Monday, 19 November 2018

Alcohol Change: The Voice of Moderation?

Today the new charity formed out of the merger of Alcohol Concern and Alcohol Research UK has been launched.  You might remember that when this merger was first announced I was pretty sceptical that it could work.

I felt that fundamentally the two organisations had different visions that were basically at odds with each other.  Alcohol Research UK sought to improve knowledge and information to help reduce alcohol-related harm, while Alcohol Concern sought to eliminate alcohol-related harm altogether.

These might only be seen as matters of degree, but the idea of a world free from alcohol harm is as utopian as the UN’s claim that we should create a ‘drug free world’.  Given what we know about alcohol, the only way to guarantee you won’t suffer any harm related to it is not only for you not to drink, but for no-one around you to drink.  A world free from alcohol harm means, in reality, a world free from alcohol.

The new organisation – Alcohol Change – defines its vision as being a society where there is an end to ‘serious alcohol harm’, and envisages bringing this about by improving knowledge, policy and treatment, and therefore changing cultural norms and drinking behaviours.

You can read about Alcohol Change’s proposed approach in a kind of ‘state of the nation’ report released to coincide with Alcohol Awareness Week.  I just want to pick out a few gems and talking points from this that have made me eat humble pie: I think that maybe the staff and Trustees at Alcohol Change have managed to do what I thought was if not impossible then certainly highly challenging.

First, there’s a paragraph in Alan Maryon-Davis’ introduction that I think should be shared with every journalist and political commentator ever considering discussing alcohol policy:
There is nothing inevitable about the way we drink, how we behave when drinking or how difficult it is to access the support that can help turn lives around. Research shows that the majority of dependent drinkers recover, that heavy drinkers can make new choices, and that the social and cultural environment in which people drink can and does change. Change is possible for individuals, and it is possible for society. (p.1)
Far too often we view drinking habits as unchanging and unchangeable: we’ve been drinking too much as a nation since well before William the Conqueror arrived.
‘Drinking in particular was a universal practice in which occupation they passed entire nights as well as days. They consumed their whole sustenance in mean and despicable houses, unlike the Normans and French, who in noble and splendid mansions lived in frugality … They were accustomed to eat till they became surfeited and to drink till they were sick. The latter qualities they imparted to their conquerors.’ William of Malmesbury, 12th century

But that raises the inevitable question: if change happens, and we can shape it, what sort of culture should we be aiming for?  And this is where the ideas of knowledge, information and choice come through strongly and, for me, positively in the Alcohol Change document.

I’m generally sceptical about health and behaviour change programmes based around ‘choice’ because they tend to ignore (or at least downplay) the level to which people’s choices are structured by the situation they find themselves in: who their parents are; where they live; how much money they have; the job they have; the personal relationships surrounding them; and so on.

But this document doesn’t duck this issue; it notes the importance of culture and norms in shaping our preferences and expectations, and how these in turn can be shaped by policy levers.

The changes in alcohol consumption shown in the graph above were partly down to some short and medium terms factors – both conscious policy decisions and the simple fact of a dire economic situation – but they cast a very long shadow, with alcohol consumption for most the twentieth century remaining at historically low levels.

And the policy point is made with a bit of nuance too.  As I’ve argued elsewhere, too often policy discussions focus on exciting new initiatives – such as minimum unit pricing – at the national or even international level.  In reality, there’s massive variety and impact generated by local decision-making – but somehow Town Halls are seen as less interesting than Whitehall.  It’s refreshing, therefore, to read a strategic document that emphasises the importance of engaging with ‘local government … commissioners of treatment services [that’s me!], the police, local planning, and all the other local stakeholders with a role in reducing alcohol harms’ (p.11).

For me, this document seems to have got the approach just right.

There will of course be campaigners who feel that ‘serious’ is a weasel word that dilutes the utopian aspiration of a world completely free from alcohol harm, and the focus on knowledge and information is a naïve concession to the evil industry of ‘big alcohol’.  And conversely there will be libertarians who see the emphasis on culture change as beyond the scope of reasonable activities, which should allow people to pursue their own choices.

For me, that’s the ideal position for a new charity like this to be in.  I’ve complained before about the polarised, adversarial approach that often characterises alcohol policy debates – ‘public health’ versus ‘the industry’ – where both sides have some valid points but neither is listening to the other.

There will always be these voices at either end of the spectrum, and there’s little value in duplicating one or the other – a simple approach to balance will mean both are heard (or at least given the opportunity to shout over each other).

The value of Alcohol Change should rest in being a different voice, not associated with a partisan position but as a trusted messenger and ‘truth teller’.  And in playing that role – rather than simply being a vocal, idealistic (even utopian) campaigning organisation – it may find its ideas and proposals are listened to more seriously than either of the two extremes.  As so many alcohol researchers and lobbyists have noted, there is great power in being able to define what the ‘moderation’ is.  Alcohol Change can position itself as the voice of moderation in more ways than one.

The last time I wrote about this merger, I summed up my scepticism with a reflection on my personal feelings – valuable because so often (as drinkers, professionals or campaigners) our views on alcohol are shaped by personal experiences and beliefs.  I said that while I would be keen to work for Alcohol Research UK, I just couldn’t see myself being a good fit with Alcohol Concern, given its hardline, lobbying approach.  I don’t know whether it’s praise or not, but I can honestly say that Alcohol Change looks like the sort of organisation I’d enjoy working for.

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