Evaluating the Huberman Lab alcohol episode

In this episode Dr James Morris evaluates the Huberman Lab's alcohol episode, particularly addressing why the language and terms used around alcohol problems are important. For instance, whilst the Huberman Lab's episode provides a detailed description of the ways alcohol can affect the brain, body and health, in using alcoholism terminology it overlooks a number of important issues. Notably, alcoholism is a non-scientific concept and embedded with stigma and myths about alcohol problems and their causes. Dr Morris therefore discusses why, except when people self-identify as 'alcoholics' (for instance as per Alcoholics Anonymous), scientists and the general public at large should avoid using alcoholism terminology, and instead consider terms like alcohol problems, alcohol dependence or alcohol use disorder.

You can view this podcast on Youtube here.

You can read more about the issues around how alcohol problems are understood in one of my articles here or one of my publications in the journal Drug and Alcohol Dependence.

Transcript

Hello and welcome to the Alcohol Problem podcast. I'm Dr. James Morris, an alcohol researcher interested in alcohol problems and how we understand them. Usually in this podcast, I interview people with lived experience or academics with a special interest in an alcohol-related subject. However, in this episode, I wanted to do something a bit different and I wanted to evaluate a podcast episode from the Huberman Lab.

The Huberman Lab is a very widely downloaded, very well-known podcast and is hosted by Dr. Andrew Huberman who is a neuroscientist and now very well-known podcast host. So the episode I want to talk about is called 'What Alcohol Does to Your Body, Brain and Health'. In this episode, Dr. Huberman provides a very comprehensive and on the whole, I would say accurate explanation of the various ways in which alcohol affects 
the body, the brain, the gut, and its potential consequences, which are essentially negative from a health point of view. 

So my goal is not to critique or attack Dr. Andrew Huberman personally, but rather to highlight I think a few issues that are important that are raised as a result of how this podcast is framed and particularly some of the language and terminology and concepts used around alcohol problems. 

So my purpose is not to really critique or disagree with the majority of the content. On the whole, I would say that it's accurate in terms of highlighting that alcohol is a toxin, that it's carcinogenic, and that even at low doses there are certain risks or negative consequences that perhaps many people who drink alcohol are not aware of. So I think it's important to raise awareness of these consequences and the ways that alcohol is metabolized and the negative effects that it can have. 

Of course, whether or not people should drink or how much they should drink as a result of that kind of knowledge is, as Dr. Huberman highlights, a personal choice. I have had several people talk to me about this episode and kind of claim that it suggests that people shouldn't drink at all or that should be the message from scientists or public health experts. That's not something I agree with because, for instance, many things that we do in our lives carry risk but we don't abstain from them, whether that's driving or kind of eating unhealthy foods or whatever. I think the general principle of moderation, if it's something you want to do, is obviously the goal if you're going to engage in drinking for instance. 

But certainly being aware of the risks and making that as a personal evaluation is important. And that is something that Dr. Huberman elaborates on the podcast. He says he's not highlighting his interpretation of the science to tell people not to drink. But as I said, I've encountered some people who are kind of using this kind of evidence as an argument to put forward that, yeah, an abstinence or a no alcohol message is what we should be advocating. Um as I said that's not really uh my position and not really what I want to discuss per se. Um however there is a broader point that I do also wish to identify within the podcast which kind of reflects some of the broader criticisms that I have come across about the Huberman Lab uh podcasts in general which essentially relate to the idea of scientific uncertainty. So generally scientists and academics are always quite careful about acknowledging the limitations of their research or the kind of where research is out on any particular given question or topic and saying you know there's still known unknowns that more research is usually always needed.

And I think there are certain claims or aspects within the Huberman Labs alcohol episode, where some more scientific uncertainty would have been more accurate in terms of reflecting what we know around or don't know around some of the effects around alcohol use. But on the whole, I think it's generally accurate in saying that alcohol is not good for us and that there are lots of myths and even that low amounts of alcohol are associated with certain negative effects. 

