Dry January and sponsored marathon running

On Tuesday, presumably to break me into my first day back at work gently, I was asked to comment on Dry January for Radio 5’s Drive Time programme.  I’d been asked because they were looking for a slightly sceptical viewpoint, and although I was a little concerned that this might not fit terribly well with my Public Health Dorset role, the team were actually supportive of me offering a bit of balance in the discussion, particularly as I’m more probably more moderate than many of the alternative commentators available.  Unfortunately for Five Live, this meant that the discussion perhaps wasn’t the most electric you might hear – though I did interrupt another contributor at one point, for which I can only apologise.

As I say, it’s might not be the most interesting 20 minutes of radio you’ll ever hear, but if you want to listen to it, I’ve copied it to my SoundCloud account here: https://soundcloud.com/will-haydock/dry-january-discussion-radio-5-whole-segment

I don’t want to exactly re-hash the piece here, but I wanted to outline my thoughts a bit more fully and clearly, and encourage a more involved debate either here or on Twitter.  (And something of a higher quality than this bizarre article pointed out to me by James Morris.  If you want a slightly different - and better - discussion of Dry January, you couldn't do much better than listening to this piece, including a contribution from James Nicholls.  It starts at around 15 minutes in.)

The first point I’d make is that it’s good anybody is talking about the possibility of going alcohol free.  Personally, I enjoy drinking and I don’t think health should necessarily be people’s number one priority when choosing how to live their lives.  But I do think we sometimes default to drinking alcohol when there’s no real reason to, and it might be worth reflecting on that occasionally – even if we then choose to carry on regardless.  Dry January opens out that possibility even for those of us who aren’t signed up.  By other people around me mentioning they’re drinking less, or not drinking at all, I might think twice myself (for better or worse, but at least for variety, and for the simple benefit of thinking at all).  And as I’ve pointed out a few times on this blog, lots of research – including my own – can be crudely summed up as proving that we tend to be pretty good at conning ourselves that it’s other people’s drinking that’s problematic, not our own.

And there’s no doubt that Professor Moore was right when he stated on the programme that there are significant benefits for lots of people from giving up alcohol, even if just for a month.

My concern is twofold, really.  What happens in the longer term, and is this something public sector organisations should be spending time (and potentially money) encouaraging?

In terms of the longer term point, my fear is that a month off alcohol doesn’t really fit terribly well with the standard approaches to behaviour change.  Generally, you look for realistic, sustainable change, which tends to mean small, gradual movements.  It could be argued that this isn’t the case with more extreme problems, such as addiction, where physiological detox is the starting point – but that’s generally undertaken where the long-term aim is abstinence.  In any case, Dry January is explicitly not designed for people who are dependent on alcohol.  That doesn’t mean that some of the people doing it won’t be looking to give up alcohol completely in the long-term, but that’s unlikely.

And that’s where my concern comes in: if you’re trying to encourage yourself to develop more ‘moderate’ consumption habits, complete abstinence isn’t a great way to train for that.  I wouldn’t enjoy Dry January.  I would find it hard and frustrating.  But I think I could probably do it (and I don’t think I’m entirely conning myself on this one).  But I wouldn’t necessarily have learnt a great deal about how to drink fewer pints when I do go out on a Friday evening, or how to not finish off a bottle of wine when it’s open – which are going to be the more useful ‘skills’ or habits in the long-term.

And what’s the message that a Dry January sends?  It’s drawing on the longstanding tradition of having a bit of a ‘detox’ in the new year to try to counteract the supposed ‘excesses’ of the Christmas period.  And so there’s a danger it just reinforces that pattern of drink heavily, then make up for it later by having some time off.  In fact, it looks like patterns of drinking are important in determining how harmful a particular level of consumption is.  Spreading the same amount of alcohol over several days or weeks is less damaging to your health than cramming it into one or two ‘binges’ or ‘bouts’.  As I said in the radio piece, it would be safer to drink exactly the same amount over two months, but rather than having December be ‘wet’ and then January ‘dry’, make both of these ‘damp’ – don’t take a feast and fast approach.  (The idea of labelling something 'damp' comes from this piece on 'damp feminism' - though personally I think I'd prefer the more idealistic 'wet feminism'.)

Of course there is some evidence that people do make changes to their drinking behaviour in the light of Dry January, and I would never deny that this might be a good thing for some people.  At the very least, you’ll reap some of those health benefits Professor Moore talks about.

But who is most likely to make these changes?  Well, unsurprisingly, looking at the main evaluation of Dry January in terms of who participated and made long-term changes (rather than Prof Moore’s work on the direct and immediate health effects), the people most likely not only to have low levels of drinking, but to have changed their drinking, are those who were drinking least to start with.

This isn’t really surprising, and isn’t a condemnation of Dry January, but it is something we should be aware of if the campaign is being advocated as something that will achieve public health aims.  Most of us don’t drink more than health guidelines advise, so it follows that for most people, while Dry January might be helping at the margins, that’s not where energy should be focused.  It’s not clear it’s that effective for higher risk drinkers.  And that’s only looking at the people who participate – which is in itself a self-selecting sample.  Again – and for both of these points we simply lack robust evidence – it seems that those most in need of support are those least likely to engage.

And that’s where I have my biggest concern about the coverage given to this campaign.  Is Dry January something public health departments should be encouraging?  Well, this year PHE aren’t pulling out the stops to support it this year, and in fact our local health improvement service is more likely to be running a campaign in February.

Although it wasn’t universally acclaimed, I have a lot of time for the review of evidence on alcohol interventions PHE published shortly before Christmas – and I’d argue that if we’re going to do anything to address alcohol consumption beyond treatment for those with dependency issues, we should be focusing our time and energy on the actions they identify as being evidence based.

That doesn’t mean that individuals shouldn’t do Dry January, and I welcome the development as a potentially useful natural experiment, but it needs a lot more evidence and people undertaking it need to be clear about what they’re trying to achieve with it.  It isn’t a get out of jail free card for previous or future excesses, unfortunately.

But as soon as it’s thought of as Dryathlon, now that’s a different story.  The whole movement makes more sense when I think of it like sponsored marathon running: it’s an excuse to get people to give to charity; it raises awareness of an issue; it’s not really going to engender long-term behaviour change – it’s about undergoing a trial and proving something to yourself (and other people).

(Incidentally, Dryathlon isn’t run by Alcohol Concern.)

So if you’re thinking of giving up alcohol for January, or Lent, or any other time – go for it (assuming you’ve not got signs of dependency that would make it risky).  You can even ask me to sponsor you, and I’ll probably do it out of some form of guilt.  Just make your choice of charity a good one, and remember that I’ll be giving grudgingly as I don’t really understand the point of sponsored events in the first place.  I’m happy just to give to a good cause, without any fancy dress or test of physical endurance being undertaken.