Early Fermentation and Distillation
Prehistoric humans probably "discovered" rather than "invented" alcoholic beverages. With the help of airborne yeast, a fruit or berry mash left in a warm corner of a cave or hut would ferment; that is, the yeast would convert sugars in the fruit to alcohol. Pleased with the effects of the beverages they had unintentionally created, early humans most likely advanced quickly from accidental discovery to intentional production. Archaeological records of the oldest civilizations indicate the presence of wine and beer.
Until about the Middle Ages, most alcoholic beverages were produced only by fermentation and consisted of beers and wines with an alcohol content of up to 14%. When this percentage of alcohol is reached, yeasts die and fermentation stops.
In Europe in the fifteenth century, distillation was used to produce alcoholic beverages stronger than fermented wines and beers. These distilled products were known as spirits of wines (usually referred to as liquors today). Beverages with an alcohol content of 50% or more soon became the choice of those desiring quicker or more potent effects.
The distillation process works as follows: a liquid is heated to the lowest boiling point of one of the compounds it contains. This compound (such as ethanol) then vaporizes. The vapor is cooled and condenses (returns to the liquid state). The liquid condensate is then collected. This process of distillation produces a purer and more concentrated liquid (the condensate) than the liquid in which the condensate initially was found. In the case of liquors, ethanol is separated from water and other substances in which it is dissolved, producing a highly concentrated alcoholic product.
The basic characteristics of alcoholic beverages have remained unchanged from early times. Contemporary alcoholic beverages are little more than old recipes refined by technology and produced in much larger quantities.
Early Uses and Abuses
Beer and wine have been used since ancient times in religious rituals, both as a salute to the gods and as sacred drinks from which humans could receive the "divine" power of alcohol. Alcoholic beverages not only were required in worship and the practice of magic and medicine, but also were central to the celebrations of councils, coronations, war, peacemaking, festivals, hospitality, and the rites of birth, initiation, marriage, and death.
In ancient times, just as today, use of beer and wine sometimes led to drunkenness. One of the earliest tracts on temperance (controlling one's drinking or not drinking at all) was written in Egypt nearly three thousand years ago. These writings can be thought of as similar to present-day pamphlets espousing moderation in alcohol consumption. Similar recommendations were found in early Greek, Roman, Indian, Japanese, and Chinese writings, as well as in the Bible.
Drinking in America
In colonial America people drank much more alcohol than they do today, with estimates ranging from three to seven times more alcohol per person per year. Many drank considerable amounts of liquor daily, especially rum, which was readily available through trade with the West Indies.
Liquor was used to ease the pain and discomfort of numerous illnesses and injuries such as the common cold, fever, broken limbs, toothaches, frostbite, and the like. Parents often gave liquor to children to relieve their minor aches and pains or to help them sleep. It was also part of many social and religious occasions and was used to give courage to some individuals and to reduce tensions in others. Because of the important role alcohol played, taverns rapidly became the social and political centers of towns.
As early as 1619, drunkenness was illegal in the American colony of Virginia. It was punished in various ways: whipping, placement in the stocks, fines, and even wearing a red "D" (for "drunkard"). By the eighteenth century, all classes of people were getting drunk with greater frequency, even though it was well known that alcohol affected the senses and motor skills, and that drunkenness led to increased crime, violence, accidents, and death.
Temperance
In 1784 Dr. Benjamin Rush, a physician and signer of the Declaration of Independence, published a booklet called An Inquiry into the Effects of Ardent Spirits on the Mind and Body. The pamphlet became popular among the growing number of people concerned about the excessive drinking of many Americans. Such concern gave rise to the temperance movement.
The temperance movement in the United States began in the early 1800s and lasted until roughly 1890. By 1833 there were thousands of local temperance societies in the United States. The goal of the temperance movement initially was to promote moderation in the consumption of alcohol. By the 1850s large numbers of people were giving up alcohol completely, and by the 1870s the goal of the temperance movement had become to promote abstinence from alcohol.
Women and churches played a significant role in the growth of temperance organizations. Reformers were concerned about the effects of alcohol on the family, the labor force, and the nation, all of which needed sober participants if they were to remain healthy and productive. Temperance supporters usually saw alcoholism as a problem of personal morality. They believed that the use of alcohol eventually led the user down the path to ruin. Early women's rights activists supported the temperance movement because they recognized a connection between heavy drinking and spousal abuse.
Prohibition
In 1919 reform efforts led to the passage of the Eighteenth Amendment of the U.S. Constitution, which prohibited the "manufacture, sale, or transportation of intoxicating liquors" and their importation and exportation. The Volstead Act of 1919, passed over President Woodrow Wilson's veto, was the Prohibition law that enforced the Eighteenth Amendment.
