Should the Surgeon General’s New Warning About Alcohol Change Your Drinking Habits?
Cheers to navigating risk (it’s everywhere)🥂
ICYMI 👉
I slept terribly on New Year’s Eve. Possibly because my cat started meowing two inches from my head around 4 am. More likely, though, it was the two glasses of wine I drank at dinner that flung my eyelids open in the wee hours of 2025.
So I didn’t really need the Surgeon General’s new warning about alcohol’s link to various cancers—including breast, esophageal, and colorectal—to motivate me to abstain from booze the next night. Many of us, especially in the medical profession, have known about these risks for a long time. I discuss these risks with patients on a regular basis. For me at least, it’s alcohol’s immediate effects on sleep, mood, cognition, and energy that periodically remind me to cut back.
But should the Surgeon General’s latest warning change our collective behaviors around alcohol? Should there be a moral imperative for doctors to recommend abstinence to their patients, and for all of us to quit drinking forever?
The answers depend on three things: 1) our respective medical situation 2) our respective tolerance for risk and 3) how one conceptualizes the role of doctors in helping people navigate risk.
Whether you realize it or not, your everyday choices involve continuous micro-decisions about risk. Every time you drive a car, have sex, or breathe communal air, you’ve tacitly signed a contract with yourself, agreeing that the perceived benefit of the proposed activity outweighs the potential risks.
In short, life is about tradeoffs, and reasonable people can disagree on what is “worth” a particular risk. You drive a car because you’ve decided that walking to point B would take too long, and because you’ve accepted the risks of getting into an accident, popping a tire, or running late due to road closures. The risk of dying isn’t top-of-mind because you consider yourself a good driver and you’re nominally aware of the low death rates associated with driving.
But should you worry about the risk of dying on the drive to work? The answer depends on things like your driving route and its duration, the safety of your car, current road conditions, your past history of car accidents, your visual acuity, and your level of alertness, even your age and your reflexes. Thus, how much each of us worries about death from driving will vary person by person. For example, you might decide to walk, not drive, to point B on days you’ve slept poorly or when road conditions are bad. I, on the other hand, might be the kind of person who, despite a snowstorm or staying up all night with my cat, decides to roll the dice and get in a car anyway.
But should your doctor lecture you about highway safety—like we do about alcohol use? Ideally, yes. Pediatricians routinely ask their teen patients about wearing seatbelts, for example. Should doctors then forbid people from driving altogether, due to its inherent risks and non-zero highway fatality rates? I don’t think so, except in specific cases—dementia, low vision, serious physical disability, or other medical disorders which render the danger to self and others unreasonably high.
In short, nothing in life is risk-free. We cannot eliminate risk. We can only mitigate it, using facts, expert advice, and our subjective, personal sense of risk and reward to make decisions. As a physician, I feel that it should be up to each person to make their own decisions about risk, as long as they aren’t breaking the law or putting other people in harm’s way, and ideally with access to data and a frame to help make healthy choices.
The same logic applies to drinking alcohol. (The obvious difference between driving and drinking alcohol is that driving doesn’t itself impair judgment…so be sure to consider your risks around alcohol before you pick up a drink!) For example, my patients who face a higher-than-average risk for developing breast cancer might use the Surgeon General’s warning to quit drinking altogether. Indeed the purpose of the warning is to spread the message to people who may not have known about the risks, and to motivate anyone who already wanted to cut back.
On the flip side, these same patients would be perfectly justified in sticking to their occasional (or even regular) glass of wine—not because they enjoy flouting data or flirting with death any more than the next person, but because, for many people, social drinking is pleasurable and because this perceived pleasure might outweigh the potential increase in breast cancer risk. Risk is about playing the odds. Pleasure is in the eye of the beholder, and, in my humble opinion, it is not the job of medical providers to tell people what individual health risks they should tolerate.
(For two prime examples of medical professionals’ own risk tolerances overtaking data and nuanced messaging to dictate other people’s basic behaviors, see: THE PANDEMIC or THE CURRENT DEBATE ABOUT ASSISTED DYING for terminally ill patients. More on the latter soon.)
Of course there are exceptions to every rule. For my patients whose alcohol use is causing significant harm to themselves or to other people, I am more prescriptive with advice. I feel it’s my professional duty to insert my judgment with patients whose ability to make healthy decisions is impaired, whether it’s from an intellectual disability, a substance use disorder, or a mental health problem. Even then, people have a right to understand the nuances of risk and realistic ways to mitigate it.
So, what is a non-abstainer to do? First, I suggesting conducting your own risk-reward or cost-benefit analysis. In doing so, there are myriad reasons to consider whether the joy of drinking alcohol outweighs the potential harms. Alcohol can do serious damage to just about every organ system—and has deleterious effects on social-emotional, mental, cognitive, cardiovascular, hormonal and metabolic health, even for those who are considered casual drinkers. But if you’d rather me to tell you what to do, that’s an easy one: don’t drink. The only problem is that this assumes your tolerance for risk fits tidily within a medical textbook.
The upshot: Alcohol poses a number of health risks, including its risk for various cancers. It’s important to empower the public with data and to share the message that alcohol is a modifiable risk factor for cancer among other medical problems. It’s also important that medical professionals talk about tradeoffs and the realities of everyday life choices.
Remember that doctors are not moral authorities. Reducing your risk by cutting back on alcohol shouldn’t be intended to dazzle your doctor, nor should adding risk stress her out. The whole purpose of tolerating risk is to live your life fully. So, be honest with yourself and your physician about how you want to live it. Hopefully, that helps all of us sleep better at night. 🐈
QUESTIONS 🙋🏻♀️
Do you plan to adjust your drinking habits this year?
Will the Surgeon General’s warning change anything for you?
How do you conceptualize a doctor’s role in helping people make decisions about behaviors that involve risk?
I’m all ears!
Disclaimer: The views expressed here are entirely my own. They do not reflect those of my employer, nor are they a substitute for advice from your personal physician.
As always, love the way you frame risk and trade-offs. It’s so helpful.
My husband and I are “accidentally sober” — we would only drink when we’d go out with friends, and when that paused during the pandemic we lost all of our alcohol tolerance. I don’t miss alcohol now — the hangovers, the heart racing while trying to sleep, the questionable behavior.
What I *do* DEEPLY miss are the rituals around it: meeting up for happy hour, savoring a nice wine, kicking back with a beverage. I live in wine country, so wine tasting is a local pastime!
Non-alcoholic alternatives are becoming more common, but still tough to find and sometimes sugarbombs that leave a different hangover. All of this is to say, there is a way to get the social benefits of drinking without actually drinking — our culture just needs to catch up a bit! Maybe then giving up alcohol wouldn’t feel like giving something up quite so much?
Very well written! As a doctor myself, I find the hardest emotion to navigate with patients is defensiveness, which is also built into alcohol misuse. People often have their own idea of what it means to be a “social drinker”. At one point I found that I was drinking more at 50 than at 25 (granted, I was in med school), because 2 glasses of wine with dinner is a lot of alcohol, for a woman, especially. So now I don’t drink on weekdays, and a huge benefit is that instead of having a drink after coming home from a hard day at work, I exercise, which does a lot more to reduce stress than wine!
The key is honest appraisal, and keeping track. If you say you don’t know how much you drink, it’s probably too much.