Alcohol is so pervasive in Australian culture that abstaining has serious social consequences.
I had the same conversation about five times in the past week, four times with young patients, and one time with my younger brother.
I suppose, in a selfish way, it stayed in my mind a lot longer when it was my brother that raised it.
It’s about alcohol. But perhaps not in the way you might have assumed.
I’ve got a brother who works in finance or consulting or banking or, you know, that general corporate finance industry. He’s in his late 20s, happy, skilled, confident and absolutely obsessed with sport and fitness. The gym is the great love of his life.
He’s got the healthiest lifestyle of anyone I’ve ever met. He doesn’t eat processed foods or sweets (except on special occasions like birthdays), doesn’t have coffee or tea or energy drinks, is strictly vegetarian (and is now trying vegan days but that’s because he’s got a cool vegan sister whom he constantly copies), meal preps almost every meal, has a strict sleep schedule and goes on a walk to the local beach when he’s in a bad mood. He doesn’t smoke, he’s never tried any drugs, and he doesn’t take any supplements or steroids. And he doesn’t drink alcohol.
The thing is, he’s never drunk alcohol. We grew up with a dad who drinks rarely – perhaps a couple of times a year at a business function or expensive restaurant – and a strictly non-drinking mum. Our parents don’t smoke, we’ve all been vegetarian from birth, and had a relatively strict approach to health (I, too, am a lifelong teetotaller).
But my brother’s refusal to drink alcohol is a particularly unusual one.
My brother went to all-boys schools, and then university, and then began a career in management consulting or financial analytics (look, I’m really unclear what he does, and his explanations don’t help anyone). He’s openly atheist and doesn’t particularly subscribe to cultural or religious views around alcohol.
This is all despite growing up in Australia, which has one of the worst drinking cultures in the world.
He has been surrounded, increasingly, by a culture of alcohol and normalised underage and unsafe drinking. All of the networking events in his industry are centred around wine, but he is still constantly the guy drinking soda water or, when he’s really letting loose, a Coke Zero.
My brother is tall and can be quite physically intimidating with his muscular build, so he has the luxury of natural confidence, stature, and being a man. He tells me he never faces any pressure to drink, and if someone tries, he delivers a firm and non-negotiable, “I. Don’t. Drink”.
Admittedly, it is easy for me, too, to decline alcohol with the same retort, because I, too, am confident in what I believe to be a healthy choice for me. But the difference is that I’m in medicine, and a woman, and Indian, so people generally assume I am either not drinking because of patient responsibilities, pregnancy, or religion.
I think it is more surprising to people to accept that my brother, with no personal history or family history or any specific reason to not drink, just doesn’t want alcohol in his body. And has never wanted alcohol in his body, not even a sip.
This is all coming to a head now because my brother is moving into the next stage of his life and becoming more concrete in his beliefs and personality. His friends are changing, or not changing, and alcohol is a central part of this.
Essentially, my brother has some really outstanding male friendships with honest communication, vulnerability, and constant introspection. They put in a lot of time and love into growing the friendships and many like him are strict in their diet and lifestyle and firm in their refusal to drink alcohol.
However, he also has friends who, though they tolerate my brother’s decision to not drink, continue to live heavily alcohol-centric lives.
While it was easier to accept this when they were younger, they are now settled with their own houses, wives and established careers, and I can see the way my brother is increasingly grappling with their differing lifestyles. He is, obviously, connecting strongest with his friends who have the same beliefs and attitudes towards health and especially alcohol. His closest gym friend, Liam, once delivered a frank rebuttal when my brother was complaining about being sleep deprived and performed poorly at the gym after a miserable night of sitting at a pub, sober, watching another group of his friends binge drink for hours.
“Yeah, well, why did you go out with them? It was your decision to go when you knew they’d just be drinking. Take responsibility for the fact that you choose that instead of saying sorry, I have to go home to sleep because I have to train in the morning.”
But my brother dearly loves these friends who drink and there are years of affection that are not easily negated by the dominant force that is alcohol.
This is how the entire story about my brother ties back to my patients. I have had the same conversation about young people who don’t want to drink alcohol.
I saw a first-year university student, a bright, lovely, enthusiastic young woman in tears because she was lonely and had lost all her school friends. She wanted to do well in university, and in this next chapter of her life, so had been studying a lot, and working part-time to save for a car. She didn’t want to spend money on big nights out and didn’t enjoy the disruption to her regular routine when she had late nights drinking.
So, she decided to stop drinking entirely, and her friends quite sadly decided they wanted nothing to do with her any more since “she wasn’t fun”.
Later, a young man in a similar industry to my brother – is “money” an industry, or banking analytics? — wanted a referral to a psychologist to help him place boundaries around alcohol at work. Every Friday night the company had networking drinks and the bosses were continuously pressuring him to partake.
Feeling like a potential promotion was dependent on being a good team player, he had started drinking on these occasions and feeling miserable afterwards. The only other non-drinker was a senior employee who was known to have had issues with substance use and was proudly sober.
Despite this, the culture at the company was that only “ex-alcoholics” were the non-drinkers, and my young patient isn’t a large, loud and intimidating man like my brother who can confidently counter the pressure with an “I. Do. Not. Drink”. Or worse, maybe there genuinely would be an implication to his career growth and potential, and alcohol was a price to be paid for success.
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Third, I saw a young Muslim man, who for religious reasons did not drink alcohol. Several of his closest friends, family friends from the same mosque, had recently started drinking in secret. He felt his faith was being tested and he was resenting the burden of secrecy he now carried. He was trying to navigate, alone, how devout he wanted to be himself, and what haram he could and would tolerate in his friends.
Finally, another young woman, lonely, who grew up with a mother with alcohol use disorder, and a very strong family history of substance abuse. She, remarkably, from a young age refused to drink and is repulsed by alcohol, having seen, daily and lifelong, its harms. But sadly, again, she was struggling to find and develop adult friendships free of alcohol.
“Try AA,” someone had suggested to her once. “They don’t drink.”
“I’m trying to never need AA,” she snapped back, “by not drinking in the first place.”
My brother has very high-achieving friends and family with financial security, high health literacy and/or socioeconomic privilege, but many of our patients grow up differently.
If you come from a home or culture where alcohol is omnipresent, hiding in the shadows, normalised with celebration or sadness or dinner, then it’s an outstanding feat to step away from it. If you are surrounded by friends who drink at a young age or binge regularly then alcohol is intertwined into friendship activities and alcohol becomes the ingredient that makes the platonic love grow.
How difficult it must be to then try and separate the friendship from alcohol.
I’ll end on this point: there is obviously stigma around drinking alcohol, especially unsafely. But perhaps there is also, in Australia especially, judgement around not drinking alcohol. And both, quite honestly, are very unfair.
Dr Pallavi Prathivadi is a Melbourne GP, adjunct senior lecturer at Monash University, 2024 RACGP mentor, and newly appointed member of the Eastern Melbourne PHN Clinical Council. She holds a PhD in safe opioid prescribing and was a Fulbright Scholar at the Stanford University School of Medicine, and previous RACGP National Registrar of the Year.
