retailers The Shout By Andy Young May 17, 2019 Retail Drinks Australia has reminded all liquor retailers of the need to be vigilant about online alcohol sales and deliveries. The association has said retailers should conduct thorough self-audits to ensure any third party websites they are using are compliant with relevant state and territory legislation. Retail Drinks CEO Julie Ryan warned retailers that the liability for non-compliance sits with them and not the online marketplace, so the fundamental principals of responsibility and compliance should be front of mind for retailers. “Retailers should always take a great degree of caution in ensuring that their practices adhere to the relevant liquor legislation in all the states and territories in which they operate, especially concerning online alcohol sales and deliveries,” said Ryan. “Retailers cannot rely on representations of compliance from third-party websites, and we are actively working with several members to provide clarity on their obligations in each state and territory.” This warning follows concerns raised by liquor retailers earlier this year regarding the use of eBay by BoozeBud, an online retailer owned by AB InBev’s, ZX Ventures, to sell certain CUB products. Ryan also reaffirmed Retail Drinks’ commitment to pursuing a responsible retailing environment for the online alcohol sales and deliveries space, with a voluntary, industry-wide Code of Conduct to be launched shortly giving retailers full confidence that their processes are compliant. “Given the importance of ensuring compliance in the online and digital space, Retail Drinks is currently in the process of developing a comprehensive Code of Conduct governing online alcohol sales and deliveries,” she said. “The Code is being developed in close consultation and collaboration with various industry and government representatives and will serve as a robust, best-practice and fit for purpose framework allowing retailers to participate in this space in a responsible and compliant way.”

NABCA Daily News Update (5/17/2019) 6

Brewers Climb Capitol Hill To Advocate For Small And Independent Brewers Brewers Association By Katie Marisic May 16, 2019 134 brewers, brewery owners, employees, and state guild representatives gathered in Washington, D.C. today to advocate on behalf of the country’s small and independent brewers. The group visited the offices of more than half the United States Congress, logging 398 total visits. The top priority for attendees was supporting the Craft Beverage Modernization and Tax Reform Act(H.R. 1175/S. 362) and make the current federal excise tax recalibration rates permanent. The legislation currently has the support of 160+ members in the House and more than half of the United States Senate. Brewers shared their stories about how they are using the money they saved on the recalibration to reinvest in their businesses, hire new employees and increase employee benefits. Trade and tariffs were another key issue, with brewers discussing the impact the current tariffs have on their business. Attendees also advocated for full funding for the Alcohol and Tobacco Tax and Trade Bureau and for hops and barley funding for the United States Department of Agriculture-Agricultural Research Services. For more than a decade, the Brewers Association and their members have been coming to D.C. to advocate for the small and independent brewing community. “The attendees who participate in these events aren’t just advocating for themselves, they are representing the more than 7,000 small and independent breweries located across the country and the more than 150,000 people they employ, and they deserve our thanks.” said Brewers Association President and CEO Bob Pease. “They are making sure that the brewing community’s voice is represented and heard in D.C. and in our state capitals.” The day ended with a reception held at the Library of Congress where 22 breweries poured beer for members of Congress and Congressional staff.

EDUCATION NEWS Majority of campus alcohol policies fail to receive 'most effective' rating from experts Study of 15 Maryland colleges and universities points to a growing need to improve effectiveness of alcohol policies on college campuses HUB - Johns Hopkins University By Alicia Samuels May 16, 2019 Alcohol policy experts and researchers from the Johns Hopkins Bloomberg School of Public Health who evaluated common university alcohol policies found that fewer than half of the approaches for reducing problematic alcohol consumption rated as "most effective." Their review led to the development of an evidence-based approach that will enable colleges to analyze and update their campus alcohol policies. Underage, binge, and risky drinking are serious problems on U.S. college campuses, and many student incidents involving injury and harm have an alcohol component. Each year in the U.S., an estimated 1,825 students ages 18– 24 attending two- and four-year colleges die from alcohol-related causes. Excessive alcohol consumption is associated with injuries, vulnerability to addiction, impaired neurocognitive function, cancer, and liver disease. Earlier research has shown that campuses with strong campus alcohol policies also had less binge drinking and fewer alcohol-related injuries.