The Eighteenth Amendment and the Volstead Act did not have the intended effect. Outlawing alcohol did not stop most people from drinking; instead, alcohol was manufactured and sold illegally by gangsters, who organized themselves efficiently and gained considerable political influence from the money they earned. Some of the modern organized crime syndicates operating in the United States can be traced back to Prohibition. In addition, the apparent corruption of government and law-enforcement officials contributed to a decline in citizens' respect for these agencies. During Prohibition, some citizens took matters into their own hands, brewing alcoholic beverages at home in places like attics, sheds, and basements. Other Americans smuggled in alcohol from countries that border the United States—Canada and Mexico. Ultimately, the Eighteenth Amendment was repealed in 1933 with the passage of the Twenty-first Amendment.
Changing Attitudes
As the decades passed, recognition of the dangers of alcohol increased. In 1956 the American Medical
Table 2.1
Critical endpoints of alcohol consumption
| Critical endpoints of alcohol consumption | |||
| Women | Men | Comment | |
| Beneficial alcohol effects | |||
| Coronary heart disease | <14 g/day max. risk reduction: 14-29 g/day | <14 g/day max. risk reduction: 29-43 g/day | 14 prospective studies; 4 case-control studies particularly for persons >50 years |
| Stroke | <14 g/day | <14 g/day | 5 prospective studies; 8 case-control studies |
| Gallstones | risk reduction? | 2 prospective studies; 1 case-control study; 4 cross-sectional studies | |
| Harmful alcohol effects | |||
| Blood pressure | >20 g/day | >30 g/day | 5 prospective studies; 17 cross-sectional studies; 6 intervention studies |
| Stroke | >40 g/day | >40 g/day | 5 prospective studies; 8 case-control studies |
| Cirrhosis of the liver | >12 g/day | >24 g/day | 5 prospective studies; 9 case-control studies; 4 cross-sectional studies |
| Cancer of the mouth, pharynx, larynx, oesophagus | >10-15 g/day | >20-25 g/day | Externalised study including 3 prospective studies and 38 case-control studies |
| Cancer of the breast | >30 g/day | 14 prospective studies; 27 case-control studies accessory literature: 5 meta-analysis | |
| Cancer of the colon, rectum | >15 g/day? | >15 g/day? | Externalised study including 4 prospective studies and 10 case-control studies association generally questionable |
| All-cause mortality | max. risk reduction: ≈10 g/day | max. risk reduction: ≈19 g/day | 27 prospective studies for persons >40 years |
| No alcohol effects: | Cancer of the stomach (12 case-control studies) | ||
| Cancer of the pancreas (4 prospective studies + 11 case-control studies) | |||
| Insufficient evidence: | Steatosis (1 cross-sectional study) | ||
| Alcoholic hepatitis (1 case-control study; 1 cross-sectional study; 1 intervention study; accessory literature) | |||
| Cancer of the liver (0 qualified study) | |||
| Cancer of the gallbladder and bile duct (0 qualified study) | |||
| Pancreatitis (0 qualified study) | |||
Association endorsed classifying and treating alcoholism as a disease. In 1970 Congress created the National Institute on Alcohol Abuse and Alcoholism, establishing a public commitment to alcohol-related research. During the 1970s, however, many states lowered their drinking age to eighteen when the legal voting age was lowered to this age. The rationale was that if people were old enough to vote or to be drafted into the military at eighteen, they were old enough to drink alcoholic beverages.
Traffic fatalities rose after these laws took effect, and many such accidents involved people between the ages of eighteen and twenty-one who had been drinking and driving. Organizations such as Mothers against Drunk Driving (MADD) and Students against Drunk Driving (SADD) sought to educate the public about the great harm drunk drivers had done to others. As a result, and due to pressure from the federal government, by 1988 all states raised their minimum drinking age to twenty-one. Beginning in 1989, warning labels noting the deleterious effects of alcohol on health were required on all retail containers of alcoholic beverages. Courts began to hold restaurants and bars accountable when they permitted obviously intoxicated patrons to drive.
The National Highway Traffic Safety Administration estimates that laws making twenty-one the minimum drinking age have reduced traffic fatalities involving drivers eighteen to twenty years old by 13% and have saved an estimated 21,887 lives since 1975 (Traffic Safety Facts 2002—Alcohol, National Highway Traffic Safety Administration, 2003). Still, the misuse and abuse of alcohol remain major health and social problems in the world today.
