What we know about alcohol risk in 2026 with Sinclair Carr and Jürgen RehmWhat we know about alcohol risk in 2026 with Sinclair Carr and Jürgen Rehm
Addiction Audio
Sinclair Carr and Jürgen Rehm discuss updated evidence on alcohol’s role in disease, focusing on causality, genetic methods and public health implications. The conversation challenges ideas about protective drinking and highlights alcohol’s wider health and policy impact.
26:06•14 Aug 2026
Alcohol Risk in 2026: Genes, Heart Disease and Hard Evidence
Episode Overview
- Causality in alcohol research is judged using timing, regularity of effects and biological plausibility, mainly through cohort studies.
- Mendelian randomisation uses genes linked to alcohol metabolism and consumption as a proxy for randomisation, but relies on strong assumptions.
- Evidence suggests little to no protective effect of low-level drinking on ischemic heart disease, challenging the popular j-shaped curve narrative.
- Alcohol is now supported as a cause of premature dementia and is linked to more than 200 ICD-10 outcome categories, reinforcing its major health burden.
- Industry and economic arguments can hinder effective alcohol policy, so researchers stress the need to examine alcohol’s full social and economic impact.
“Every systematic review is only as valid as the validity of the underlying research.”
What drives someone to seek a life without alcohol? This conversation on Addiction Audio takes a step back from individual stories and looks at alcohol through a public health and research lens, asking what we really know about alcohol risk in 2026. Hosted by Dr Tsen Vei Lim, the episode features Sinclair Carr, a doctoral student in epidemiology at Harvard, and Dr Jürgen Rehm, a senior scientist at the Centre for Addiction and Mental Health.
Together, they break down their major review of how different patterns of drinking relate to disease and early death, using clear language that makes complex science feel surprisingly accessible. You’ll hear Jürgen explain a practical definition of causality in epidemiology and why cohort studies and biological plausibility matter so much. Sinclair walks through Mendelian randomisation, describing how genes can act as a "natural experiment" when randomised trials on alcohol would be unethical.
As he puts it, researchers "make use of the quasi-random assignment of genes at birth" to study alcohol’s effects later in life. The pair address one of the hottest debates in alcohol research: the supposed protective effect of low-level drinking on heart disease. They argue that once you look carefully at genetic studies, cohort data and the tricky assumptions involved, the evidence points towards alcohol being harmful rather than protective.
They also highlight new evidence that alcohol is a cause of premature dementia, and stress that alcohol is linked to more than 200 ICD-10 disease categories. There’s a strong focus on public health and policy too, including Jürgen’s experiences speaking in parliaments and challenging industry claims that alcohol is essential for economic growth. Throughout, the tone is honest, technical yet approachable, and aimed at anyone interested in how science shapes alcohol guidelines, from researchers to people questioning their own drinking.
If you’re curious about how scientific evidence is used to judge alcohol risk, this episode gives plenty to think about and may change how you look at "moderate" drinking.
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