Looking back over 2020, alcohol beverage industry leaders have to be mostly (very) pleased with alcohol policy outcomes, just as public health officials are likely quite frustrated. The last two weeks alone ushered in pair of significant policy "wins" for industry members. First, Congress made the federal excise tax breaks passed in 2017, then extended in 2019, permanent. Although the considerations were primarily financial, specifically to aid small producers, this move was not only historic (the federal excise tax on beer hadn't been reduced since the Civil War) but the complete opposite of what public health advocates have sought for decades: increased excise taxes to drive prices up and ostensibly reduce consumption. Alcohol prices are not likely to be significantly impacted by permanency, but at least Congress removed any immediate pressure to raise prices to offset the tax increase that would have occurred without action. And advocacy for higher taxes continues to get little traction in the US. With many state budgets in dire shape, it will be interesting to watch whether efforts to raise state excise taxes fare any differently.

Whether Covid drove people to drink more remains a controversial and unresolved question. Two recent studies provide some interesting input, but no definitive answers. In one study, those who were already "binge drinkers" tended to drink more, but others didn't. In the other, students who returned to live with their parents after leaving college campuses significantly (and predictably) reduced their drinking.

Progress in reducing alcohol-impaired crash deaths had stalled in recent years. But final figures for 2019, just reported by the National Highway Traffic Safety Administration, showed a decline of 568 alcohol-impaired crash deaths, 5.3% lower than in 2018. That's while total traffic fatalities dipped by just 2%, 739 deaths. As a result, alcohol-impaired deaths − when a car driver or motorcycle operator in a crash has a BAC of 0.08 or higher − were 28% of total crash deaths in 2019, "the lowest percentage since 1982, when NHTSA started reporting alcohol data." Ten years ago, alcohol-impaired crash deaths were over 31% of the total. In 2019, alcohol-impaired driving fatalities as a share of total fatalities ranged from 37% or higher in ND, TX, NH and CT to 20% or less in UT, KY and VT.

A handful of national surveys now suggest that decades of progress in reducing teen drinking rates either stalled or possibly reversed over the last 2 years. The latest evidence comes from the 2020 Monitoring the Future Surveys (MTF). This year's results are not as robust as previous years; the pandemic reduced the 2020 sample. Even so, results from almost 12,000 surveyed support a slowdown/reversal in the teen drinking decline which AII first flagged with some of the 2019 MTF results, later repeated in the National Survey on Drug Use and Health and the Youth Risk Behavioral System. Announcing the MTF results on December 15, the National Institute on Drug Abuse focused again on teen vaping issues. NIDA's sole comment on alcohol was "Alcohol use has not significantly changed over the past five years. However, across all grades, alcohol use in the past 12 months has leveled off from its historical gradual decline." But in the perhaps more relevant measure of 30-day use, rates increased quite sharply vs 2019, erasing most of the decline of the previous 5 years.

At the risk of providing our readers with a NSFW headline − at least not safe to say publicly, from a public health perspective − we happily share this advice from Hannah Jane Parkinson, a life and style writer for London's Guardian. Her provocative November 13 column acknowledges from the start, just like a familiar warning label, that "for many people and for different reasons, any alcohol is too much." And while Parkinson also advances the politically very incorrect notion that "I am not saying there isn't a time and a place for getting wasted," she celebrates "the sweet spot," the "wonderful word" that is "tipsy." Why wonderful? "It captures the brightening of spirits and loosening of the tongue.... The easy laughs…. The bonhomie of good company…the backslaps at the bar…good wine being poured across the table…easily-struck-up rapport with strangers or mutual friends…. The golden hour." Again, beyond tipsy, of course, is "the danger zone of unwise decision-making" and worse. In short, Parkinson nails the true pleasure of drinking to enjoy the "convivial character of an evening perfectly played," of "cashing in on the evening at just the right time." Because the "lure of just one more" is so strong, she points out, learning to drink this way "is a difficult skill to acquire." But for Parkinson, drinking to tipsy, "two drinks in" for her, is her friend and "is what to aim for."

It was almost exactly 15 years ago, October 16, 2005, when the NY Times front-paged a story about the then relatively new but rapidly expanding bar game called Beer Pong. In one of the beer industry's least proud moments (and an early, failed attempt to counter spirits' inroads with younger drinkers on-premise), its two largest brewers actually promoted on-premise events. They supplied distributors with materials, claimed the participants were supposed to be drinking water (AB, which sponsored "Bud Pong" tournaments), yet also told the media that "it's the perfect demographic," to promote to, since "it's mostly college kids pounding pitchers of beer" (Miller). The same article quoted players ("It's awesome. If you win, you win. If you lose, you drink. There's no negative."). Some concerned campus and local government officials tried to ban Beer Pong; others feared driving it underground. The Times also quoted public health advocates, who were handed an easy victory. Harvard's Henry Wechsler was "aghast that companies who posture themselves promoting responsible drinking promote drinking games, which by their nature involve heavy drinking." Within days, AB officially ended Bud Pong and later acknowledged "it was a bad idea. It was just too capable of being misused and it was naïve to think that it wouldn't be misused." Beer pong survived, without the industry imprimatur. So did the companies' responsible drinking programs, albeit tarnished for a time.

In AII's ongoing, informal "tests" of whether per capita consumption, alcohol taxes and other measures that public health advocates like to link with either positive or negative outcomes to advance policy do actually seem to matter, some recent rankings from the website wallethub.com caught our attention. The tables, texts and graphics of "2020's Most Overweight and Obese States in America," look at first glance like just another example of internet clickbait. But the rankings/lists were based on what appears to be legitimate data from the Bureau of Labor Statistics, Gallup, Robert Wood Johnson Foundation, CDC, the Dept of Agriculture and other similarly solid sources. Among the main findings, the authors created a list of unfortunately poorly named "Fattest States," actually a designation that combined data based on rates of: 1) obesity/ overweight prevalence; 2) health consequences (from diabetes rates and cholesterol levels to heart disease and hypertension to several health care cost measures); 3) food and fitness, via dietary and physical activity measures. So, in this case, "fattest" could be viewed as pejorative catch-all for "least healthy."

As part of its Alcohol Research: Current Reviews series, NIAAA's scientific advisor Aaron White contributed one of the articles in a focus on "Women and Alcohol." Over the last century, but especially in recent decades, "differences in alcohol use and related harms between males and females in the United States have diminished considerably," he points out. While men still drink more and are more likely to experience harms linked to alcohol, "the gaps are narrowing."

While AUD rates have declined among young adults in the US, overall rates of alcohol-abuse, substance abuse and suicide, grouped by some observers as "deaths of despair," have contributed to a rare decline in life expectancy in the US in recent years. Indeed, the annual downtrend in life expectancy in the US between 2015 and 2017 was the "longest sustained decline since 1915-1918." So noted a group of researchers from Penn State University and a data scientist at insurance company Highmark Health in a recent (unsparing) paper published by the British Medical Journal. The team documented trends in "the diagnosis of diseases of despair" in the US from 2009 through 2018. The trends are not good. Nor are prospects for near-term improvement in US life expectancy, according to the authors, especially given the coronavirus pandemic.