Moderate Alcohol Use: The Heterogeneity of Abstention
Principal Investigator: Robert I. Lipton, Ph.D.

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This project is designed to describe a relatively under-described population, abstainers, in more depth. This is an important population because differences in abstainer health may help explain why moderate alcohol consumption seems to protect against heart disease. In this research, I would like to determine if abstainers have a higher prevalence of physical and mental illness compared to light-to-moderate alcohol drinkers and, among abstainers, determine if differences exist in regard to prevalence of physical and mental illness. Socio-demographic measures, lifestyle, and ethnic/cultural differences will also be examined for abstainers and light-to-moderate alcohol consumers. To this end, a nationally representative dataset, the National Longitudinal Alcohol Epidemiologic Survey will be used to (1) measure alcohol use in terms of frequency, quantity, and binge drinking; (2) distinguish amongst those abstaining based on differences in health, smoking, ethnicity, and socio-demographic measures; (3) determine amongst those abstaining if there are differences in risk of heart disease by type of abstainer-sick never drinkers, healthy never drinkers, former light, moderate, heavy drinkers, abusing drinkers; (4) determine among those abstaining if there are differences in risk of depression by type of abstainer; (5) determine if abstainers have higher levels of depression/mood problems than those not abstaining when controlling for socio-demographic variables, ethnicity, and physical illness; and (6) determine if abstainers have higher levels of heart disease, compared to those not abstaining.

Information from these activities will serve two related purposes: (1) to increase our understanding of the correlates of abstention, particularly differences across age, gender, and ethnicity and (2) to increase our ability to classify abstainers into etiologically meaningful categories relevant to moderate alcohol and health. Often moderate drinkers, who may also be moderate in many different measures of lifestyle and health status, are typically compared to abstainers who may have combinations of measures that are considerably less moderate, or at the least, very different. Thus, instead of measuring differences in health outcomes based on alcohol consumption between moderate and abstention categories, researchers frequently are comparing, for example, sick former heavy drinkers with relatively healthy moderate drinkers. Similarly, sick never drinkers might be compared to moderate alcohol drinkers. In either case, the possible beneficial effect of moderate alcohol use is obscured by other factors that may be influencing health outcomes independently from moderate alcohol use or abstention. Results from this project will allow a more insightful examination of the role of moderate alcohol in protecting against certain chronic diseases.

Findings: I found that former drinkers who smoke have much higher rates of myocardial infarction than do either lifetime abstainers (who smoke) or current drinkers (who smoke). Lifetime abstainers have lower rates of clinical depression than current drinkers and ex-drinkers. Further, I have found that people who are never smokers and currently employed, regardless of alcohol consumption (life-time abstainers, ex-drinkers, moderate drinkers, current drinkers), are protected against ever having a (self-reported) myocardial infarction.

Abstainers are a heterogeneous group, with former drinkers being sicker than lifetime abstainers or current drinkers. There could be something like a healthy drinker effect in play, whereby people who are simply too sick to continue drinking wind up in the abstainer/ex-drinker category.


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