Do mocktails really help you drink less alcohol?

The Washington Post / Teddy Amenabar

12:03 JST, January 18, 2023

Mocktails and other nonalcoholic drinks are surging in popularity in the United States. But can alcohol-free beer, zero-proof wine and faux cocktails really help someone reduce the alcohol they consume?

The answer depends on your drinking habits. Health experts say those trying to curb their drinking or stay sober for Dry January may find it helpful to hold an alcohol-free mimosa or faux mai tai when they socialize.

But, for people who have moderate to severe alcohol use disorder (AUD), defined by the National Institutes of Health as the inability “to stop or control alcohol use” despite the consequences, these nonalcoholic drinks are generally discouraged because they might actually create a craving for alcohol, not cut it.

“It really is, basically, a no,” said George Koob, the director of the National Institute on Alcohol Abuse and Alcoholism. The cues created by a mocktail can “trigger relapse and re-engagement in excessive drinking.”

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Mocktails are getting increasingly sophisticated as marketers respond to growing demand and as more people experiment with sober living during events such as Dry January and Sober October.

Ted’s Bulletin, a popular restaurant in Washington, has added four mocktails to its menu that use “zero-proof” rum, tequila, whiskey and gin – carefully crafted to taste close to the real thing but without the alcohol. The “Garden Surprise” uses Ritual gin-alternative, lime, mint, ginger and muddled cucumber, while the mai tai alternative called “Rum that Ran” uses Ritual’s rum alternative, orgeat syrup, lime and pineapple.

Alcohol-free beverages are useful for people who don’t want to drink alcohol because they’re pregnant, taking a certain medication, don’t like alcohol or have just decided they want to drink a little less.

These no-alcohol alternatives allow you to order a mocktail margarita to sip with your chips and salsa without waking up to a pounding headache the next morning. And for some, drinking a nonalcoholic beer or alcohol-free glass of wine helps relieve some of the social pressure when everyone else at the party is holding a glass or cup.

“It’s wonderful for folks who don’t have an alcohol use disorder,” said Tim Brennan, chief of clinical services for the Addiction Institute of Mount Sinai Health System. “For those folks who might want to mitigate the negative effects of alcohol like headache, fatigue, morning sluggishness, a mild hangover, things like that, I think it’s really great they now have options.”

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Two studies on households in Spain and the United Kingdom found the introduction of no-and-low-alcohol alternatives led to consumers drinking a little less alcohol. But, Jürgen Rehm, a professor and senior scientist at the Centre for Addiction and Mental Health in Toronto, said the findings in the U.K. don’t represent some sort of “mass movement.” The alternatives in the U.K. led to a small but significant reduction in alcohol consumption for a portion of the households, Rehm said.

“Overall drinking was reduced. However, it was not reduced drastically,” Rehm said. “It helped a little.”

Still, public health experts say any reduction in the amount of alcohol consumed is a good thing. During the first year of the pandemic, sales of alcohol spiked and alcohol-related deaths in the United States rose to the highest rate in decades. And the World Health Organization has concluded there’s no “safe amount” of alcohol to consume.

“If you stop drinking or cut back on drinking and you feel better, then listen to your body because your body is telling you something,” Koob said. “I think that’s the bottom line.”

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When you switch to certain nonalcoholic drinks, you also run the risk of trading alcohol for some sugar.

Beer and wine tend to be low in sugar due to the fermentation process for both. But check the nutrition label on a can of alcohol-free beer and you may find sugar. The nonalcoholic beer from Athletic Brewing, for instance, has 4.3 grams of sugar per can or about a teaspoon. Some alcohol-free beers have much less. Heineken’s standard beer doesn’t have any sugar, and its nonalcoholic version has 1.3 grams of sugar.

Regular cocktails often have a lot of sugar anyway, but your sugar consumption may go up if you end up drinking extra mocktails because they’re alcohol free.

Ashley Gearhardt, an associate professor at the University of Michigan who researches food and addiction science, said our cravings for both sugar and alcohol rely on the same circuitry in the brain. Trading alcohol for sugar, she said, isn’t a “zero-risk” proposition because diets rich in sugary, processed drinks and foods that are low in nutrients lead to other health risks, as well.

“Just because it doesn’t have alcohol doesn’t mean it’s a get out of jail free card,” Gearhardt said. “People should really consider what they’re replacing alcohol with.”

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For those recovering from AUD, the smells, sounds and behaviors associated with cracking a can of alcohol-free beer or wine may be too triggering, Brennan said.

He cautioned against drinking mocktails or other drinks that are supposed to mimic gin, bourbon or other alcoholic beverages. He also said it’s important that people with AUD know that alcohol-free beer, in addition to tasting like beer, typically has small amounts of alcohol.

“People with alcohol use disorder who start drinking alcohol-free beer are quickly on the road to relapse,” Brennan said. “It’s too triggering. It’s simply too close to the problematic substance.”

Many people with AUD choose seltzer on ice with a lime wedge to hold at social gatherings. Victor Karpyak, a Mayo Clinic psychiatrist treating AUD, said the beverage someone chooses is only one part of staying sober.

“It’s only a small part of what needs to be considered,” Karpyak said. “Making a decision about this small part is certainly important but may or may not be sufficient to achieve their goals.”

Koob said it’s similar to how walking by a green Starbucks sign might make you think of a cup of coffee. For someone recovering from AUD, passing a bar or sipping a mocktail may be a cue to crave alcohol.

Paul Linde, the clinical supervisor for Ria Health, a telehealth program that helps people cut back on their drinking, sees mocktails as a short-term solution that still requires “long-term behavior change.” He doesn’t want people to see mocktails as a “remedy” for people who want to drink less.

“It’s a good start, but it really is only a start,” Linde said. “I’d like to think more about other behavioral changes that need to be made.”

For people who are “pretty solid in recovery,” a mocktail may be a reasonable option, said Hosia Keene, the outpatient services director of the Hazelden Betty Ford Foundation in Bellevue, Wash.

But she suggests that people who are thinking about ordering a mocktail ask themselves: Am I ordering this drink as a replacement for alcohol? Or does that drink just sound good?

“Those are going to be pretty different experiences,” Keene said.

If the mocktail is only going to serve as a reminder for the alcohol you’re not having, Keene said she’d want to have a conversation ahead of time with that person to make sure they’re prepared to recognize when their body is craving alcohol.

“I don’t expect these drinks to go away,” Keene said. “I would still want somebody to have a lot of tools put in place before testing anything that puts established sobriety at risk.”