Fancy a pint? It’s a phrase that’s as fundamental to British culture as cups of tea, complaining about the weather and the Magna Carta. The question possesses a special kind of gravity, one that reaches its peak strength at 5pm on a Friday, when it forces millions of Brits making their way home to change course and head into the nearest bar.
Of course, drinking (alcoholic beverages) isn’t just a British pastime. It’s a habit that reaches back into our Neolithic past: the earliest evidence of booze dates back to 7000 BCE in China – residue on pottery jars recovered from the ancient village of Jiahu in the Henan province was found to be from a drink made of fermented rice, honey and fruit.
And there are depictions of people drinking from horns and similar vessels in cave art that date back even further, with some scholars arguing that these suggest our drinking habit may pre-date agriculture.
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Our relationship with booze could be even older still. In the Bossou area of Guinea, researchers have observed chimpanzees consuming the sap from a palm tree that naturally ferments. The chimps fashion a ‘sponge’ out of chewed-up leaves that they use to soak up the sap, which, when tested, was found to have an alcohol volume of about three per cent.
Whether they were there for the sugar or the mind-altering effects of ethanol (aka alcohol) is up for debate, but it suggests that we may have been consuming alcohol for the vast majority of our past.
This is all to illustrate that human culture and alcohol have a deep, entangled relationship. But the relationship might be about to change.
It seems Gen Z (people born between the mid 1990s and early 2010s) and Millennials (people born from the early 1980s to the mid 1990s) are sober curious. No matter where you look, the statistics paint a similar picture: people aged 16-34 today are drinking far less than their predecessors. So, what have they figured out that the rest of us haven’t?
The benefits of avoiding alcohol are clear (for your body, brain and wallet) and doing so will almost certainly improve your life. But if you don’t want to completely turn your back on booze, what’s the key to consuming less of it? How do you reframe your relationship with alcohol when it’s so engrained in our culture?
Before you can do anything to change your relationship with alcohol, however, you have to understand what it does.
Effects on the brain
“Alcohol is quite a promiscuous drug,” says Dr Rayyan Zafar, a neuropsychopharmacologist from Imperial College London and member of Drug Science. Promiscuous in the sense that it affects multiple receptors in the brain: most notably gamma-aminobutyric acid (GABA), dopamine and serotonin.
GABA is an inhibitory neurotransmitter that calms brain activity, reducing stress and anxiety. It’s stimulated by alcohol. If you’ve ever gone to the pub at the end of a busy day and felt your worries melt away with a wine or beer, you’ve felt the power of GABA.
“That immediate activation of GABA is a pretty central mechanism to alcohol,” Zafar says. Disruptions in the GABA system can contribute to anxiety and benzodiazepine medications (depressants prescribed to relax the nervous system) are sometimes referred to as GABAergic – due to their role in modulating its release.
While it’s stimulating GABA, alcohol also inhibits glutamate – an excitatory neurotransmitter. This means you receive a double dose of relaxation and the GABA effects are primarily what you feel after that first drink or two.
Then comes dopamine, the hormone and transmitter released by doing pleasurable things, such as eating delicious food, having sex or listening to a cherished song. It’s commonly associated with cocaine and smartphones, and is very rewarding for your brain – not to mention moreish.
Studies have shown the dopaminergic systems of alcohol-dependent brains are altered and, broadly, the more you release, the greater your motivation for it will be. The capacity to make good judgements – not having a fourth glass of wine, for instance – may be further incapacitated by the disrupting effect GABA has on the prefrontal cortex, the rational, decision-making part of your brain.
Then there’s serotonin: colloquially known as the ‘love hormone’, it helps to induce feelings of well-being and joy. All of which makes this chemical cocktail sound rather appealing. So, what’s the catch?
Toxic damage
For a drug that’s so freely available and culturally feted, alcohol has serious negative effects that are well known. It’s a global driver of suicide, violent crime, domestic violence and road accidents.
In 2022, the World Health Organization attributed 5.1 per cent of the global disease and injury burden to booze; in the UK alone, alcohol-related diseases caused 9,641 deaths in 2021 (a record).
Liver disease is perhaps the most common condition people associate with excessive alcohol use. “It’s where the body metabolises poisons,” Zafar says. “The liver’s cells are responsible for converting ethanol to acetaldehyde, which is then expelled from the body. It’s the build-up of this poison that can lead to fatty liver.”
Zafar says that just three consecutive days of drinking will increase the levels of fat on your liver. He adds that alcohol-related fatty liver disease develops in 90 per cent of people who drink more than 40g of alcohol (or four units, approximately two pints of beer or cider, or two glasses of wine) per day.
