‘No safe level’, risk, and identity: Is ‘moderation’ friend or foe to positive sobriety?

Dr James Morris draws on his professional experience as an alcohol researcher and his personal experience of alcohol use and sobriety to examine the place of ‘moderate drinking’ in the cultural discourse.

One of the most interesting aspects of the sustained decline in youth drinking since 2004 has been the emergence of ‘positive’ or ‘new’ sobriety – a visible and proud sober movement seeking to normalise non-drinking as an acceptable and healthier choice. An extensive online space now exists based on this new form of sobriety content with an abstinence message that is not about recovery from addiction, but that challenges societal pressure to drink and help anyone unlock the benefits of an alcohol-free life.

The motives for people to engage in positive sobriety are varied, with young people in particular seeing alcohol less positively than previous generations. However, it is the benefits of an alcohol-free lifestyle, including freedom from hangovers and improved general well-being, which are highlighted consistently across all groups.

All positive for positive sobriety?

From the perspective of reducing alcohol-related harms, the positive sobriety movement is a welcome development. Alcohol use and, more problematically, heavy drinking is still the default in many settings and there has been limited progress on effective policy measures in the context of powerful industry lobbying. Whilst any meaningful health benefits of alcohol have essentially been debunked, many still believe that alcohol ‘in moderation’ is good for health or are unaware of issues such as cancer risk. In societies where alcohol harm is prevalent, more people not drinking – and spreading sobriety through social contagion – is unquestionably a good thing.

However, I would argue that some elements of the positive sobriety movement warrant critical attention. As a former ‘problem drinker’, ‘non-drinker’, and now ‘moderate drinker’ (who still engages in periods of sobriety), I sometimes talk publicly or on social media about my experience of learning to drink without problems. This is consistent with a robust evidence base supporting the existence of ‘non-abstinent recovery’ (formerly ‘controlled drinking’) for some people with alcohol problems. However, I have been accused of being ‘a fraud’ or ‘in denial’ or never having had a ‘real alcohol problem’ – reactions that follow a long history of efforts to discredit those who defend moderate drinking.

This type of response raises important questions about why moderation might be so threatening to non-drinkers such that they would reject empirical evidence and my own lived experience, or even resort to personal attacks. I would suggest a number of potential reasons, including the recent over-simplification of a ‘no safe level’ message of alcohol consumption, and how drinking-based social identities can lead to siloed beliefs that do not recognise the broad diversity of alcohol use, risk, and problems.

Alcohol use: An acceptable choice?

The objective of shifting the culture to make non-drinking an acceptable and normalised choice is a valuable and important ambition, and I do not wish to undermine it. However, it is evident that in efforts to advance this important agenda, some are framing all alcohol use as inherently bad. In turn, those who choose to drink are sometimes positioned as simply making a ‘bad choice’. Whilst many sobriety advocates have rightly called out ‘sober shaming’, some new sobriety content is arguably in danger of casting similar judgment on people who choose to drink, even at low levels.

Of particular note has been the rise in popularity of a ‘no safe level of alcohol’ message, as promoted by the World Health Organization (WHO). This message draws on the principle that since alcohol is a toxic drug, and that even small doses increase the risk of certain conditions including multiple cancers, there is ‘no safe level’ of alcohol. Large amounts of content have gone viral based on this message – widely praised and shared by those who have switched to an alcohol-free life.

Increasing the public’s knowledge of alcohol’s carcinogenic status starting at any level of use is in itself a valid public health objective, and indeed one that alcohol industry groups appear to fear. However, interpreting ‘no safe level’ to mean that any decision to drink is a bad one is flawed, or what may be termed a logical fallacy. Some consumption of ultra-processed foods or red meat is broadly considered an acceptable dietary choice, despite also increasing certain cancer risks. As pointed out by Professor David Speigelhater, driving is risky, but is still generally regarded as an acceptable behaviour; in fact, living in itself is fundamentally risky. The presence of risk alone does not make a behaviour ‘wrong’.

