No-one living in the UK at the moment could fail to notice the high profile that is being placed on what has been described sardonically as “our love affair with alcohol”. In the last ten days alone here in Scotland we have had an academic report which states that the costs of alcohol per head in Scotland is many times greater than previously estimated, another report from the NHS which shows that Scottish consumption of alcohol is a quarter greater than that of England, equivalent to drinking 40 bottles of vodka each in a year, and a call by doctors based in Scotland for alcohol advertising to be banned, particularly because of its encouragement of teenage drinking. And this ten day period is fairly typical of what has, for the last several years at least, been a remorseless campaign highlighting the dangers of alcohol in all of its facets. This campaign in Scotland comes against the background of the Nationalist Government trying to impose a minimum pricing on alcohol which would mean that it could not be sold at a price lower than 40p per unit.
The focus on alcohol, therefore, in the media, amongst the political establishment, and in social policy circles, is intense. We are in the midst of a proverbially typical full-on British moral panic which engulfs the nation on certain key issues periodically. This moral panic around alcohol is cyclical in the sense that British society seems to go through two distinct cycles in relation to alcohol. One, which in fact over the historical period, is the norm is a fairly laissez-faire, almost blithely indifferent, attitude of cheerful tolerance to alcohol punctuated by a second intense phase of moral disapproval, agitation, even frenzy about the demon drink, usually accompanied by strictures about the health and other consequences of excessive drinking and associated legislation restricting the sale and consumption of alcohol. We are currently most definitely in the second phase of the cycle.
Moral panics in certain academic circles are often dismissed as having no substance, almost as having been orchestrated by reactionary politicians and right-wing media to whip up the masses. But, at least in terms of crime and other aspects of social policy, such panics are usually based on real concerns and fears which are impacting adversely on peoples’ lives. And, in the case of alcohol, there is incontestably all too real harm and distress caused. As the former head of an alcohol agency I speak with some certainty about the devastation wreaked on lives by alcohol. At weekends up to two-thirds of admissions to accident and emergency units in British hospitals are under the influence of alcohol. Drink is severely implicated in domestic abuse, broken relationships, offending behaviour, days lost at work and so on. Alcohol is a very toxic, powerful addictive substance. It has significant short and long-term physical and psychological effects on the body and can successively make a person feel disinhibited, emotional, sentimental, narcissistic, aggressive, angry, paranoid and relaxed within a short period of time rendering a drunk person extremely volatile and unpredictable. In short, drunkenness can reduce people, initially to adolescence and latterly to a state of near infantilism. In addition and to cap it all, it is a major contributor to premature deaths in these isles.
Three powerful forces have helped to give rise to the current concerns around alcohol and these can helpfully be symbolised as ‘the three As’. That is, alcohol is, firstly, more affordable than ever, particularly when sold at heavily discounted rates at supermarkets. It is also more available than before with a greatly expanded number of outlets selling it. Finally, it is probably far more acceptable now than in the past especially among whole groups of people such as women and young people for whom drinking in the past was strongly regarded as an unacceptable practice. Cumulatively, the three As have probably been prime factors in leading to a far greater prevalence of alcohol consumption and its attendant problems.
And yet, in spite of all these issues stemming from alcohol misuse, there is something profoundly unsettling about the current emphasis on alcohol. For one thing, there is always the danger that when an issue is brought into the glare of high profile media attention it is treated as something profoundly new and shocking when in fact it is merely casting new light on something that has been there all along. If you were to go into an A & E unit in a city such as Glasgow in any year in the 20th century you’d probably find the majority of people there at the weekends were under the influence. Similarly with those occupying the police cells in the city at weekends, incidents of domestic violence and days lost at work. All would have drink as a major factor, but largely unheralded and unpublicised, except in popular culture where the image of the drunken man (particularly in Glasgow) was a fairly constant theme. And it goes back further than the last century. T.C. Smout in his seminal A Century of the Scottish People 1830-1950 quotes a Dr George Bell’s descriptions of the slums of Edinburgh written in 1849 and 1850:
“From the toothless infant to the toothless old man, the population of the wynds (dark, impenetrable labyrinths of narrow streets and alleyways surmounted by tenements) drinks whiskey. The drunken dram that is expended on Saturday night and Sabbath morning beggars description. The scene is terrible and the music dreadful. It is impossible to say how much is expended on the chronic drinking, or everyday consumption of whiskey; and how much on the weekly exacerbation or grand infernal orgie” .