Alcohol is also a leading cause of hypertension, which can lead to heart attacks and strokes, and multiple cancers – Zafar notes that women who consume one drink a day increase their chances of developing breast cancer by between five and nine per cent.
It also reduces fertility for both sexes and a study of nearly 100,000 women in the journal Nature found that light drinking reduced fertility by 11 per cent, with moderate-to-heavy drinking reducing ‘fecundability’ (the probability of conception within one month/menstrual cycle) by 23 per cent.
Furthermore, alcohol will interrupt your sleep, primarily through the disruption of sleep cycles. There are four cycles and booze most notably interrupts the rapid eye movement (REM) cycle, when you dream, your memories are consolidated and your emotions, such as anxiety, are processed.
According to the Sleep Foundation: “Since alcohol is a sedative, sleep onset is often shorter for drinkers and some fall into deep sleep rather quickly. As the night progresses, this can create an imbalance between slow-wave sleep and REM sleep, resulting in less of the latter and more of the former. This imbalance decreases overall sleep quality, which can result in shorter sleep duration and more sleep disruptions.”
Reduced REM can mean those anxieties remain unprocessed and have a ruinous effect on mental health – as will the diuretic effect of booze.
In his book Drink? neuropharmacologist Prof David Nutt writes: “Alcohol dehydrates your whole body, but your skin is where you’ll see it. In fact, each unit of alcohol – that is, 8g – makes you pee out roughly 80ml of urine. So if you drink one 175ml glass of 13.5 per cent wine, you’ll pee out nearly 200ml extra urine. Which is why it’s a good idea to hydrate before drinking, have a glass of water with every glass of wine, and a pint before bed, too.”
The above is just a snapshot of why you might want to consider changing your relationship with booze. The question is, how do you do it?
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Nothing normal
Sally Baker, a therapist based in London who specialises in anxiety and compulsive behaviours, has guided many people on their own alcohol journeys.
“Clients very rarely present with an alcohol problem,” Baker says. “They’ll say they’re hyper-anxious or paranoid. Then I ask what their relationship with booze is like and they’ll say it’s completely normal. I’ll ask when they last blacked out and get a reply like: ‘Oh, I haven’t blacked out for at least a week.’ We’ve normalised alcohol consumption, but there’s nothing normal about imbibing alcohol excessively, how toxic it is and what it does to us.”
She says that “the holy grail of drinking is moderate drinking”, but that she’s had very little success with reducing heavy drinkers to this without a period of abstinence: ideally three months, but at least three weeks.
Anna Donaghey, an alcohol mindset coach, recently started The Big Drink Rethink podcast, exploring the nascent culture of sober curiosity. A former dependent drinker, Donaghey is careful not to sermonise about abstinence. She says she aimed the podcast “at people who probably don’t count themselves as problem drinkers, but have become a bit uncomfortable with their drinking.”
That The Big Drink Rethink exists appears indicative of a wider societal reframing, irrespective of Gen Z (who might not be statistically drinking as much, but are taking record amounts of the increasingly accessible ketamine, which, like alcohol, is a depressant).
There’s the popularity of Club Soda – the low and no-alcohol community, festival and shop – and the inexorable rise of ‘dry January’, as evidenced by the nearly nine million UK citizens who embarked on it this year.
Regardless, cutting back is hard, especially in a society where booze is so culturally and politically embedded (the issue of ‘Big Alcohol’s’ influence on government and policy is for another article).
“I think it presents a real conflict in people’s minds,” says Donaghey. “They don’t want to [drink]: maybe they know a lot about it and how it affects mental health. But we have a massive drive to feel connected to people. And if all our friends drink, there’s peer pressure. The demand to fit in is huge.”
She has a really good tip: whatever period of the day it is that you normally have an alcoholic drink, have two pints of water to slake your thirst.
The TV and radio presenter Adrian Chiles, meanwhile, swears by the Drink Less app, which counts units and maintains a constant vigilance, but also allows leeway for the occasional misstep.
Danger zone
Chiles is arguably the face of the moderate drinking movement. In 2021, he fronted the documentary Drinkers Like Me and followed it up in 2022 with his book The Good Drinker. The book recounts his 40-odd years of high-volume drinking (80-100 units per week) and his efforts to reduce this to safer levels.
“My drinking is very mundane,” he writes. “But this is the point: the most dangerous drinking stories are mundane. The very mundanity of drinking stories like mine is the most dangerous thing about them. We go under the radar, yet most cases of health blighted by heavy drinking are among users like me.”
The Department of Health and Social Care (DHSC) says that the limit for low-risk drinking is 14 units a week: roughly six medium glasses of wine or five pints of strong (5.2 per cent alcohol by volume) beer.
