In Why We Drink Too Much: The Hidden Science of Just One More, Dr Charles Knowles weaves memoir and science to investigate the reasons why alcohol has become the world’s most popular drug. He discusses the rise of ‘grey area’ drinking, the influence of the alcohol industry, and why drinking problems merit sympathy and understanding.
Have you ever thought about why we drink? What is it that makes humans so attracted to alcohol? Because one thing is certain – we do like alcohol. Alcohol is the world’s longest-serving and most popular drug. Our human ancestors evolved to metabolise it over ten million years ago and we have been deliberately manufacturing it for over ten thousand years. In consuming alcohol, we are not alone. From rodents to apes, we have many kindred spirits when it comes to the drink.
This is because drinking alcohol can be fun. The psychostimulant and relaxant effects of alcohol mediated by changes in chemical pathways in the brain are fundamentally pleasurable. These effects can enhance how we feel and behave and allow us to temporarily forget the troubles in our lives. We must acknowledge this – we simply cannot write it off solely as a poison and a depressant. How could drinking ever be so popular if it didn’t feel good? There is no trillion-dollar industry in grape juice.
Unlike that of most other popular drugs, the consumption of alcohol is a legal pastime that is engrained in many cultures and promoted by its widespread availability. Compared to drugs like heroin and nicotine, most drinkers are not addicted to alcohol. Although regular excessive consumption may be an individual and public health issue, many people can just take it or leave it. By comparison, a small proportion of people like me may progress to a point where alcohol threatens to take their lives. Explaining such differences in our human relationship with alcohol is not straightforward. It requires the synthesis of information from many scientific disciplines, including medicine, neuroscience, psychology, genetics, epidemiology, sociology, and even anthropology. Moreover, any explanation must satisfy an acid test – does it fit with the lived experience of someone who is either coming to worry about their drinking and their ability to control it, or someone who is dependent? Ultimately, many problems with alcohol derive from an erosion of choice caused by changes in our brain. These changes result from the way we process reward and how we remember such experiences. For some of us, the effect of alcohol on our psyche is just not the same as for other people – we feel more reward from it, and we more deeply memorise the experience. Such variation stems partly from genetics but greatly from what the world throws at us, especially during our childhoods.
I am a senior academic at a major UK university who has published over three hundred peer-reviewed scientific papers and several other books. While many of these papers concern aspects of neuroscience which align with my interest in bowel disease, I am not a trained expert in any health discipline pertaining to alcohol. However, my lack of formal qualification has enabled me to cast a fresh pair of eyes on a very challenging subject without being professionally siloed. In so doing, I have applied the scientific rigour I would apply to any subject in my own field, but also the personal experience gained only by seeing the problem first hand in myself and many others.
I started writing this book to answer the ‘why me?’ question for myself, one that seems to be almost uniformly swerved by other books. I also realised that there was a need to close the gap between the content of abundantly available memoirs, quit-lit, self-help books, and the detailed information found in several medical textbooks. The result, I hope, is a book that avoids excessive medical jargon but does contain a lot of scientific information, especially in regard to the troublesome complexity of the brain. Where possible, I have used examples, analogies, and some of my own experiences to illustrate certain themes. My wife, Annie, has also added some further perspective on my story. I have tried at all times to carefully separate my opinion from what we know with a level of certainty. The text is scientifically referenced for the interested reader with selected citations taken, where possible, from top scientific journals such as the Lancet and Nature. It also covers the relevant historical scientific discoveries that underpin the study of any complex disease.
Although I never drank at or before work, in telling my own story I have applied a level of honesty that some people may find troubling for a practicing surgeon. This is deliberate on my part. A great deal of the societal problems with alcohol stem from ongoing prejudice. When I eventually got sober, I asked the question that if the very people tasked with providing healthcare couldn’t lead in coming clean about their own problems, what hope did everyone else have? In this I am in good company. One of the two original founders of Alcoholics Anonymous, ‘Dr Bob’, also was a proctologist. After so much progress in destigmatising other areas of mental health, why do people addicted to alcohol have to remain anonymous?
This extract was edited for the SSA website by Fiona Hughes. From Why We Drink Too Much: The Hidden Science of Just One More, first published in 2026 in the UK by Picador, an imprint of Pan Macmillan. Reproduced by permission of Macmillan Publishers International Limited. Copyright © Dr Charles Knowles 2025.
Dr Charles Knowles is a practicing surgeon, Chief Academic Officer, and Clinical Director of Research at the esteemed Cleveland Clinic. He is also a Professor of Surgery at Queen Mary University of London. He has published over 300 peer-reviewed scientific papers and several academic books, and contributed as an expert to sober community groups and programmes. Why We Drink Too Much is his first popular book.
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