Investigating the Association Between Moderate Drinking and Mental Health

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In an attempt to relate “moderate drinking” to “mental health,” inadequacies of definition for both terms become apparent. Moderate drinking can be variously defined by a certain number of drinks to “nonintoxicating” to “noninjurious” to “optimal,” whereas mental health definitions range from “the absence of psychopathology” to “positive psychology” to “subjective well-being.” Nevertheless, we evaluated the relation by conducting an electronic search of the literature from 1980 onwards using the terms “moderate drinking,” “moderate alcohol consumption,” “mental health,” and “quality of life.”

Most studies report a “J-shaped curve,” with positive self-reports of subjective mental health associated with moderate drinking but not with heavier drinking. The relevance of expectancies has been unevenly acknowledged, and studies on the cultural differences among expectancies are largely lacking. The potential role of moderate drinking in stress reduction and studies of social integration have yielded inconsistent results as previous levels of drinking, age, social isolation, and other factors have often not been adequately controlled. Future anthropological, epidemiological, and pharmacological interactions preferably must be studied through a prospective design and with better definitions of moderate drinking and mental health.

Introduction

Difficulties in capturing the concept of “moderate drinking” 1, 2 are matched by the challenges in identifying valid indicators of mental health. While mental health can be simply defined as “the absence of psychopathology,” Vaillant and Vaillant (3) have reviewed 6 empirical approaches to mental health, which are outlined.

Among these approaches, studies of “moderate drinking” have investigated psychosocial benefits, including positive subjective health and positive mood effects, both anticipated and experienced. Another line of investigation has been the reduction of psychopathology. The current body of research integrates large epidemiological studies with anthropological data.

Most studies use the definitions of “moderate drinking” as set out in available guidelines, expressed as a number of drinks. Main methodological caveats reviewed include the array of definitions of “moderate drinking” and “mental health,” the need to differentiate between “lifestyle” abstinence and those abstainers recovering from drinking problems, and the assessment of psychological benefits in the context of expectancies, social context and cultural norms.

Further study is required of the risks-benefits of moderate drinking in non-Western countries, as well as the directions of causality and their policy implications.

Section snippets

Method

An electronic search of the available literature from 1980 onwards was conducted using the terms “moderate drinking,” “moderate alcohol consumption,” “mental health,” and “quality of life.” The search engines involved were MEDLINE, PyschInfo, and CINAHL. The search was complemented by a retrieval of the references cited in previously published literature reviews.

What Is “Moderate” Drinking?

The conceptual evolution and meanings of “moderate” consumption has been summarized by Eckardt et al. (1). Moderate drinking can be defined as any drinking that is “nonintoxicating;” in other words, consumption that is controlled or restrained, for example, as evident in current campaigns against drinking-driving (Social motivation). Another meaning includes “noninjurious” drinking, or consumption, the cumulative effect of which does not result in health deterioration or harm. Herein,

Moderate Drinking and Mental Health

Within the constraint of the above challenges in definition, the association of moderate drinking and mental health has been the topic of a number of research lines. The initial studies were mostly of a social-anthropological nature and were reviewed by Baum-Baicker (8). Overall small samples were generally involved, interestingly, involving medical students in several cases. The review is considered to be mainly of historical interest.

Fifteen years later, comprehensive reviews by Chick (9), as

Conclusions

In this review of studies around the association of moderate drinking and mental health, several methodological caveats are evident. These relate, first, to the existing array of definitions of “moderate drinking” and “mental health.” Most studies appear to use definitions of “moderate drinking” as laid out in dietary guidelines, favoring those that refer to the number of drinks. Studies into mental health mostly highlight subjective well-being, positive psychological attributes and the absence

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