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.

Wednesday 17 September 2014

What's new about neoliberalism?

A while ago I wrote about an academic article I’d had published that suggested successive governments’ alcohol policies can usefully be labelled neoliberal.  The reason this was worth saying, I suggested, was that some policy commentators have talked about policy entering a new phase since 2008, as confidence in market mechanisms and individual rationality have faltered in light of the crash and recession and there’s been an increasing emphasis on community-focused interventions through developments such as Blue Labour, Red Toryism, and David Cameron’s idea of the Big Society.

The first step in this argument is to note that governments have loosened regulation of the alcohol industry, particularly through the 2003 Licensing Act, but also well before that, from the 1980s on.  Phil Mellows has suggested that the Beer Orders can be seen as neoliberal, as (however misguidedly) they sought to open up the market to greater levels of competition.

But in itself this could just be liberalism.  The same arguments about competition were made in the nineteenth century in terms of the Beer Acts.  What made these more recent developments neoliberalism, I argued, was the peculiar way in which government was clearly panicked about alcohol and worried about particular types of drinking.  Alcohol strategies were published by successive governments, and millions of pounds were spent on advertising campaigns to persuade the public to Know Your Limits, know your Units, and behave on a night out in a sober fashion.

This can be seen as neoliberal because it isn’t based on a belief that a person’s own way of laying out their life is by definition the best for them.  Rather, the government thinks it knows best, and it’s unhappy about the results produced when British people (who are born to binge?) are invited to binge.

For most of the twentieth century, the response by government to such a feeling of unhappiness would have been to change the environment that seemed to produce that outcomes – hence the Central Control Board (CCB) and the retention of relatively restrictive licensing laws even after the end of the First World War, more or less through to the 21st century.  It’s not really important what this period is called (some would question the term ‘expansive liberalism’ which a few social policy academics use), but it’s clearly quite different to the approach to alcohol policy taken by successive governments in the past 30 years.  In this more recent approach, the market is taken as given, and it’s the individual drinkers who are told to change.

It’s possible to say that the 20th century was unusual in terms of the restrictions put on the alcohol trade, but I’d argue that such a position is misleading.  Retail of alcohol has been licensed for centuries, and it was only for rare periods of history that numbers of pubs, inns, taverns, alehouses and so forth were determined solely by market forces.  In fact, schemes comparable to the CCB were in operation in a range of towns at various points in the early modern period, on the basis that directly controlling the numbers of licences wasn’t enough; the profit motive should also be removed from licensees’ day-to-day operations.*

So far, so neoliberal.  And yet, writing recently about the particular context for England’s apparently neoliberal alcohol policy (it unsurprisingly involves the carnivalesque, in case you were wondering), I was reminded of James Nicholls’ work on liberalism and alcohol policy, and his broader work on the history of alcohol policy, which notes how many of the same arguments and dynamics crop up again and again – if in slightly different forms.  This reminded me that there isn’t a single ‘liberal’ position in relation to this unusual substance, alcohol.  TH Green was a liberal who advocated prohibition, while this was anathema to JS Mill.  Perhaps we could see the 20th century as a form of watered down (or beered up?) TH Green style liberalism, and the current period as Millian?  (This post owes much to James Nicholls.)

The distinction between the period from 1915 to the 1980s and the time since then is, in my account, that both had clear view of how people should drink, and accepted the free(ish) market wouldn’t produce these, but the solutions to this perceived problem were different.  The first sought to change the environment in which people made their drinking decisions; the second sought to change the people.

The latter might sound distant from an idea of pure, classical liberalism that values individual judgement, but is in fact remarkably similar to the views of Adam Smith or Mill.  They accepted that there were higher pleasures, or that the desire for drunkenness was a bad thing – but argued that education, exposure to alternative pastimes and changes in working conditions would be better solutions than limiting the numbers of alehouses or prohibiting the sale of alcohol altogether.