Scotland (and the UK’s) deadly love affair with alcohol is nothing new and is intrinsic to our culture and way of life. Yes, the extent and scope may be greater, and certainly, in terms of media coverage, the visibility is, but our alcohol demons have been with us for centuries.
Then take the concerns around the aforementioned three As. Cheaper, more available booze in a culture more readily accepting of drunkenness and drunken behaviour have been implicated as the prime factors leading to binge drinking and transforming our towns and cities into hotspots of intoxicated young people engaged in lewd and offensive conduct making them no-go areas for the sober and the abstinent. The images from Britain’s wild city-centres at weekends are now constantly relayed on newscasts whenever the topic of alcohol is aired and provide diverting entertainment on umpteen TV programmes such as Booze Britain and Cops which seem to be broadcast constantly on freeview and satellite TV.
But the three As didn’t come from nowhere. There is not the space here to go into this in detail but in the last 30 years Britain’s formerly run-down, de-industrialised city-centres have been revived and regenerated with an emphasis on entertainment. At the same time Britain’s previously staid and moribund brewing and drinks industry which had been dominated by a few large companies, was effectively broken up in the 1980s allowing a new breed of retail drinks companies to move in and buy up swathes of former banks, shops, warehouses and even churches and turn them into pubs. These new companies were able to push prices down aggressively. During the same period, licensing boards became ever more mindful of European free trade laws which had become law in the UK. In practical terms this meant that a convention within British licensing boards of restricting the number of pubs in an area to a few at any one time, could now be interpreted as a restraint on free trade with potentially onerous financial penalties for local authorities: consequently the number of licences granted and premises opened increased enormously. Finally, wider changes in society and popular culture overcame any remaining taboos on consumerism, celebrating success and even excess and opened up new freedoms to groups such as women and young people; drinks companies re-oriented their marketing and advertising campaigns quite cleverly to appeal to these new markets.
The upshot of this is the night-time economy premised on relatively cheap booze, served by dozens of pubs all located adjacent to each other targeted at mostly young people with loud music. Add to this, a ridiculously short, archaic 15 minute drinking up time to consume copious amounts of alcohol before closing time which is zealously enforced by pub and club staff. And, compounding this, and in spite of recent 24 hours opening legislation in England, all these licensed premises will close at the same time ejecting tens of thousands of drunk, highly charged, energetic and volatile young people into the night and you end up with..well just watch your TV sets for the next news item about alcohol or see for yourself at 3am in any British town centre, if you’re brave enough. –
The point is that there are many culprits for the three As; local authorities, licensing boards, drinks companies and promoters, free trade laws which treat alcohol as just another consumer product, national politicians and political parties who were unaware of or turned a blind eye to where this was leading and a media and culture who celebrated excess, including boorish drunken behaviour as an expression of ‘individuality’. So the next time you want to shake that scantily clad young lady who is falling over her high-heels, drunk at 3am which you’re now seeing for the 50th time on your TV screens, or want the police to arrest those two aggressive staggering males squaring up to each other captured on CCTV, don’t just blame them, but the many behind the scenes players that led to this situation, not least politicians whose own policies helped to bring this about and who are now screaming for action.
And then there are the units.
In Britain the recommended safe weekly units of alcohol for men in Britain are 21, while for women it is 14. The daily equivalents for these standard weekly safe limits are 3-4 units for men and 2-3 units for women which means that you cannot get away with taking 19 of the 21 units if you’re a man in the one evening because you are still under your weekly limit as this far exceeds your daily total. This is a strong injunction against “binge drinking”, a common definition of which is taking more than half the recommended weekly levels at one drinking session. So, for a UK male conforming to the UK definition of an alcohol unit (the definition of a unit varies from country to country) and what the safe limits are, taking four pints of beer or lager containing 5% alcohol per volume would constitute binge drinking while a UK female consuming 3 glasses of white wine containing 12% alcohol per volume would be binge drinking.