So when I say low amounts of alcohol, I generally mean drinking within the recommended guidelines. So these vary across the world, but generally they're fairly close to our UK guidelines. The guidelines that state 14 units a week or less or advise 14 units a week or less spread over three days or more, but still with having alcohol-free days. So that's roughly equivalent to maybe six or seven pints of average strength lager or one and a half bottles of wine over a course of the week. So generally, drinking at that level is unlikely to result in long term health consequences in and of itself. But as Dr. Huberman points out, that other lifestyle factors and other health behaviors or other environmental factors are going to be important influences on those health outcomes rather than just drinking or consuming alcohol per se. 

And  certain claims around risks of low level drinking, I think are generally well reflected within the evidence base. For instance, effects on brain matter or brain thickness. So yeah, the evidence seems fairly robust that even low levels of alcohol drinking within the guidelines does tend to have some negative effects on kind of brain tissue, grey and white matter. That's not my research area, but as I understand it, it's pretty well established that those kind of effects do exist. 

And the other key issue for kind of low risk drinking is around the carcinogenic status of alcohol. And this is a kind of debate that's going on in lots of different circles in terms of the extent to which alcohol is carcinogenic and what implications that has for low level drinking. So Dr. Huberman gives some, a really good detailed explanation of some of the mechanisms or ways in which alcohol is thought to be carcinogenic. So that is a factor, albeit that again, at low risk levels, drinking alcohol might technically increase risk of certain cancers, but those risks are still relatively low if staying within low risk guidelines. One exception to that may be kind of breast cancer where the risk is really significantly elevated. So cancer risk is greatest for breast cancer, even at low levels of alcohol use.

So my goal is not to kind of criticize the main message of the podcast, which is that essentially alcohol is not good for us, and that people should be more aware of that and factoring that into their decisions to drink. But what I really wanted to talk about is the use of language and the reflection of certain concepts or ideas around alcohol problems. And in particular, use of the terminology or ideas around alcoholism. 

So throughout the podcast, Dr. Huberman does use a wide range of different terms to describe problematic drinking patterns or behaviors. And on the whole, they seem to be used quite interchangeably. And I think that's problematic. So throughout the podcast Dr. Huberman does use the term severe alcohol intake, binge drinking, dependence, chronic abuse of alcohol, over consumption, heavy drinkers, and alcoholics and alcoholism. And it's those last two terms that I really take particular issue with and think really needs further attention and essentially retiring from scientific and professional -
and as much as possible - public discussions around alcohol problems, with the exception of people who self identify, of course, as alcoholics, particularly members of Alcoholics Anonymous. 

So the alcoholism model obviously evolves in large part through the development and growth of AA, Alcoholics Anonymous, into a worldwide fellowship. And again, I'm not here to attack AA or criticize Alcoholics Anonymous, which for some people, particularly those people who do have more severe alcohol problems, more severe degrees of alcohol dependence, which I'll explain a bit more shortly. 

Alcoholics Anonymous can be a really valuable and effective route to recovery. On the other hand, the alcoholism model and Alcoholics Anonymous doesn't work for everybody. In fact, the vast majority, the biggest groups of people who experience negative effects or harms or even alcohol dependence do not benefit or do not wish to engage in Alcoholics Anonymous. And that's why in a broad sense the language of alcoholism is problematic. Because fundamentally when we say alcoholism or alcoholic, it implies that there's two groups of people, that there's kind of people with alcoholism and that that there's everybody else and that everybody else is somehow without this kind of condition or disease and that people with alcoholism do have this kind of 'disease'. 

But modern addiction science is very contested around the concept of disease, but certainly in terms of how kind of most people understand it and think about alcoholics as kind of genetically or biomedically different - and that's certainly not born out in kind of modern understandings of alcohol problems. So in particular, alcohol problems, when we look at them through kind of scientific or clinical measures, we'll use terms of either alcohol dependence or alcohol use disorder, or define certain types of drinking patterns like hazardous or harmful. And all of those can be measured or assessed using  scientifically tested and validated and widely recognised screening or assessment tools. And what we see in all of these tools is that all of these problems exist in degrees of severity, that they exist across continuums. And what that really shows us when we look at the population as a whole, people who drink alcohol, even at low amounts through to the very severe end of the spectrum, that these symptoms and these signs of alcohol problems or consequences of alcohol problems exist in many degrees of severity. So that really does show us that there really aren't two groups of people in the way that it's kind of implied when we talk about alcoholism - that there's kind of 'alcoholics' and everybody else. 