Beneficial and Harmful Health Effects of Moderate Alcohol Consumption
Not all of the effects of alcohol consumption are harmful to health. Table 2.1 shows levels of alcohol consumption that can provide beneficial health effects as well as levels that can provide harmful health effects. The number of scientific studies that support the data listed in each row of the table are noted in the "comment" column.
For example, findings of eighteen studies show that alcohol consumption of less than fourteen grams per day lowered the risk of coronary heart disease (CHD) for both men and women compared to no alcohol consumption. (In the United States, a standard drink contains fourteen grams of alcohol, which is about one five-ounce glass of table wine, one twelve-ounce glass of beer, or 1.5 ounces of eighty-proof gin, vodka, or whiskey.) Risk was lowered the most for women drinking fourteen to twenty-nine grams of alcohol per day and for men drinking twenty-nine to forty-three grams of alcohol per day.
TABLE 2.2
National drinking guidelines for the U.S., Canada, the U.K., and Scandinavia
| USAb | Ontario (Canada)d | United Kingdoma | Scandinaviac | |
| Drinking guidelines | Women: ≤1 drink/day Men: ≤2 drinks/day —Together with meals |
Women: ≤2 drinks/day max. 9 drinks/week Men: ≤2 drinks/day max. 14 drinks/week —Together with meals —Together with nonalcoholic beverages |
Women: ≤2-3 units/day Men: ≤3-4 units/day —Pregnant women: ≤1-2 units/week |
4-5% of total energy intake Women: ≤15 g alcohol/day Men: ≤20 g alcohol/day |
| Definition of a drink/unit | 1 drink: ≈350 mL beer ≈150 mL wine ≈4 dL spirits |
1 drink≈13.6 g alcohol: ≈340 mL beer (5 vol.%) ≈140 mL wine (12 vol.%) ≈85 mL wine (20 vol.%) ≈4 dL spirits (40 vol.%) |
1 unit: ≈285 mL beer ≈1 small glass of wine ≈1 pub measure of spirits |
|
| Target group | Adults, except for pregnant women, women trying to conceive, in the case of drinking problems, road traffic, and medication | Healthy adults, except for pregnant and breast-feeding women, women trying to conceive, in the case of drinking problems, special diseases, medication, road traffic, working with dangerous machinery or equipment, responsibility for the safety of others or public order, and physical activity | Adults, except for persons in road traffic, in the case of working with dangerous machinery or electric material, physical activity, medication, and before working or in the workplace | Healthy persons >15 years old, except for pregnant women, in the case of special diseases |
| Background information | Moderate alcohol consumption reduces risk of several diseases (coronary heart disease) | Amount of alcohol not yet related with health risk; health benefits of alcohol apply mainly to people >45 years; however, there are less risky alternatives than alcohol use for abstainers to reduce coronary heart disease risk | Significant reduction of risk of coronary heart disease for persons >40 years, and after menopause as a result of drinking 1-2 drinks/day; no risk for higher alcohol intake when keeping drinking guidelines | Alcohol per se is harmful; reference to reduced nutrient density with increasing alcohol intake; beneficial effects of moderate alcohol consumption for persons >40 years |
| Unusual feature | Citation of recent guidelines: "Alcoholic beverages have been used to enhance the enjoyment of meals by many societies throughout human history" | Previous weekly and lower limit: Women: ≤21 units/week Men: ≤14 units/week |
||
| aDepartment of Health. The report of an inter-departmental working group. Sensible Drinking, 1995 (Dec). | ||||
| bUS Department of Agriculture, US. Department of Health and Human Services. Dietary Guidelines for Americans. 4th rev. ed.; 1995. | ||||
| cA task under the Nordic Council of Ministers. Nordic nutrition recommendations. Scandinavian Journal of Nutrition 1996; 40:161-5. | ||||
| dA report of the committee to recommend draft guidelines on low risk drinking of the province of Ontario. Low Risk Drinking Guidelines for Ontario. Phase I: Review of Scientific Evidence: A Discussion Document; 1996 Oct 15. | ||||
Conversely, alcohol consumption of greater than twelve grams per day in women and twenty-four grams per day in men raised the risk of cirrhosis of the liver, a chronic and sometimes fatal disease in which the liver becomes scarred and does not function properly (see Table 2.1). Additionally, alcohol consumption of greater than thirty grams per day in women was associated with an increased risk in breast cancer.
The national drinking guidelines of the United States, Canada, the United Kingdom, and Scandinavia are shown in Table 2.2, and reflect the concept that alcohol has both beneficial and harmful effects.
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