These recommended guidelines around the maximum weekly and daily safe number of alcohol units are now promoted throughout the health service in the UK at GP surgeries, hospital wards and accident and emergency units, are constantly reiterated by government and other official sources including local authorities, ceaselessly disseminated in the media and provide the bedrock for umpteen prevention and education initiatives and projects and safer/moderate/sensible drinking campaigns. One would imagine, therefore, that the guidelines are backed up by a solid corpus of research evidence comparable to that which underlies most other major public health campaigns. But, according to the London Times in October 2007, based on comments from a former editor of the British Medical Journal and member of the Royal College of Physician’s working party on alcohol, the current guidelines, introduced in 1987, were “plucked out of the air” and have “no firm scientific basis whatsoever”. Moreover, “Subsequent studies found evidence which suggested that the safety limits should be raised, but they were ignored by a succession of health ministers”.
This resonates with a sneaking, but apparently well-founded suspicion that the recommended safe drinking limits are set far too low. The Times article cites a liver-disease specialist at Newcastle University who says that “it doesn’t really matter what the limits are”. “What we do know is, the more you drink, the greater the risk. The trouble is that we all have different genes. Some people can drink considerably more than [the limits] and they won’t get into any trouble.”
The point here is that limits or bars such as the alcohol guidelines are statistical averages, which like all averages are heavily skewed by extremes. Their effectiveness and reliability as a guide or benchmark must assuredly be dependent on how they relate to the norm of how much people drink without coming into problems in relation to their health and other issues. And this is where the guidelines would appear to have a severe credibility problem.
The vast majority of people, who drink regularly, sometimes even those who do so only occasionally, do so to relax, to get tipsy, or to get moderately drunk. They overtly express this when they go to the pub at the end of a working week to unwind, or to celebrate success or a special event or to commiserate or to drown their sorrows at some setback or disappointment. Very few of the vast numbers of people who drink regularly will adhere to the guidelines, and only a small number of these will come into problems with alcohol use, given that the proportion of admissions to hospital both for alcohol related incidents and long-term illness caused by alcohol is only a fraction of the total number of regular drinkers. These are not people consuming units of alcohol many multiples greater than the current recommendations, which is unquestionably harmful, but drinking up to 35, perhaps 40 units per week, almost double the present limit (two-and-a-half times if you’re female).
Consequently, we have a situation whereby the public health guidelines around alcohol in the UK are ignored by people who drink, including a large number of those such as public health and addiction workers who are supposed to administer them while those who support them and rigorously uphold them either don’t drink themselves on a regular basis, or do so only sporadically.
To repeat the vast majority of people who drink and drink regularly and exceed the current guidelines, will come to no harm. A stratum of people who drink will come into problems around their drinking, not least addiction, and we need good quality services to deal with and treat them, preferably at an early stage of their problem drinking. The people in this stratum are not in the least bit influenced by guidelines as, in the vast majority of cases, their drink problems are due to deep seated personal issues. Finally, as a result of a series of socio-economic, political and cultural factors we have a highly visible (and publicised) problem of predominantly young people binge drinking in our city-centres, which we need to address through sensible measures including planning and licensing controls on the number of pubs and clubs gathered in any one area, stopping irresponsible and reckless drink promotions, ending the stupid and dangerous 15 minute drinking-up time which encourages rapid bingeing at the end of an already alcohol fuelled evening and all pubs and clubs shutting at the same time in the wee small hours. None of these are the responsibility of individual drinkers but lie firmly at the door of those authorities at local and national level who are meant to ensure that our cities and towns are safe places to live, work and socialise in.
We need an urgent and honest assessment of what the real issues are in regard to alcohol including what the best limits and units to adhere to are in order to prevent long-term damage occurring as a consequence of alcohol use. What seems to be apparent is that people will go on drinking and ignoring the present guidelines and associated campaigns because, however rightly or wrongly, they are perceived to be set too low and cut across an important aspect of alcohol that has underpinned its popularity for centuries. This is that people can engage in almost controlled bursts of intoxication which occur at set times and set places and can be fitted into the rhythms and demands of a working week without incurring major long-term harm. And by setting the bar on alcohol units which are too low, there is a good chance we will turn people off from listening to and acting on very good advice about how to cut down from truly harmful levels of drinking and mitigate and reduce the harm that those really dangerous levels of harm are causing in our society.
In 1980 Pink Floyd had a no 1 hit with Another brick in the wall, one of whose celebrated lines was “Hi teacher! Leave them kids alone”. We could adapt that in 2010 by declaring: Hi politician! Leave them drinkers alone.