And so for that reason, alcoholism has been retired. It's no longer used in scientific or most scientific papers and research studies, certainly amongst within the alcohol field, very few people use that terminology. And those people that do, again, who self identify, then that's absolutely right for them and can be useful for that recovery. But anything outside of that context and in science communication and talking about risk factors associated with alcohol problems, we really should be avoiding the alcoholism framing and use instead, what we know are kind of scientific validated terms - either alcohol use disorder or alcohol dependence, where we can kind of properly capture and understand and measure these on a more scientifically empirical basis. 

And the reasons for this are kind of not just because alcoholism is kind of not scientific 
but also because it's so heavily embedded in problematic stereotypes that have a lot of negative consequences for certainly public health goals of reducing alcohol problems beyond that kind of very severe end of the dependence spectrum. So stigma - alcohol problems are highly stigmatized. We know that the public judge people who have seen to have alcohol problems very negatively,  that they'll that they'll attach certain negative stereotypes and they'll enact prejudice and discrimination against them. And that itself is harmful. It hurts recovery and it hinders people from recognizing maybe that they have a problem even if it doesn't fit kind of the alcoholism model. 

So we know that using kind of other terms like alcohol use disorder is more beneficial in terms of reducing stigma or avoiding some of the problems that kind of stigma is really responsible for. And the other issue really, or another key issue with alcoholism terminology in the kind of broader sense, where outside of AA contexts or self-identification contexts is implications for what causes or how alcohol problems exist as. 

So as I've said, 'alcoholism' implies that it's some kind of disease individually located within the person. Whereas what we actually know is that alcohol problems, yes, do have biomedical components and obviously addiction and alcohol dependence involves the brain and brain changes and that there are genetic predisposing factors that contribute, to some degree, to the development of alcohol problems or other addictions. However, the weight that the general public generally places on these factors of kind of disease or genetics is really not very reflective of what we know is the true kind of contributory factors to the development and recovery from alcohol problems. 

So for example, we know that there are many, many psychological factors that contribute to alcohol dependence or alcohol problems, particularly other mental health issues, stress as a major cause or driver of alcohol problems. But we also know that social networks and the environment and the culture that we exist in are heavily influential on the level of alcohol consumption within populations and specifically the development of different types of problems. So we know that public health measures like minimum pricing,  like restrictions on advertising and availability - these are the most effective levers for reducing alcohol problems at the population level. And of course, when we use the term alcoholism, it kind of detracts from that because it  places or locates the problem within that person or implies that it's a problem of their genes.

So that's another issue that really comes up for me within the Huberman Labs alcohol episode, is that Dr. Huberman refers on many occasions or several occasions at least to people with genetic predispositions to alcoholism or talks about how genetics are kind of a driving factor for much of the development of alcohol problems. And I'm not denying that genes play a role. And indeed, to be fair to Dr. Huberman, he does acknowledge that genes are not deterministic, that they interact with the environment. But at the same time, I think that there's much more caution needed around the actual role that genes play in the development of alcohol problems. And something like alcohol problems are very much polygenic, so it's not that there is a single or small number of genes that contribute to the development of alcohol problems or alcohol dependence. It's probably spread across thousands of genes that may play each very, very tiny role in contributing to those kind of risk factors. And it's commonly described as being heritable to like 50% heritable, but 50% heritability doesn't mean someone's chances are kind of like 50% of developing an alcohol problem. You know, that it's actually a requirement that a lot of other things are needed, environmental factors and, life stressors or adverse childhood experiences, we know, are very strong drivers of alcohol and mental health problems.

