Alcohol isn't like sushi

I’m off work for a few days this week, so while I’ve been catching up on jobs around the house I’ve also been catching up on my podcast listening.  One of those I’ve made time for is Suzi Gage’s ‘Say Why To Drugs’.  I can absolutely recommend all episodes of this, and as someone who now works more on the practical (as opposed to academic) side of things, I really welcome the focus in this collection on practical issues like drinking in pregnancy, recovery from ‘addiction’, education in schools and broader drug policy.

I could write about all of these themes, but I don’t have a huge amount to add or question – except for one almost throwaway comment made in the episode on alcohol and pregnancy, which I thought might illuminate a wider idea about alcohol’s place in our society.

I should preface this discussion by saying that drinking in pregnancy is not my specific area of academic or professional expertise, and I’m aware I’m a man without children, so I’m not speaking from personal experience.  (However, it is a major issue in my work, as we look to improve guidance for professionals and patients during pregnancy.)  And I'm not criticising that almost throwaway comment itself; it's precisely because I think it's helpful that I want to use it to discuss some wider issues surrounding alcohol and drug policy.

So what comment am I talking about?  Well, both guests, Dr Kate Fleming and Dr Luisa Zuccolo, made reference to the fact that consuming alcohol is normalised in our society – that it even appears at seminars about alcohol harm, for example.  And one way in which this was discussed was how abstinence from alcohol during pregnancy is viewed differently from other ‘rules’ or ‘guidance’ that people are given at the same time.

That is, why is stopping drinking for 9 months (or quite possibly less) seen as more difficult or frustrating than giving up sushi, cured meat or certain cheeses?

I think the answer can be seen in the words I’ve just used.  You’ve read that sentence in italics, and hopefully understood what I mean.  I used the word ‘drinking’, but it was probably clear I was talking about alcohol specifically – about giving up beer, cider, wine and spirits.

Given we talk about ‘food and drink’, that phrasing makes it sound like giving up alcohol (‘drinking’) is like giving up something equivalent to food as a whole, which is going to make things sound psychologically challenging.

In fact, we’re not even talking about whole categories of food, like giving up all cheese, or all fish – just certain types or preparation.  And of course, we’re not talking about all ‘drinking’; just drinking alcohol.

But these are still very different categories.  If you think of that as focusing down using categories, you might construct something like: Food > Meat > Fish > Raw fish.  The comparable categories for ‘drinking’ might be: Drinking > Alcohol > Wine > Sparkling wine.

If you can’t have some cheese, there would be another cheese you could use as a substitute.  And any single item on the list might bring you pleasure, but there would be some other food-based pleasures available.  So the first thing to note is that asking someone to forgo raw fish isn’t like asking them to forgo alcohol as a whole, but perhaps sparkling wine – a particular form of wine that is unusual, but very much enjoyed by some people.

Of course there’s an argument here that I’m placing alcohol on a level with ‘meat’, when to many people it’s just a ‘nice to have’ or some kind of treat that we should be able to take or leave.  (I’ve written before on whether alcohol is like meat or potatoes, or neither.)

But here’s where it gets interesting.  Alcohol is effectively in a category of its own in our society.  It’s a legal, intoxicating drug.  We don’t really think of anything else available as being in the same category.  The intoxication from nicotine is more short-lived, and most people wouldn’t understand caffeine in this way at all.  (At this point, I’m not too interested in some scientific critique of these categories or distinctions; what’s more relevant for our purposes is how people actually understand the world around them.)

That’s perhaps as much about the nature of these ‘drugs’ as much as their legal status: alcohol is something lots of people use to relax or escape from the everyday, whereas caffeine at least is generally understood to help us focus or be more efficient – ways of being which people drinking are often deliberately trying to avoid.

So one immediate thought is that perhaps the term that’s analogous to ‘food’ isn’t ‘alcohol’, but ‘drugs’, and it would be good if we had an alternative to substitute.  And that’s where I think the discussion of ‘drinking’ makes a serious point about how narrow our options as a society are.

However, this is a big drug policy perspective, and in this specific example of drinking in pregnancy, it’s unlikely there are many low-risk alternative drugs to alcohol (though there are certainly lower-risk alternatives).  So what’s the alternative in pregnancy?  It is, as with so many elements of behaviour change (and indeed treatment for substance use disorders) to think about the function of the drug/behaviour.  What is alcohol actually doing in someone’s life?

Is it about signifying a change in time – maybe the switch from work to leisure?  In which case, it’s not really about intoxication, as Joseph Gusfield explained neatly, but a symbolic transition.  At times in my life when I’ve stopped drinking, I found personally that alcohol-free beer could serve this function pretty well.

But alternatively (or in addition), the function may be more directly related to the intoxicating properties of alcohol: genuinely altering the way we think and behave.  In that case, the options for replacement would be different: certain activities like watching a film, or playing an engrossing game might work better.

These aren’t really evidence-based suggestions, but I want to make that broader point: when we think about ‘drinking’, we’re not necessarily thinking about one pleasure that can easily be replaced with another, just as one preferred food might be.

In our society, alcohol has a unique status, as both drug and not-drug.  It is legal, and therefore different to ‘drugs’, and yet it is seen as having the properties of drug, in terms of intoxication, in a way that its other legal counterparts aren’t.

Our conversations about alcohol, then, are distorted for two reasons.  We separate it off from other drugs, but we also separate it off from other pleasures.  And this has important implications.

When lots of people who feel they need to stop drinking (whether because of ‘addiction’ or any other reason) are faced with some of the ‘substitutes’ above, it can initially seem that life is going to be somehow boring.  (There was some excellent discussion of this on an episode of BBC Hooked, while we’re on podcasts.). To be honest when I read it, I feel a slight inward groan.

This is partly because we separate out alcohol-related pleasure from other pleasures – as do lots of fervent campaigners for sobriety.  As I’ve written about before, pleasure in intoxication is sometimes seen as ‘cheating’, or less real or worthwhile than the pleasure someone might take in going for a run, reading a book or doing some yoga.  Or somehow someone who is intoxicated is less ‘authentic’ or ‘fulfilled’ than someone sober.

Sometimes this way of framing alcohol-related pleasure is helpful, in the same way that for some people the idea of a lifetime of complete abstinence from alcohol can be useful in giving clarity and structure (and even release).

But counterintuitively, I wonder if the ‘normalisation’ of alcohol, which is quite reasonably criticised in the podcast, is actually a function of its uniqueness.  It might be ubiquitous, but it’s far from ‘normal’.  The wine served at a seminar about alcohol issues or a school fete isn’t ‘normal’; it’s a treat.  If it were unremarkable, then it would make no difference if tea was served instead, but there would certainly be grumblings and surprise.  And no wonder, when it has this unique status as an intoxicating treat.  It is understood to be effectively irreplaceable.

So we’re back to that question of what alcohol is for.  As I’ve suggested before, I worry when alcohol is viewed solely as an intoxicant, and it has unique status in that.  And listening to another episode of Say Why To Drugs, with James Nicholls from Transform, I wondered if we could ever resolve this ‘specialness’ of alcohol while it is (seen as) our only legal intoxicant.

Perhaps, to continue a theme, I can end with another podcast reference, recommending Adrian Chiles in conversation with James Morris.  We maybe need to think more about our pleasure (or lack of it) in drinking, and understand why we do what we do.  If alcohol is no ordinary commodity, as many campaigners would suggest, it’s equally not uniquely extraordinary, and we would do well not to separate discussions off from other elements of our lives.