March 2008Family Medicine
The relationship between moderate alcohol use and
health is complex. Over the last 30 years, a series of
observational studies have suggested a U- or L-shaped
relationship between alcohol use and coronary heart
disease (CHD), with the lowest risk among people
who drink approximately one drink daily.1, 2 In many of
these studies, all-cause mortality was also found to be
lowest among moderate drinkers.3-5 Moderate alcohol
use has also been associated with a lower incidence of
peripheral vascular disease,6, 7 cholelithiasis,8 and type
II diabetes mellitus.9
Several concerns have been raised about the studies
that link moderate alcohol use and CHD.10-14 Most im-
portantly, all of these studies have been observational,
raising the possibility that an unmeasured confounding
factor explains the association, and no long-term con-
trolled trial of the issue is apt to be completed in the
near future. Recent examples highlight the difficulty
that can occur in attempts to interpret the results of
In addition, even moderate alcohol consumption can
have risk. A pooled analysis of 322,647 women dem-
onstrated a dose-dependent increase in breast cancer
risk associated with moderate alcohol use.16 Alcohol use
also potentiates the hepatocellular injury of hepatitis
C, which could explain the increase in cirrhosis attrib-
utable to even moderate alcohol intake.4,17 Accidental
injuries are also associated with moderate drinking,18
and some investigators have found that moderate al-
cohol consumption may increase the risk of osteopo-
rotic fractures.19 Finally, concern has been raised that,
because of the habituating effect of alcohol, moderate
consumption could rise to an excessive level.20 At this
time, it is not known whether alcohol abuse is likely to
develop after a recommendation for increased alcohol
intake is made to a given individual.
Despite these controversies, we know little about
how patients view these concerns or whether they
Clinical Research and Methods
Beliefs, Motivations, and Opinions about Moderate
Drinking: A Cross-Sectional Survey
Kenneth J. Mukamal, MD, MPH, MA; Russell S. Phillips, MD; Murray A. Mittleman, MD
From the Division of General Medicine and Primary Care (Drs Mukamal
and Phillips) and the Division of Cardiology (Dr Mittleman), Beth Israel
Deaconess Medical Center, Boston, Mass.
Background: The relationship of moderate alcohol use and health remains controversial and un-
certain. How physicians and patients react to this uncertainty is unknown. Methods: We surveyed
outpatients at a single urban medical center that provides primary and tertiary care. Participants
completed a self-administered anonymous survey regarding their medical history, usual alcohol
consumption, and preferences and opinions regarding moderate drinking, defined as a drink every
1 to 2 days. All English-speaking individuals ages 21 years and older were eligible. Results: A total
of 878 outpatients participated, with a response rate of 79%. The median age was 47 years, and
57% were women. Approximately 60% of drinkers and 35% of abstainers agreed with the statement
that moderate drinking is a healthy activity and that it is safe for most people. About one third of
participants cited possible health benefits as part of their motivation for drinking alcohol. Those who
cited health benefits tended to be older, consumed alcohol more frequently but with a lower quantity
per drinking day, and were more likely to have a history of coronary heart disease. Only about 10%
of participants identified breast cancer as a possible risk of moderate drinking. When asked whether
they would be willing to consume one drink every 1–2 days if their doctor so recommended, 41%
of abstainers and 72% of all drinkers were willing to do so. Conclusions: A substantial number of
medical outpatients cite health benefits as a motivation for drinking alcohol and a willingness to
drink alcohol regularly if so recommended by a physician, although few recognize health risks from
(Fam Med 2008;40(3):188-95.)
195Vol. 40, No. 3
Clinical Research and Methods
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