Maybe I read too much in, but the author seems to (wrongly, IMHO) feel higher per capita consumption in the Mediterranean indicates that is not a factor. Moderate and sustained drinking could (and, again, IMHO, does) increase consumption in some areas far beyond that in areas where binge drinking is a greater problem. However, "getting wasted" has no illicit or pleasurable appeal in areas where alcohol consumption is so common and widespread it lacks any special allure. On the contrary, residents of such places are far more likely to recognize and avoid the ills of excess because they correctly regard them as foolishness rather than recreation. In that sense, a cultural shift regarding alcohol and many other things as well would be beneficial in many places.