Friday, 19 September 2014

Drinking within limits with Drinkaware

Last week, Drinkaware published a report called ‘Drunken Nights Out’.  It’s definitely worth reading, and the analysis of drinking practices and beliefs underlying it is surprisingly nuanced and thought-through.  Perhaps that’s testimony not only to the researchers but to those who sat on advisory panels.  If you don’t have time to look through even just the executive summary, then I can recommend a summary provided by Alcohol Policy UK.

The report carefully assesses people’s beliefs, behaviours, activities, fears and motivations.  For example, it’s noted how (certain forms of) drunkenness are considered normal, that many people’s early experiences of drinking enforced an instrumental approach to alcohol (drinking to get drunk), but that even such determined drunkenness (as Measham and Brain would call it) is ‘within limits’.

It’s this last point that’s particularly interesting, because it’s noted that these ‘limits’ aren’t like the limits government refers to, and in fact are framed in completely different terms.

However, the report falls down, in my opinion, when it moves to solutions to the perceived problems.  This is partly due to the restrictions applied to the scope of the report, but it’s also due to certain assumptions applied.

First, the report sets its terms of reference by stating that it’s only concerned with what’s in Drinkaware’s remit.  In the eyes of some public health professionals, this will immediately limit its usefulness, as the key factors of price and availability are not within Drinkaware’s gift.  Moreover, it’s stated that the report takes a harm reduction approach, meaning that it’s not aiming to reduce the number of ‘drunken nights out’ so much as reduce the harms associated with them.

This statement leaves me in a slightly uncomfortable place.  I agree that the focus shouldn’t particularly be on reducing the number of drunken nights out per se.  If people want to spend their evenings (and money) on this, I can’t immediately see why it’s any more execrable than partaking in state-subsidised opera, or skiing (so long as they know what they’re getting into).  Both of those alternatives often (or always in the case of certain opera companies) involve the state paying for the choices of individuals, which is the only real downfall of ‘drunken nights out’ as identified by Drinkaware.

On the other hand, that limiting of the scope of the report doesn’t actually follow from the initial statement that it will only look at interventions that are in the gift of Drinkaware.  In fact, given the strong links between drinking, drunkenness and the carnivalesque (or simply outrageous behaviour) in the way we think about alcohol in today’s Britain, it could be argued that educative approaches would be more likely to persuade people to go out on such nights less often, than to completely change their understanding of alcohol.

This brings me back to my old frustration with the alcohol industry (though I shouldn’t lump a whole range of interests together like that).  I often agree with them, but sometimes for completely different reasons, but other times find myself hugely disappointed by their cynical, self-interested approach – and I can’t help feeling this report is too constrained by a particular way of thinking about what is appropriate for Drinkaware to do.  I don’t think in this case these limitations are due to the same calculating cynical approach I’ve seen from the WSTA and Portman Group, but rather just accepting what they already do as inevitable restrictions.

But back to the practical recommendations of the report.  First, there’s one suggestion that people with a public health perspective should be applauding.  The report notes that education initiatives should challenge the assumption that if you ‘get away with it’ on the night, there’s no long-term problem.  Once the hangover is gone, you might feel fine on each occasion, but you could be doing long-term damage to your health.  I don’t expect to see a magical intervention that can successfully defeat this assumption, given that a belief in one’s immortality is something we cling to despite mountains of evidence – but this is an appropriate target for intervention.

After this, though, my academic perspective saw a couple of key flaws in the approach.  First off, methodologically, there are problems with simply asking people what they think or do regarding drinking.  We’re actually concerned with what they do, which doesn’t always correspond exactly with what they say – particularly regarding drinking within limits or having safekeeping strategies.  Most people know that some of the best laid plans for a night out can often fall apart in reality.  You have just one more drink, and raid the money you’ve saved for the taxi home to do this, but you might well still talk about knowing your limits and setting boundaries when you describe your drinking to other people.

This then leads into the broader point around limits.  Although the report is refreshingly clear about people having limits around their drinking, it doesn’t pay enough attention to its own acknowledgement that these are founded on completely different principles to the limits the government espouses, or indeed those placed on the same individuals’ behaviour at other times in the week.

I never seem to stop citing MacAndrew and Edgerton on drunkenness and limits, and here’s another opportunity.  Basically, they compared how drunk people behaved (and were treated) in different societies, and argued that drunkenness is set of norms and is ‘learned’ as much as everyday behaviour.  To give a simple example, in some societies people became fired up when drunk, whereas in others they chilled out.

And the ‘limits’ were different too.  Even when apparently blind drunk and on a drunken rampage, a reveller in one society found time to apologise to a researcher – acknowledging that his actions were ritualised and the outrage shouldn’t apply to a visitor.

These sorts of limits aren’t what Drinkaware is talking about in the report; they’re wider and more fundamental.  They are not about whether you set yourself the limit of four drinks or five on a works night out, but instead whether murder, drink driving or domestic violence when drunk is acceptable.

These sort of limits aren’t just individual; they’re influenced by broader issues like the legal framework surrounding alcohol.  That doesn’t mean Drinkaware can’t do anything about them, though.  And more importantly it has serious implications for the solutions proposed in this report.

The report makes the same mistake as the ‘Would You?’ campaign, which I’ve written and spoken about a number of times at conferences and in academic articles: it suggests that education campaigns should remind people that ‘they would not accept such behaviour outside the context of drunken nights out’ (p.10).

This is irrelevant.  The whole point of ‘drunken nights out’ is that these evenings operate under different norms to the everyday.  To tell someone they wouldn’t accept this behaviour outside of a drunken night out is just to remind them that’s why they go on these nights out in the first place.

I’d suggest that a more appropriate response is to stress certain absolute lines.  Looking at the work of MacAndrew and Edgerton, or indeed our experience in recent decades in the UK, we can see that certain things can be branded unacceptable regardless of drunkenness.  The claim shouldn’t be that you wouldn’t do something sober, making the comparison between the two scenarios; it should be simply to state that certain behaviours are unacceptable regardless of context.  We’re perfectly capable of holding onto certain norms when drunk, and there’s no reason to think this approach shouldn’t be considered within the scope of Drinkaware.

This might seem like a semantic distinction, but I think it’s crucial, and does reflect a genuine misunderstanding on the part of the report’s authors.  It’s not just that such strategies wouldn’t be effective; it’s also that it would be sad to apply everyday norms to all aspects of human life, and that’s what the general philosophy of ‘you wouldn’t do this sober’ suggests.  There are some benefits and pleasures in drunkenness and carnival.

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