Over the past weekend I was involved in a twitter
conversation and I happen to make the observation that alcohol consumption was
linked to price. The reply which came
from people I know to be health professionals left me a little surprised. The link between alcohol and price was
doubted and then a comment was made how will this help the addict? Further conversation stressed the need for
more education. Clearly there are
evidential blind spots in operation here.
Lets deal with price first. As
the alcohol industry will not tire of tell you there is no proof of a causal
relationship between alcohol consumption and price. In this they are correct, but what they won’t
say is when looking at wider population effects this is almost impossible to
show. What we have is the very next best
thing, a plethora of cross-cultural/international evidence that shows there is
a strong relationship with greater levels of alcohol-related harms and low
priced alcohol. Paying a realistic price
helps the addict because it means that alcohol is not so ingrained into our
culture.
Secondly the panacea of education that is often beloved of
health professionals and certainly the alcohol industry largely because it makes
barely a dent in their profits. I
support alcohol education so long as it is delivered in an evidence based
way-which unfortunately is rare. But
even when delivered according to the evidence, behavioural change is
minimal. The alcohol industry loves it
because it gives the impression of doing something but in reality has a minimal
effect. The result of education is to increase
knowledge but the evidence for behaviour change is very weak, indeed sometimes
it has shown that it encourages rather discourages experimentation. So please let us have evidence driven
education programmes but accompanied by measures that really will have an
impact;-increase in price and reduction of availability.
Especially whenever representatives of the alcohol industry
are asked to comment on consumption the spectre of the predominance of the
responsible drinker or consumer is raised-ergo people who are not responsible
are "spoiling the fun of the majority.”
Alcohol is fun I am a drinker and most of time I consume responsibly but
there will be occasions when I don’t but I think elements of “fun for the
majority” need to be unpacked. It may be
a bit po-faced but I despair of some of the attitudes that surround
drinking. I have lost count of the
number of times I have heard comments along the lines of when I get home “there
will be a nice glass of something cold waiting for me.” Notwithstanding the inherent dangers of using
alcohol as a reward (see my last blog-Home drinking: because I am worth it) if
the words “glass of something cold” was replaced with “a joint” “ a valium”,
“line of coke” “syringe of heroin” it does not quite have the same ring.
This week I read something that threw into sharp relief the
dysfunctional culture that surrounds drink.
Devon and Cornwall police returned 27 sixteen year old youths staying as
a group without their parents in Newquay who were “running riot” having smashed up their rented accommodation whilst
on drunken sprees with alcohol brought down from Bristol, Birmingham and
Guildford respectively. For some on
twitter apparently this was caused by a “lack of alcohol education.” If ever there is a case of the horse having
bolted this is it. I am less critical of
the young people than their parents.
Nice to give someone a rite of passage provided other people pick up the
tab. No doubt most of the parents would
regard themselves as responsible I beg to differ, I shudder to think what
messages they have been given albeit not consciously concerning how alcohol is
fun. Education has no chance when it is
undermined in such a manner by our wider culture.
Now for some final thoughts about addiction, I welcome more
treatment services but I also feel that wider society can help the addict by
realising that an addiction is just the extension of an unhealthy habit and “there
but for the grace of God go I.” I have
worked with individuals who were addicted to alcohol for many years and
understand from talking to many of them that the main challenge they face is
relapsing on leaving treatment services.
They will describe putting themselves in situations where eventually
they are overwhelmed by cues. (although they are unlikely to use such a word)
usually in response to a stressful situation or wishing to test themselves. A cue is something that they associate with
drinking, such as a pub, going back to areas where they drank, the smell of
alcohol. I spoke to someone recently who
had been drinking for many years and could provide a thirty year
perspective. The main challenge he now
faces is that alcohol is far easier to obtain and cheaper- he stressed the role
of supermarkets in making alcohol easily available.
The addict plays a vital role in helping to persuade
ourselves that we are not like him or her for we use alcohol “responsibly”. I may be making a utopian suggestion here, but
if we paid a realistic price for alcohol, accepted some restrictions on its’ availability
and examined some of our own beliefs and attitudes to alcohol we might be
creating a creating a healthy culture for us all and at the same time making
recovery for those who have become addicted to alcohol just a little bit
easier.
Dr John Foster is Principal Research Fellow at the
University of Greenwich-School of Health and Social Care. This blog represents my personal opinions and
do not represent those of the University of Greenwich.