Hasn’t that been the hope of Labour and Coalition policies?  Drop MUP but keep funding Units, Would You and Change for Life to show people the ‘better’ life they could have?

Maybe this neoliberalism isn’t so new after all.

*See the chapter by James Brown in this excellent book.

Wednesday 3 September 2014

The old news of sobriety orders

The rationale for the policy is explained clearly here, but its application to a wide range of offences initially made me feel uneasy.  In the US, from what I can tell, the schemes were run – in the first instance at least – to address drink driving offences.  Setting aside the thorny issue of fixing an exact ‘safe’ limit of alcohol, people are not allowed to ‘drink and drive’, and when they do the restriction has generally been of their driving rather than their drinking.

There’s actually no reason why this shouldn’t be reversed if it’s more effective.  It’s not necessarily true that these individuals are bad drivers when sober, just as they may hurt no-one when they drink unless they drive.  To fully forfeit one right is no more arbitrary than forfeiting the other, since the precise offence is the combination of drinking and driving, not either on its own.

The requirement to stay sober fits, though, because of the specific nature of the offence of drink driving: we have a specific, apparently ‘objective’ limit on blood alcohol concentration, over which a person is not allowed to drive.  Driving while ‘drunk’ is an offence in itself, banned on the basis that there is a direct physiological/pharmacological relationship between alcohol consumption and impaired driving.  Without the alcohol, there is, by definition, no drink driving.

We know this is not the case for violence and other crimes.  Not everyone in every culture is more likely to become violent or commit a crime when drunk; the way we behave when drunk is learned and more conscious than we might think (given that we react in similar ways when we’ve drunk a placebo).

Combined with the way the offences are defined, this means that we just can’t say for an individual who commits an offence while drunk – as we can for drink driving – that without the alcohol there is no offending (of this specific nature).

Of course the same sort of principle already underpins Drug Rehabilitation Requirements (DRRs) or Alcohol Treatment Requirements (ATRs), which are used as part of community sentences now, and which I’m very much in favour of.  These are handed out where the courts feel the offending is drug- or alcohol-related.  However, those should do far more than simply stopping an individual drinking; they should look at why they drink or use drugs and why they commit crime.

I agree with Keith Humphreys that people frequently recover from drug and alcohol use without accessing specialist services, and this new initiative offers them an incentive to kick start that process regardless of any related treatment requirement, but the relationship between drinking and offending more broadly isn’t quite so straightforward as drinking and driving.  It’s clear the scheme designers are aware of this, as they have excluded domestic violence offences from those listed as suitable for tagging.

I’m not against the scheme, but when it’s looked at in some detail – it will be supervised by probation and those on the programme will be offered alcohol advice and treatment – it’s apparent it’s not a huge innovation, but simply a technically more effective ATR, and almost identical to DRRs, which already involve drug testing.  To be fair to Humphreys, it’s the technical and procedural innovations he stresses, but it’s certainly far from the revolutionary or radical initiative some have painted it, whether in favour or opposed.

The key difference from DRRs is, of course, that those ‘drugs’ by that definition are illegal, and so it doesn’t seem so unreasonable to require someone not to be using a particular substance.  Although the argument of the Adam Smith Institute that the tags are a novel infringement of civil liberties falls down somewhat given that ATRs have been around for years, perhaps what’s really highlighted is this inconsistency: we really feel that it’s an Englishman’s right to drink beer.

And so we’re back to Virginia Berridge again: I wouldn’t start from here.  It’s maybe not helpful to have that feeling of a right to beer, if indeed that’s what’s going on.  Unfortunately, policy has to start from here.  A liberal argument can be made that action should be focused on the offences, not the alcohol, but the idea of limiting people’s access to certain factors that influence their offending behaviour if they tend to commit crime is pretty well established.  I’ll be interested to see not just the evaluation of the project, but whether whatever government is in power after next year’s election feels the scheme is something it should endorse nationally.