So this kind of issue of kind of overemphasizing or overvaluing the role of genes in the development of alcohol problem has been called genetic essentialism, whereby it's kind of believed that it's kind of a person's nature, it's within their nature to have developed that alcohol problem rather than as we know through kind of huge amounts of psychological and social research that the environment and people's experiences are very heavily determinant of the development of alcohol problems and may interact or result in certain gene expression functions. But on the whole, it's certainly not the case that the existence of certain genes leads to alcohol problems. 

And the other issue with kind of maybe unintentionally over-emphasizing kind of genetic or biomedical components around alcohol problems is it doesn't really help us with, certainly in terms of where we're at with the current science or treatment status, that these kind of genetic or biomedical approaches generally don't help us with the treatment or prevention of alcohol problems because as I've said, the most important, almost valuable levers available to us, certainly at a population level, are the environmental factors around price availability and marketing. And when we're looking at kind of individualized treatments, as well as making recovery networks available, whether that's Alcoholics Anonymous, or other groups that can work just as well without using that kind of disease model, that those treatments are very much behavioral and psychological in kind of their mechanisms as well. 

So as I said, the social networks are really important for many people when they recover a really important component of that is kind of changing their social network or adopting protective behavioral strategies so that they can identify risk factors and manage those or avoid those. So a huge amount of addiction treatment or treatment for alcohol problems or alcohol dependence in particular involves not just medically managing withdrawal but also very psychological and behavioral components of alcohol problems that these biomedical focuses or alcoholism attributions tend to overemphasize. 

There's one more key issue really with that I really want to highlight with both the kind of alcoholism framing, outside of that kind of recovery or severe dependence context, where it may sometimes be useful or applicable, which is the idea around abstinence as always necessary for recovery, which Dr. Huberman kind of perpetrates this, this false idea in a couple of points within the podcast. He does acknowledge that there's some controversy around the issue of whether abstinence is always essential for recovery. But it's actually not really controversial if you look at the evidence base available. Yes, of course scientific uncertainty in that we need we need to continue and further research under what circumstances non-abstinent recovery, or as it used to be called controlled drinking, might be suitable or a kind of relevant recovery goal. But we've had a couple of years ago, a systematic review of meta-analysis that looked at all of the literature on, or all of the sufficient quality literature on controlled drinking or non-abstinent recovery outcomes in treatment, and found that for those people who were choosing or were suitable for a controlled drinking or non-abstinent those people did just as well in their recovery outcomes as people suitable choosing abstinence goals. 

So it's not to say that everybody can moderate or control their drinking who has an alcohol problem or an alcohol dependence. That's absolutely not the case. And for many people, abstinence is the best option or necessary for their recovery potentially.  But it's just simply not true that anybody who has alcohol dependence or an alcohol problem needs lifelong abstinence to recover.

So that's another problem, particularly with kind of over applying or using the alcoholism framework or kind of language outside of the context of kind of alcoholics anonymous or people who self identify with it because it again is so rooted in this idea that abstinence is necessary. And also rooted in the idea that alcohol problems are always severe and that maybe people need to hit rock bottom before they can actually recover. And as I said we know from the much broader literature and the nature of alcohol problems as across continuums whether you look at them as dependence or behavioral consequences or consequences for well-being or mental health, we know that all these kind of consequences and symptoms and patterns exist in continuums. And for many people, particularly perhaps lower down on those continuums in terms of their severity, for many of them, abstinence is not going to be something they're interested in and something that they possibly, or in many cases, will not need.