In his book Drink? Prof Nutt recounts that the DHSC divides people into five categories: non-drinker; low-risk (14 units or less); hazardous (14-35 for women, 14-50 for men); harmful (anything above these numbers); and dependent, for which there’s no set limit.
Nutt also highlights the concepts of ‘microlives’, developed by the statistician Prof David Spiegelhalter, which breaks our lives down into 30-minute segments.
Nutt suggests seven units of alcohol might reduce the life of a 30-year-old man by 30 minutes. Many of us may see this as a reasonable price to pay: but what happens when this endures for days, years or even decades? And what if those seven units evolve to 17 or 70 a week?
Nutt estimates that drinking within the 14 units a week for 40 years will reduce life expectancy by 0.4 years, and for 21 units, it’s 0.8 years. What’s notable, however, is the steep dose-response curve after this: 35 units (half a bottle of wine every day, or around 12 strong beers a week, reduces life expectancy by two years. For 70 units (a bottle of wine per day, or around 23 beers per week), it more than triples to seven years.
Double the units to 140 units and you’re likely to meet your end 21 years before your time.
Smoking, being overweight and/or taking other harmful alcohol-adjacent substances, such as cocaine, will have their own additional life-limiting effects.
The definition of moderate drinking is really in the eyes of the beholder. Chiles has reduced his intake to around 25 units per week – above low-risk levels, but a quarter of the 100 units he was regularly consuming. “I believe I’ve earned the right to call myself a good drinker,” he writes, near the end of his book.
No safe level
For those in the DHSC’s ‘harmful drinker’ category, perhaps aiming for the lower categories (35 units and below) is an achievable, damage-reducing aim, but Zafar warns the old adage about red wine being good for you is hokum: “Research shows that if you’re a 65-year-old man, then about half a glass of red wine per day could be of small benefit to cardiovascular function. But there’s no safe level of alcohol that doesn’t increase your risk of cancer. It’s a carcinogen and wouldn’t pass any type of testing now.”
To reduce alcohol-related harms, Zafar says a person must ensure they have at least two successive days of non-drinking per week; and that there are more non-drinking than drinking days each week. “This allows your liver to undergo normal rates of metabolism, which alcohol prevents, and stabilises your brain’s neurochemistry,” he says.
Baker thinks the 0.5-per-cent pale ales are a great option, though they could be triggering for heavy drinkers for whom Alcoholics Anonymous may work. On the latter, she says: “I think people should try it, but it doesn’t suit everyone. Admitting one’s lack of power in the face of alcohol is a big ask for some people and they won’t go near it. But I’ve had several clients for whom it’s a complete lifeline,” she adds.
The biggest trick of all? Embrace the change.
“Alcohol is a change of state and most of us need to find a way to find that [elsewhere]. Go dancing, go running; get the dopamine moving,” Baker says. “When you drink with people it’s hard to tell whether [your enjoyment] is real – remove the booze and you’ll spend your precious time with the people you really care about. Also, you’ll have total clarity about everything you said on a night out, which is a gift for the socially anxious.”
Baker says the pub can be a tricky arena to negotiate – at least to begin with. “There’s little crossover between sober people and drinkers – they’re on a different trajectory.”
The tide can turn, however, as you ease into your new low-/no-alcohol reality. “It comes, but I think it takes time: maybe six to eight months before you can really relax in that environment, become funny and silly. But your ability to be daft sober, when it comes, is joy. Pure joy.”
Even if you don’t make it that far, but manage to sustainably chip any units away from your normal intake, that’ll likely have a tangible impact on your health and happiness, too. Cheers to that.
Take action
If you’re worried about your drinking, or someone else’s, you can call Drinkline for confidential advice 0300 123 1110
About our experts
Dr Rayyan Zafar is a neuropsychopharmacologist from Imperial College London and member of Drug Science. His work is published in Frontiers in Psychiatry, Neuropharmacology, and Molecular Psychiatry.
Prof David Nutt is a neuropsychopharmacology professor at Imperial College London and Chair of DrugScience. Scholar GPs ranked him as the world's leading psychopharmacologist in 2024. His work has been published in a number of books including Drink? and Psychedelics: The Revolutionary drugs that could change your life - a guide from the expert. He is also published in Suicide Research, British Journal of Clinical Pharmacology, and Drugs & Aging (to name a few).
Sally Baker is a therapist based in London who specialises in anxiety and compulsive behaviours. She has three books published: The Getting of Resilience From The Inside Out, 7 simple steps to stop emotional eating, and How to feel differently about food. You may have seen her in one of her many TV appearances across the BBC (or elsewhere).
Anna Donaghey is a qualified and certified alcohol mindset life coach and host of The Big Drink Rethink podcast.
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