Although alcohol is arguably far too culturally normalised given its status as a carcinogenic and addictive drug, people are not automatically making a ‘bad choice’ if they choose to drink. The ‘no safe level’ of alcohol use message may be accurate in a biological sense, but it does not justify a moralistic position that people should not drink alcohol simply because it involves risk. Drinking motives are complex, and it is important to recognise that those who do drink alcohol are not doing so simply out of ignorance of its harmful effects. Some of the perceived benefits of drinking may be ‘psychological artefacts’ (for example, the expectancy that alcohol will improve how people feel), but some benefits are also real, even if they come with risks or consequences.

A ‘no safe level’ message is also untested in terms of how it actually affects drinking behaviour. People are prone to reacting defensively to messages which trigger threats to their autonomy, ignore their own experience, or most importantly, threaten their identity. Indeed, in a recent study, a colleague and I found that a ‘no safe level’ message had negligible effects on problem recognition amongst heavier drinkers but, compared to other messages, resulted in significantly more negative emotional responses including fear.

As Professor Tim Stockwell and others have argued, ‘no risk-free level’ would more accurately convey alcohol’s dose–risk curve than a ‘no safe level’ message. Yet in my own attempts to convey this in public spheres, I am typically met with responses such as ‘go and learn about the harmful effects of alcohol’, told that I am ‘not a medical doctor’, or even accused of pushing alcohol industry narratives.

Drinking status and social identity

As with recovery-driven abstinence, positive sobriety often involves important ‘social identity’ aspects. That is, positive sobriety is not just about the well-being related benefits of an alcohol-free life but can also become part of how one sees oneself: as a member of a group disrupting the long-standing normalisation of drinking.

Social identity theory shows how people subconsciously favour their own ‘in-groups’ and judge or discriminate against ‘out-groups’. Since one’s drinking status often matters in many social contexts, one’s view about alcohol, or what it says about a person to be a drinker, becomes especially relevant to one’s attitudes and behaviours.

Strong social identities can lead to strong emotional and cognitive biases. For people who drink alcohol, especially regularly, there is a social incentive to see ‘drinkers’ as a positive in-group and to ignore or downplay negatives like the risks of drinking. In turn, being a drinker becomes valuable to one’s self-concept, and can drive the stigmatisation of non-drinkers.

Equally, for non-drinkers, it makes sense to see sobriety as positively as possible, and for the same social identity motives, to subconsciously emphasise or even inflate the benefits. However, because people who choose not to drink alcohol are frequently confronted with pro-alcohol signals like advertising or pressure to drink, their identity may be more frequently threatened. When someone’s identity is under threat, they will instinctively seek to protect and strengthen it, for example by increasing the size of the in-group or emphasising its beliefs. However, this can come with a cost. Conforming to the values of the group can become the highest priority, which can be seen in some of the fixed mindsets and echo chambers across social media and political spaces.

Moderate drinkers as sober allies?

Whilst I hope to see the continued growth of positive sobriety via the normalisation of non-drinking, many people will never choose sobriety. Drinking will continue to take place in pubs and at many social events for the foreseeable future, and so moderate rather than heavy drinking norms would seem to be preferable.

I suggest that people who drink moderately should be seen as allies, not threats, to positive sobriety objectives. As a careful ‘moderate drinker’ or ‘low-risk drinker’ myself, I am happy to socialise with people who don’t drink but am cautious about socialising with heavy drinkers who are liable to put pressure on me to drink to protect their drinking identity. Heavy drinkers are most likely to undermine or attack sobriety or associated norms, whilst moderate drinking norms might in fact serve as a protective buffer against heavy drinking norms.

Although we should be cautious of the creeping normalisation of drinking in previously alcohol-free spaces places such as cinemas, I would argue that a positive ambition is for a future where pubs and social events are as free as possible from heavy drinking, and where both non-drinkers and moderate drinkers are free from pressure to drink or drink more than they wish to. There are of course complexities behind this vision. Alcohol-free spaces will always be important, including for some in recovery, or for people who want to engage in social activities without any alcohol around. There are shades of grey between moderate drinking and heavy drinking. And, sections of the alcohol industry will continue to use ‘responsible drinking’ frames to emphasise individual choice and oppose tighter regulation.

Nonetheless, moderation has a history of being unfairly discredited by some non-drinking groups and the use of a ‘no safe level’ message is now being used in this vein. The positive sobriety movement is vital to shifting harmful drinking cultures, but some sobriety messages risk alienating many of us by framing any and all alcohol use as inherently wrong.

by James Morris

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