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Tis the season of the non-alcoholic drink.
It’s Dry January, after all—the month-long break from booze has become an annual tradition among many in the United Kingdom and the United States in recent years. In fact, sober living in general has begun to attract a following, particularly among younger generations.
Zero proof spirits, near beer, and de-alcoholized wines now pepper the shelves of many supermarkets and hold pride of place on bar menus, while recipes for mocktails have taken off on the internet. The spirit-free beverages have become a popular way to avoid the potential social consequences of cutting back.
“We still live in cultures where drinking is normalized and non-drinking requires explanation,” says Emily Nicholls, a sociologist at the University of York who studies consumption of non-alcoholic drinks. The virgin alternatives allow people to participate in alcohol-centric gatherings or even “pass” as drinkers. (Many of them also taste pretty good.)
But most of the no- and low-alcohol products, often referred to as NoLos, mimic the taste and appearance of alcoholic beverages and even contain tiny amounts of actual alcohol. Which is why some experts have begun to ask whether these substitutes actually curtail alcohol use in the long run, particularly in people with conditions like alcohol use disorder (AUD). The subject is relatively understudied and research results have so far been mixed.
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One worry is that booze-free drinks could lead to relapse in people who are trying to quit by triggering alcohol cravings. Some evidence suggests they may provoke not only the subjective desire to drink but also a physiological arousal response similar to what occurs when the person is actually drinking alcohol—with the strength of the cravings tracking the level of alcohol dependence.
Even the packaging of some non-alcoholic beers has been shown to elicit cravings, since it is so close to that of alcohol sold by the same beverage companies. This is especially concerning because non-alcoholic beverages can often legally be sold or advertised in places where alcohol itself is banned.
“Suddenly, those places may become much less inclusive for people who are trying to recover from alcohol use disorders and really can’t cope with that exposure to all that alcohol branding,” says John Holmes, a professor of alcohol policy at the University of Sheffield. Along with increasing the risk of relapse, Holmes says, the presence of such beverages can force some people to avoid otherwise alcohol-free spaces, worsening the isolation that already makes recovery rough.
On the other hand, booze-free alternatives may be what puts recovery within reach for some people. Most patients are unable to fully achieve abstinence, Holmes says. As a result, traditional approaches that make total abstinence the sole aim of treatment can discourage people from seeking help. While abstinence may be the ideal, Holmes explains, evidence suggests that many people can achieve recovery by cutting back. A moderation-based approach to recovery that allows non-alcoholic beers and focuses on developing a healthy long-term relationship with alcohol may be more realistic for some people.
Overall, the ambiguity around non-alcoholic beverages makes it hard to create clear protocols for their use, including clinical guidelines to help providers treat patients for alcohol use disorder, along with regulations for sales and marketing of the beverages. For example, when non-alcoholic beverages are sold by businesses with no liquor license, such as supermarkets, does the easy access put people with alcohol use disorder at risk of relapse, or does it help them by making it possible to use these drinks in their recovery without setting foot in a liquor store?
What’s tough about answering questions like this is that there’s unlikely to be one right answer. “Every person who has alcohol dependence is quite different,” says Holmes. “The question is sort of, who will this work for? … How do the effects differ across those different types of people?” Non-alcoholic beverages themselves also vary widely—some contain no trace of alcohol, while others have an ABV as high as about 1.2 percent, though the exact cutoff varies by country. “Should guidance be distinguishing between those two different types of products?” asks Holmes. “Those are the kind of questions that we don’t have clear answers to yet.”
Guidelines also need to recognize that, for some people, non-alcoholic cocktails, wine, and beer aren’t a feasible option. Not only are people with alcohol use disorder at risk of cravings and relapse, they may have court orders or employment requirements that bar them from consuming even a drop of alcohol without consequences. The drinks are also not cheap.
For now, non-alcoholic drinks sit in an uncomfortable middle ground: a lifeline for some, a land mine for others, and a category the science has not yet caught up with. 
Lead image: Blan_k / Shutterstock