NABCA Daily News Update (5/17/2019) 7

The federal government requires colleges and universities to issue written campus alcohol policies, which include associated consequences for students and other college affiliates. This study is thought to be the first time that experts and researchers have rated the effectiveness of approaches typically included in campus alcohol policies. For the study, published online in the journal Alcoholism: Clinical and Experimental Research, researchers assessed the campus alcohol policies of the 15 partner schools in the Maryland Collaborative to Reduce College Drinking and Related Problems, a network of schools whose presidents have agreed to work together with community partners to reduce alcohol use on their campuses and create environments, policies, and practices using data- driven approaches. Johns Hopkins University President Ronald J. Daniels and Robert L. Caret, chancellor of the University System of Maryland, serve as co-conveners for the collaborative. "Our intent is to offer meaningful feedback for colleges in Maryland and across the U.S. to use to reduce excessive drinking and promote the well-being of their students," says study co-author Molly Mitchell, a senior program manager with the Center on Alcohol Marketing and Youth in the Bloomberg School and the alcohol policy program manager with the aforementioned collaborative. "For a campus alcohol policy to be effective, students must be aware of it, must be able to understand it, and it must include policies that evidence suggests will be effective at reducing the availability of alcohol." The researchers asked a panel of 12 alcohol policy experts and university officials to rate 35 policies and 13 sanctions commonly included in campus alcohol policies based on criteria of accessibility, clarity, policy effectiveness, and sanctions effectiveness. The panel of experts included five alcohol policy researchers, three vice presidents of student affairs, and a campus alcohol and drug education officer. Based on their knowledge of published academic research and expert opinion, panelists determined that 17, or 49%, of the campus alcohol policies should be rated as "most effective." The most effective policies were those determined by panelists as likely to comprehensively affect the physical and/or normative drinking environment on campus. Banning alcohol consumption in public places, for example, was classified as most effective because it restricts campus alcohol consumption and is likely to influence social norms around drinking. Other policies classified as most effective include: • Banning alcohol at student recruitment events • Prohibiting alcohol delivery to campus • Prohibiting drinking games • Mandatory ID checks at all campus events with alcohol The researchers also found that accessibility of the campus alcohol policies could be improved, with many of the schools' policies spread across multiple locations on the schools' websites, and that the text in the campus alcohol policies across the 15 schools was overall considered very difficult to understand. Sanctions effectiveness was more positive: on average, the colleges included four of the five sanctions considered to have the strongest deterrent effect, ranging from parental notification to dismissal from housing. On average, the universities studied had six of the 17 most effective polices in place, indicating the potential for improvement in schools' ability to reduce alcohol problems on their campuses. "Alcohol consumption can impede the health, safety, and academic success of students, and campus alcohol policies are the first line of defense against alcohol problems on campus," Mitchell said. "One way to prioritize the health and well-being of students is for colleges across the U.S. to replicate the research we did and regularly assess and improve their policies." As part of this research, the study authors provided each school studied with the results of the assessment as well as specific recommendations for improvement in the school's written policies, and they will evaluate later this year whether the assessment influenced the school's campus alcohol policies.

