No doctor tells patients to smoke cigarettes "in moderation", they are a known carcinogen and not smoking cigarettes is one of the top three ways to prevent lifestyle diseases. Yet culture has been grabbed by twin pincers when it comes to alcohol. American women are told if they have a glass of wine their child may get fetal alcohol syndrome while everyone else will be fine with alcohol in moderation.(1)

The people with the most risk in all cases are those who drink a lot. With all chemicals 'the dose makes the poison', even if environmental lawyers try to convince you that PFAS in water is killing you. Yet some chemical compounds, it's easy to think dose resets each day. With alcohol, you are rolling those epidemiology dice, there is no 'house money', so the fewer dice rolls the better.

Alcoholics clearly have the most risk, just like chain smokers and the morbidly obese in those lifestyle diseases. Yet while the narrative of someone drinking alcohol alone and passing out is an obvious warning sign, it is not how most alcohol abuse starts.  Oddly, the tiny minority of abuses is where most studies focus. It instead starts in youth, like cigarette smoking, and with other people, like cigarette smoking.



A recent review notes that studies of the solitary drinker outnumber studies of the social drinker by a factor of nearly ten-fold, and theories of problem drinking seek to explain alcohol use disorder via broadly asocial mechanisms. This is despite studies noting that those who report the highest levels of enjoyment from drinking in social situations also are more likely to develop alcohol-related problems. 

That may be a mistake. Group functions are considered beneficial to most people and alcohol can lower anxiety and inhibition, but the paper argues that group functions are responsible for the majority of alcohol-related societal harms. Young people most often get into alcohol with other young people, and heavy drinkers socialize with other heavy drinkers. People consume more alcohol in social settings than in private, likely because of the trope that 'drinking alone is bad for you' - meaning drinking in bars is not.

“Some of the most serious negative consequences from alcohol use are linked specifically with social consumption,” the authors write. “In particular, alcohol-related violence, risky sex, and extreme binge drinking are all primarily or exclusively social-drinking phenomena,” as are traffic-related fatalities.

NOTE:

(1) Neither of those are backed by science. European women who drank small amounts of wine have shown no more birth defects in children, much less fetal alcohol syndrome, while alcohol in moderation guidance hasn't been shown to save any lives.