Disunity as strength

The government recently published its ‘modern’ crime prevention strategy.  Apart from the bizarre title, given that modernism makes me think more of 1916 than 2016, there’s been some concern expressed that this signifies the end of any joint alcohol strategy.  It seems that alcohol-related crime will now be addressed through this crime prevention strategy rather than something covering alcohol issues as a whole.  And separately HMRC has just published its own alcohol strategy in relation to tax.

As usual, what I want to do here is raise the possibility that this actually might be a more positive development than it at first appears.  The fear from some in the field is that without an overarching strategy for ‘alcohol’ there will be no clear vision for action on alcohol from different government departments.

But why did I just put ‘alcohol’ in quotation marks?  It’s not just because our understanding of this topic is socially constructed – banal as that point is.  It’s that actually we group together issues under the banner of alcohol that don’t necessarily have a lot in common.  I’m not convinced by this banner as a unifying term.

Regular readers of this blog will be bored of me stating that there is a myriad of problems associated with alcohol.  And often that’s all they are – associated with, rather than caused by, the substance.  Those who frequently attend hospital emergency departments often have alcohol misuse disorders, but these are generally amongst several other problems where the line of causality isn’t obvious.  The same applies to many people in alcohol treatment.  It’s not just that seeing them as having an ‘alcohol’ issue is an incomplete picture, it can actively be unhelpful to dissociate alcohol from the other factors in their lives – just think of ‘dual diagnosis’ where substance misuse and mental health teams fail to work together because they see the problem as being rooted in the other discipline.  Recovery from substance misuse in lots of ways isn’t about the substance itself so much as the ingrained behaviours associated with it, and making sure people have the full range of appropriate resources (‘recovery capital’, if you will) to make effective and lasting changes to their lives.

But more fundamentally, even if we were to accept alcohol as at some level the root cause of certain problems, the way in which this happens – and the way in which the people affected understand this – varies hugely.  We know that people are very good at dodging the definition of problem drinking, and this is partly because it’s always easy to point to an ‘alcohol problem that you don’t have, and therefore you can’t be a ‘binge drinker’ or ‘problem drinker’ or ‘risky drinker’ or ‘alcoholic’.

Think of my research, where I was told by a group of people who had been drinking for more than seven hours straight that their drinking wasn’t an issue because they weren’t about to ‘kick off’ like some people would after two pints of ‘Stella’.  Or those who said they weren’t ‘binge’ drinkers and behaved responsibly, but admitted in the same conversation that on the way home from a night out they had set fire to several bins in a park.

This isn’t to condemn these types of drinking, but there’s no question that they would be deemed problematic from certain perspectives, and yet drinkers are able to dodge that classification by pointing to others who are the real ‘binge’ or ‘problem’ drinkers.

I’d suggest this is the curse of thinking about ‘alcohol’ problems.  As I’ve written about addiction before, we can sometimes try to pin down an almost infinite number of problems into one definition.  In the case of alcohol, I don’t think anyone is trying to get that kind of elusive single definition of ‘alcohol’ problems, but the discussion can still have much the same effect.

As John Holmes has persuasively suggested, assuming that the aim of policymakers isn’t abstinence from alcohol or prohibition, public policy would benefit from a debate about what desirable drinking might look like.  There’s a fundamental problem with that idea in this context, though.  An instant liberal (or libertarian) response might be that it isn’t for government to prescribe what desirable behaviour would be; instead it should proscribe activity that is undesirable, defined as being harmful to others.

But in fact, if we’re trying to set strategic objectives, it could be seen as being (unusually for policy) harder to define what is undesirable than what is desirable.  The problem is that even if we could define a single ideal of drinking (and mine might well look different to yours), there would be an infinite number of ways to deviate from this.  It doesn’t get us any closer to understanding that (a) drinking ‘risky’ amounts for health, (b) alcohol dependence, (c) ‘binge’ drinking, and (d) something that might be called ‘alcoholism’ can all be different issues, with different causes, different effects and different solutions.  That’s by no means an exhaustive list, and each individual will have unique circumstances, making the ‘problem’, ‘cause’ and ‘solution’ unique.

But more importantly for my original question of whether it’s worth grouping issues together under the banner of ‘alcohol’, I’m not convinced there’s a great deal to be gained by looking at dependency issues alongside the public health concerns of drinking a bit more than guidelines, alongside alcohol-related violent crime.  These involve different agencies, and different ‘solutions’.

At the risk of repeating myself, that approach offers us an all-too-welcome way of avoiding admitting the problems we might have: at least we don’t have that alcohol problem; which means, of course, that we don’t have an alcohol problem at all.  And that goes for towns, cities and government departments, as much as individual drinkers.  With that in mind, maybe there is some merit in having a crime strategy, a public health strategy, and a substance misuse strategy.  They should all address alcohol-related issues, of course, but maybe there’s a certain strength in disunity.  I’d rather try addressing the ‘alcohol harm paradox’ by thinking about smoking, drinking, diet and physical activity together, than by trying to link up alcohol-related violent crime, recommended drinking guidelines and what should be prescribed for detox.