NABCA Daily News Update (5/17/2019) 8

DAILY NEWS Control States See Trading Up In Key Categories, Growth For E-Commerce Shanken News Daily By Carol Ward May 16, 2019 The 17 control states, along with separate control jurisdictions in other states, represent just over one-quarter of the nation’s population and account for roughly 22% of distilled spirits sales, along with a significantly smaller percentage of beer and wine sales, according to the National Alcoholic Beverage Control Association (NABCA). By most accounts, business is on the rise, especially with premium products. Depletions of distilled spirits in control states increased 2.8% in 2018 to 53.1 million nine-liter cases, according to Impact Databank. Of the top 10 control states, all but one—second-ranked Pennsylvania—registered spirits volume increases. Michigan topped the rankings with a 3.2% increase to 8.19 million cases, followed by Pennsylvania with a 1.6% decline to 7.67 million cases. Ohio’s consumption advanced 4.6% to 6.16 million cases, North Carolina registered a 5.2% increase to 5.98 million cases, and Virginia consumption gained 3.4% to 5 million cases. Among the leading brands, Tito’s became the largest distilled spirits label in control states during the first quarter of this year. In 2018, the Texas vodka brand jumped 32.8% to 1.81 million cases in NABCA channels. Smirnoff vodka held on to the No.-1 position for calendar 2018 with a 1.3% gain to 1.93 million cases, but it appears likely that Tito’s will gain that title this year, given its extraordinary growth trajectory. Noting the recent rapid growth of Tito’s in Ohio, Jim Canepa, superintendent of the Ohio Division of Liquor Control, says momentum continues. “We really don’t see a slowdown on Tito’s,” he says, adding, “Without Tito’s, vodka as a whole would be in the red.” The vodka category accounted for more than one-third of distilled spirits sales in control states in 2018, according to Impact Databank, but whiskies and Tequila continue to drive much of the growth. “Bourbon is up almost 8% this year, and rye is up 25%,” says John Shiffer, marketing director for the Virginia Alcoholic Beverage Control Authority. In Pennsylvania, “growth in the Tequila category last year was driven by increases in the premium (+17.1%) and ultra-premium (+15.9%) price segments, which we expect to continue in 2019,” notes Charles Mooney, executive director of the Pennsylvania Liquor Control Board (PLCB). Meanwhile, control states are looking to up their game in e-commerce, including with delivery. “We’re going to be expanding and enhancing our e-commerce capabilities with real-time inventory,” Shiffer says, noting that the online effort is in its early stages. In Pennsylvania, the FineWineAndGoodSpirits.com site is gaining momentum. While online is “still a very small part of our overall sales, it’s growing at a much more substantial rate than sales at our brick-and-mortar stores. From a shopping perspective, we believe the future is e-commerce, and as such we’re investing significant resources,” says Mooney. “We’re completely redesigning our site to provide a modern-looking, mobile-friendly shopping experience.” He adds that the PLCB is also hoping to introduce a same-day delivery service pilot program in the Philadelphia area this year.—Carol Ward

How Much Alcohol Can You Drink Safely? The New York Times Magazine By Kim Tingley May 16, 2019 Humans have been drinking fermented concoctions since the beginning of recorded time. But despite that long relationship with alcohol, we still don’t know what exactly the molecule does to our brains to create a feeling of intoxication. Likewise, though the health harms of heavy drinking are fairly obvious, scientists have struggled to

NABCA Daily News Update (5/17/2019) 9 identify what negative impacts lesser volumes may lead to. Last September, the prestigious peer-reviewed British medical journal The Lancet published a study that is thought to be the most comprehensive global analysis of the risks of alcohol consumption. Its conclusion, which the media widely reported, sounded unequivocal: “The safest level of drinking is none.” Sorting through the latest research on how to optimize your well-being is a constant and confounding feature of modern life. A scientific study becomes a press release becomes a news alert, shedding context at each stage. Often, it’s a steady stream of resulting headlines that seem to contradict one another, which makes it easy to justify ignoring them. “There’s so much information on chocolate, coffee, alcohol,” says Nicholas Steneck, a former consultant to the Office of Research Integrity for the U.S. Department of Health and Human Services. “You basically believe what you want to believe unless people are dropping dead all over the place.” Scientific studies are written primarily for other scientists. But to make informed decisions, members of the general public have to engage with them, too. Does our current method of doing so — study by study, conclusion by conclusion — make us more informed as readers or simply more mistrustful? As Steneck asks: “If we turn our back on all research results, how do we make decisions? How do you know what research to trust?” It’s a question this new monthly column aims to explore: What can, and can’t, studies tell us when it comes to our health? The truth is, putting alcohol research in context is tricky even for scientists. The Lancet study is epidemiological, which means it looks for patterns in data related to the health of entire populations. That data might come from surveys or public records that describe how people behave in their everyday environments, settings that scientists cannot absolutely control. Epidemiological studies are a crucial means of discovering possible relationships between variables and how they change over time. (Hippocrates founded the field when he posited an environmental rather than a supernatural cause for malaria, which, he noted, occurred most often in swampy areas.) They can include millions of people, far more than could be entered into a randomized-control trial. And they are an ethical way to study risky behaviors: You can’t experiment by randomly assigning groups of people to drive drunk or sober for a year. But because epidemiologists can only observe — not control — the conditions in which their subjects behave, there are also a vast and an unknown number of variables acting on those subjects, which means such studies can’t say for certain that one variable causes another. Modern epidemiology took off in the 1950s and ’60s, when public-health researchers in the United States and Britain began long-term studies tracking a wide variety of health factors in thousands of people over decades and surveying them about their behavior to try to identify risks. What they found when they looked at alcohol consumption in particular was puzzling: People who reported being moderate drinkers tended to have a lower risk of mortality and many specific health problems than abstainers did. Did this mean that a certain amount of alcohol offered a “protective” effect? And if so, how much? In 1992, an influential study in The Lancet observed that the French had a much lower risk of death from coronary heart disease than people in other developed countries, even though they all consumed high levels of saturated fat. The reason, the authors proposed, was partly that the French drank significantly more wine. The notion that alcohol may improve heart health has persisted ever since, even as further research has revealed that it can cause cancer and other health problems and increase the risk of injury and death. But equally plausible counterhypotheses also emerged to explain why teetotalers fared worse than moderate drinkers. For instance, people might abstain from alcohol because they are already in poor health, and most studies can’t distinguish between people who have never had a drink and those who drank heavily earlier in their lives and then quit. Indeed, over the years, compared with abstinence, moderate drinking has been associated with conditions it couldn’t logically protect against: a lower risk of deafness, hip fractures, the common cold and even alcoholic liver cirrhosis. All of which advances a conclusion that health determines drinking rather than the other way around. If that’s the case, and abstainers are predisposed toward ill health, then comparing drinkers to them will underestimate any negative effects that alcohol has. “This problem of the reference group in alcohol epidemiology affects everything,” says Tim Stockwell, director of the Canadian Institute for Substance Use Research at the University of Victoria in British Columbia. “It’s urgent to establish, What is the comparison point? All we know is that risk goes up the more you drink for all of these conditions.” But without a reliable comparison group, it is impossible to say precisely how dire those risks are. NABCA Daily News Update (5/17/2019) 10

