Why secondhand drinking isn't like secondhand smoke

This week the Guardian have published a piece highlighting the indirect harms that can arise from drinking.  This is important stuff that should be more prominent in alcohol policy debates.  Too often, issues around alcohol policy drift into the classic libertarian territory of saying that it’s simply someone’s individual choice what they put into their body.

This position neglects two key points.  First, decisions are made in specific contexts that have been designed, consciously or not, by policy.

Second, our decisions have impacts on other people; no man is an island.  The classical liberal debates about alcohol aren’t simply about whether alcohol enslaves the individual drinker, as JS Mill put it, but also in terms of his ‘harm principle’: do your actions harm those around you?

The article in the Guardian lays out quite clearly some potential harms from other people’s drinking: violence, drink driving, neglect, abuse, and so on.  And Ian Gilmore makes what seems an obvious comparison with passive smoking.  Indeed it’s referred to as ‘secondhand smoke’, and the title of the article refers to secondhand drinking.  We’ve been here before.  In 2009 Liam Donaldson referred to ‘passive drinking’, though the concept didn’t get much traction.

I should be clear that I think discussing these very real and serious harms is important, and can – indeed should – reshape our debates about alcohol policy.  However, this analogy worries me, for all the usual reasons I write about on this blog.  We need clarity and honesty from messengers on this issue for two reasons.  First, you want to protect your reputation as a messenger for being open and truthful.  Second, and much more importantly, you actually want to generate the best policy solutions, which means being clear about what exactly the problem is.

For ‘passive’ or ‘secondhand’ drinking, the problem is qualitatively different from ‘passive’ or ‘secondhand’ smoke.  If we base our solutions for alcohol simply on analogy with tobacco, we’ll make some serious mistakes, as they’re quite different drugs, perceived quite differently, that play different roles in our society.

Crucially, the danger with passive smoking is in the substance itself: someone else is exposed to the toxins in the smoke.  This is the key justification for the smoking ban: you physically need to separate non-smokers from smoke to reduce their risk of developing certain health issues.

For alcohol, this does not happen.  A child might access a parent’s alcohol, for example, but this is not ‘passive drinking’; it’s actual drinking.  The harm comes not directly from the substance, but indirectly through the person using it.

As the Guardian piece points out, there are all sorts of harms that are related to alcohol.  However, these are quite different to those related to tobacco.  People in smoking areas tend not to start fights after they’ve had just a few cigarettes.  People tend not to fail to get the children to school because they’ve been busy smoking too many cigars the night before.  You don’t have a few pipes of tobacco and become incapable of driving safely.

To be fair, I think Ian Gilmore knows this.  He explains that the smoking ban, which he sees as a positive policy intervention, was only possible as a result of increasing awareness amongst policymakers and the public that secondhand smoke is bad for your health.  But he then recommends a completely different policy solution for ‘secondhand drinking’: increasing duty, and therefore the price.  This is genuinely analogous to tobacco – but analogous to an intervention introduced to reduce harm to the smoker, not those around them.  The idea is that higher taxes both reduce consumption and enable society to pay for the treatment of health conditions of those who do continue to smoke (though the cost-benefit analysis of the latter point is much debated).

What Gilmore is really doing is being disingenuous, or more generously being a pragmatic lobbyist.  He states: “Secondhand smoking [as a concept] really changed public opinion and paved the way for legislation to make bars and public places smoke-free.”  Here he is stating his lobbying approach.  He wants to establish secondhand drinking as a concept in public opinion so that different policy solutions are contemplated.

And this is fine by me.  If we define the problem differently (it’s not just about harm to the individual drinker, but the people around them too) then it’s reasonable we should consider different policies to address this.

The problem is that tobacco is a poor comparison because of what causes problems and what it’s place in society is.  And in pragmatic terms this is important not just because we want to have accurate descriptions of reality, but because lobbyists want to use the right tactics.

But for the moment let’s just focus on the reality.  Most of the problems with tobacco are about tobacco.  If you replace the tobacco smoke with other ways of getting the actual drug – nicotine – then suddenly much of the harm (to others as well as the person using) disperses too.  When we’re talking about bans on e-cigs, we’re in the slightly trickier territory of JS Mill’s use of the word ‘nuisance’ rather than his clearer idea of ‘harm’.

As I wrote last week, many of the problems related to alcohol are not neatly about alcohol.  We can take the substance away and still not resolve the underlying issues.  A reductive focus simply on price and availability will not serve those who still end up drinking – and those around them.  When we discuss the harm of ‘secondhand drinking’ we need to be thinking about treatment, culture, education, social support, wider resources.  I worry that the analogy with tobacco leads people to a narrow set of ‘solutions’.  Gilmore states: “[With cigarettes] we have relentlessly pushed the price up.  Quietly, but relentlessly.  And that’s made a huge impact.  The UK is the leading European country in reducing smoking rates.”  The analogy remains and the conversation comes back to price.

‘Passive drinking’ never caught on as a concept.  Maybe ‘secondhand drinking’ will, but it needs to mean something more than an analogy with smoking, otherwise the public and policymakers will, quite rightly, see through it.  We can do better than this.  Let’s be open and honest about this issue (as most of the Guardian piece is), and work from that to realistic, sensible policy interventions.