TheOtherDave comments on Social Necessity of Drinking - Less Wrong Discussion
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I don't drink, and haven't for about 20 years.
I generally go with "No thanks," on those rare occasions where someone asks why not I explain "I don't drink."
It's actually astonishingly rare for people to ask why not a second time; I don't remember the last time it happened, nor what I said, but I suspect I would go with "I react badly to alcohol," which is certainly true.
Thinking about it some more, I might go with "I haven't had any alcohol since my stroke" instead, should the question arise. It's true enough, though grossly misleading, and invokes all kinds of conversation-stoppers.