The authors of the recent study in The Lancet endeavored to address this problem, at least in part, by removing former drinkers from their reference group, leaving only never-drinkers. To do so, they spent two years searching for every epidemiological study of alcohol ever done that met certain criteria and then extracting the original data. They marked those that already excluded former drinkers, which they thought would make the comparison group more accurate; to those that didn’t, they applied a mathematical model that would control for differences between their comparison group and that of the preferred studies. The results — which are broken down by age, sex, 195 geographical locations and 23 health problems previously associated with alcohol — show that over all, compared with having zero drinks per day, having one drink per day increases the risk of developing most of those health problems. They include infections like tuberculosis, chronic conditions like diabetes, eight kinds of cancer, accidents and self-harm. (The more you drank, the higher those risks became.) This suggests that, on the whole, the benefits of abstaining actually outweigh the loss of any health improvements moderate drinking has to offer. The results, however, also show that a serving of alcohol every day slightly lowers the risk of certain types of heart disease — especially in developed countries, where people are much more likely to live long enough to get it. So, theoretically, if you are a daily drinker who survives the increased risk of accidents or cancers that are more likely to strike young to middle-aged people, by 80, when heart disease becomes a major cause of death, your moderate drinking could prolong your life. Then again, it might be your innate biological resilience that kept you healthy enough to drink. The data still can’t say. Keep in mind that population studies like these are not meant to directly change individual behavior. They offer generalizations — in the case of the Lancet study, that alcohol consumption is probably riskier and less potentially beneficial than we thought — that may eventually influence policies, like higher taxes on alcohol or warning labels on bottles. Paradoxically, only if those policies, in turn, reduce the amount that millions of individuals drink will we know whether doing so improved their overall health. In the immediate term, a better way of understanding the value of scientific studies might be to think of each as a slight adjustment of an eyeglass-lens prescription. Each one answers the question “Is it clearer like this, or like this?” and in doing so, brings our view of reality — our understanding of ourselves and the world around us — into sharper focus. If we dwell too much on the conclusions studies seem to offer, instead of also considering how they were reached, we risk missing out on one of the great benefits of the scientific process: its ability to reveal all that we don’t know.

This email and any files transmitted with it are intended solely for the use of NABCA members, free-of-charge. If you do not wish to receive this daily service, please respond with “UNSUBSCRIBE” in the Subject line. In addition, if there is another individual within your company who should also be receiving this service, please forward their NAME, TITLE, EMPLOYER, and EMAIL ADDRESS to [email protected]. Thank you for your time and attention as we continue to work to improve upon the services and benefits that we provide to our members. Please note that any views or opinions presented in this email are solely those of the author(s) and do not necessarily represent those of the National Alcohol Beverage Control Association.