Concern isn't research and reducing harm won't mean zero harm

This morning, the merger of Alcohol Research UK (ARUK) and Alcohol Concern has been announced.

I have some concerns about this, and they really hang on whether the two organisations do in fact have ‘virtually identical charitable objects’, as the press release suggests.

But I want to explain that in a bit more detail, and give some insight into the background and perspective I bring to this discussion, as I think that’s crucially important.  In commenting on this merger, I’ll be revealing my prejudices about Alcohol Concern, which are really twofold.

And I do mean prejudices: people and organisations come to alcohol issues with their own background and perspective.  One thing I’ve discussed with some people in the sector is the way in which people’s own views and experiences of drinking and drunkenness can shape their views of alcohol.  So people who don’t find alcohol or drunkenness particularly attractive or enjoyable will tend to take a view of indifference or bemusement to the drug, if not outright hostility – much in the way many people now do of tobacco, which I always think of one of the worst drugs around in terms of cost-benefit or risk analysis (and yet it’s still bizarrely attractive for all that).

My use of the ‘carnivalesque’ as a concept is deliberately positive and ‘constructive’ – as the standard sociological/anthropological approach to alcohol is.  If I could sum up my concern with the merger in one sentence, it would be that I don't think Alcohol Concern can comfortably take that approach of thinking of ‘constructive drinking’.  However, that might not be the role of Alcohol Concern/Research – or at least only insofar as we have to acknowledge the ‘real world’ of how people interact with alcohol.

But specifically, here are those two negative impressions of Alcohol Concern.

First, they have a particular reputation within the sector and the wider media, as a go-to organisation for ‘anti-alcohol’ stories.  I can see that some people would argue that we need that kind of contribution to the debate, given the way media discussions seem to be set up as adversarial (despite my personal discomfort with playing that game).

Second, and partly as a consequence, I worry about the accuracy and impartiality of their research and advocacy.  I’m still not persuaded on Dry January.  It’s not really a reminder of the health benefits of regular alcohol free days, and I worry that it encourages an on-off approach to alcohol that isn’t always healthy.  (See also the potential negative consequences of the Scottish drink drive limit leading to ‘strategically’ planned drinking.  If I'm ‘strategically planning’ my drinking, you can be confident I won't be drinking halves.)

When Alcohol Concern report on Dry January, which is a potentially important public health intervention to change drinking cultures, they’re not aiming to be the most accurate and impartial people in the discussion; they’re also thinking about boosting the numbers signing up for the next round.

Sometimes, I get the same impression I do of the police or the Amy Winehouse foundation going into schools to deliver things that are well-intentioned but potentially counter-productive – or at best inefficient.

So much for my concern about Alcohol Concern.  By contrast, I see ARUK as an organisation that has carved out a niche in terms of being relatively impartial and simply representing ‘the evidence’ (even if that itself is a questionable concept).

Now there are potential positives there, as ARUK could drag Alcohol Concern’s lobbying and advocacy to be more accurate.  If Dry January really is effective, great.  If it isn’t, the ARUK-style influence might push them towards other interventions.  And Alcohol Concern (and Dry January particularly) has a high profile, and ARUK does amongst a different group of people, so perhaps together there will be an organisation with a louder, more accurate voice contributing to the debate.

But the flipside is that potentially ARUK’s apparently neutral position to reduce harm (and of course nothing is ‘neutral’) could be tarnished.  Of course Chris Snowdon’s at this already.

Now it might be that this isn’t the case, and it’s certainly simplistic, but I fear that with people like (the other) Dave Roberts, Mark Baird, Chris etc already looking for holes in any alcohol-related research, this could dilute the influence attached to ARUK interventions.

Much as I like the idea of commentators having some kind of ‘skin in the game’, to reference Nassim Nicholas Taleb, I think this doesn’t look so good for commentators on ‘evidence’.  Public debate is still structured around this idea of independent evidence that can (or should) speak for itself.  I heard a PHE regional representative yesterday describe the alcohol evidence review in these terms, still talking very clearly in the language of ‘evidence based policy’.

Dave/Chris/Mark have started not only to attack the accuracy of the Sheffield model (which I think the ARUK-type voice could credibly counter), but also their very motivation – that they have a vested interest in claiming the model works, either as temperance advocates or because they’ve got economic and egoistic interests in being proved right.  Once you’re on that ground, there’s no need to even engage with the ‘evidence’ because of its source.

This is pretty close to my discomfort with the Alcohol Concern advocacy/research/campaign work (which is why I call it a bit of a prejudice). To be fair, though, alcohol and tobacco academic researchers do this with industry-related work – though this does mean that some commentators are, as so often, having their cake and eating it.

And this comes back to that point of the moral or personal preference baggage you bring with you, and why Alcohol Concern has rubbed me up the wrong way.  They seem to come from a position where alcohol consumption is bad in itself.

I challenged former Chief Exec Jackie Ballard at an event about alcohol use and older people where she suggested that we should be telling older people they’ll get cancer or other diseases if they drink at certain levels.  This wasn’t what the research we’d just been hearing about showed.  In fact, it showed almost the opposite: that there are plenty of people who drink at pretty high levels who don’t suffer harm.  That’s precisely the challenge in communicating risk.  We can’t offer a credible message that is apocalyptic.  Jackie’s response to me could have been read as not understanding the nature of risk, but I felt it was something more than that; it was wanting to be able to make the case that all alcohol consumption is harmful (or bad).  I’ve written before about how that makes me feel uncomfortable.

Although the mission statements of the two organisations are remarkably similar, I think this difference in approach is shown by just one word: ‘no’.  The press release announcing the merger notes that ‘Alcohol Research UK works to reduce levels of alcohol-related harm’ and ‘Alcohol Concern works throughout England and Wales towards our vision of a world where alcohol does no harm’.

Reducing harm is not the same as seeing the ideal as a world where alcohol does no harm.  Of course, there are arguments for setting unachievable aspirations – as in ‘outcomes based accountability’, for example.  But in relation to practical policymaking, it feels a little awkward and utopian.

More importantly, though, it suggests a genuine difference of approach between the two organisations.  Given the nature of risk, the only way to ensure Alcohol Concern’s vision of ‘a world where alcohol does no harm’ is to reduce alcohol consumption to zero.  This is not just a quantitatively, but qualitatively, different aim from ARUK’s ‘reduce levels of alcohol-related harm’.  Even if this zero consumption world will only ever be an aspiration, it makes for a very different approach, and betrays a very different fundamental approach to this multifaceted substance.  (It’s not quite, but nearly, back to that old debate of whether we’re concerned with consumption or harm.)

Some of this response to the merger is inevitably personal, but I think it’s no less important for that – and commentators in general could be a bit more open about their own perspective.  If I were to write about my gut reaction, it would be the same as this slightly intellectualised response to the words ‘no’ or ‘zero’: I feel ARUK are probably ‘like me’, where I don’t think that of Alcohol Concern.

Of course, it could be that the influence of ARUK overcomes my concerns on all of this, and I’d genuinely welcome that, because of the frustrations outlined above – but I think the merger will pose a significant PR challenge for the new organisation.

There will always be tensions in merging what could simplistically be described as a ‘doing’ organisation in Alcohol Concern – with its research, consultancy and advocacy – and a ‘thinking’ organisation in ARUK.  But maybe those distinctions are breaking down in a world where research must demonstrate ‘impact’ – and perhaps that’s a good thing.