That said, for many people who achieve controlled drinking or non-abstinence recovery or moderation (again, those terms are pretty interchangeable, although might be defined differently in different contexts), for those people, a period of abstinence is usually going to be necessary or particularly helpful. So on other episodes, I've spoken about my experience. I had a long period of abstinence, of many years before I drank again - kind of as an experiment to kind of see whether it was possible. And yeah,  partly  because of this very long period of abstinence, maybe not just because of the neurological changes that I was able to, that maybe would have took place during that long period of abstinence, the kind of maybe synaptic pruning of unlearning some of those kinds of behaviors that I developed that led to, uh, kind of cravings or beliefs around alcohol and the desire to drink heavily or problematically, that those were perhaps kind of unwound in some ways.  I've got an episode with Dr. Mark Lewis, where we talk more about those kinds of processes. But also because I addressed lots of other factors in my life, much more psychological factors, kind of thinking about, or learning and understanding and exploring some of the reasons why I wanted to drink problematically or destructively in the past and also like changing my social network so that I no longer had social networks who were kind of pushing me or encouraging me to drink heavily, but to ones who kind of accepted me or respected me as a non-drinker or at least now a moderate drinker. 

So the issue around non-abstinent recovery of controlled drinking is complex and again, I'm not to say that everybody with an alcohol problem can achieve controlled drinking. Certainly abstinence has many advantages and its usually always going to be necessary, or very often going to be necessary, to have a period of abstinence before successfully moderating someone's drinking. It's complex and there's lots of factors involved in that, but just the idea that everyone with alcohol dependence or an alcohol problem needs abstinence is just not reflected in the contemporary scientific literature. 

So those are the main issues that I really wanted to highlight. Really that, as I said at the start, the vast majority of the content in the podcast, the Huberman Lab's alcohol episode, I think is accurate. That alcohol is not good for us in any way and that even low to moderate amounts of alcohol carry certain risks. But my issue really is about the misuse or use of old and unhelpful or problematic language, particularly relating to alcoholism and the embedded stereotypes and negative connotations that it really has. 

So as I've said, for people that self identify as alcoholics or with the model of alcoholism, then that's absolutely fine and many people recover through doing so. But for the much broader population of people who experience problems resulting from their alcohol use, whether those problems are degrees of alcohol dependence or impacts on their mood, their sleep, their energy, or as contributory factors to other diseases or illnesses, for the vast majority of those people, they will not identify with or benefit from a kind of alcoholism model. 

And we need to, you know, improve awareness and understanding that the alcohol problems exist on many broad spectrums and that they don't just fall into kind of two categories. And with that it's really important that we don't overemphasize the kind of biomedical factors as kind of causes or perhaps solutions to alcohol problems. It's really important that we understand that, yeah, that there are some genetic elements to the development of alcohol problems and certainly as alcohol problems develop, they're interacting with of our genes and our physiological processes and, you know, things going on in the brain. 

But it's by no means alcohol problems are being driven by, or not primarily driven by genetic factors, that these are much more or very heavily embedded within our social and lived experience in terms of stress and social environment and kind of normalization of alcohol in society. 

So I think that's really, really what I wanted to cover that, you know, alcohol problems and  alcohol use are something that we need to scrutinise more and we need more availability of so I really welcome the Huberman Labs podcast overall in terms of highlighting some of these consequences that we need greater awareness of.  But really it is a plea for certainly scientists and even members of the general public to really be careful about avoiding outdated language that's deeply embedded in stigma and often false ideas or wrong ideas about how alcohol problems exist and their implications for recovery. 

So yeah, sometimes  I've been accused of kind of like word policing or those kind of debates are relevant that, you know, we're not going to help or change things by just changing the language. But actually, there's pretty strong evidence that language really does matter, that how we use these terms and how we describe these problems really does have very clear and direct consequences for a range of things, both in terms of how people identify themselves as potentially having an issue or kind of a dependence, or in terms of the stigma, or in terms of their likelihood of seeking help, or how they might talk about or think about related factors and problems in their lives. 

So I think I'll wrap it up there. And I think I said at the start, I'd invited, I'd reached out to the Huberman Lab and said I was willing to discuss this with them further. But obviously it's a very busy, widely hugely popular podcast. They get many invitations and weren't able to accept mine, but I'm still open to doing so. And I look forward to hearing any other comments or discussion in the comments here.  And you can also contact us or follow us on social media, Instagram and Twitter @alcoholpodcast. So yeah, please do follow us and rate us and I hope you've enjoyed this episode.