Friday 2 February 2018

Accepting complexity but thinking simply

I can’t be the only person interested in alcohol policy who feels like minimum unit pricing (MUP) is in the news constantly at the moment.  Whether it’s the judgement from Scotland, the plans to introduce it in Wales, or the hearings of select committees in Westminster, it’s the lightning rod through which all discussions of alcohol policy seem to be conducted.  (As I was writing four years ago!)

This leads, sometimes, to bizarre commentaries on the issue, as people see in it whatever they want to.  Lewis Robertson suggested that the ‘temptingly simply idea’ behind MUP was to ‘increase the price of strong and inexpensive booze and it will become unaffordable for problem drinkers’.

But that’s not really what it’s about – or at least it’s only one interpretation.  For a start, MUP isn’t about making alcohol ‘unaffordable’; it’s based on the fact that, for most goods, we buy less of them if they become more expensive.

But more important than this quibbling is the question begged by the phrase ‘problem drinkers’.

James Morris has been vocal on this issue for years, and recently got good coverage in The Guardian, arguing that we should be wary of the term ‘alcoholic’, because it leads us to picture a specific kind of person when alcohol is linked to a whole range of issues amongst a whole range of people.

Is MUP really designed to target ‘problem drinkers’?  And if it is, then who are these people and what is the ‘problem’?

I’d suggest that, fundamentally, we don’t know the answer to either of these questions.  In Scotland, the campaign for MUP has been founded on an acceptance that Scotland has a national, cultural problem with alcohol – and I’d suggest that’s why the initiative has had reasonable levels of public support.

In England, it’s been more likely to be presented as a way to address issues with specific ‘problem’ drinkers – notably street drinkers or young ‘binge’ drinkers (as in David Cameron’s foreword to the 2012 Alcohol Strategy).  This is why I argued at the time that English discussions of MUP were still couched in neoliberal terms: MUP wasn’t seen as a population-wide intervention to deal with a problematic substance; it was a ‘targeted’ initiative to deal with individual ‘flawed consumers’, as an academic sociologist might put it.

And this is why MUP is the perfect lightning conductor for all the old arguments about alcohol.  It can be all things to all people.

And so on to the usual conclusion of this blog: if we can’t agree on what the problem is, how can we agree on a solution?

And I don’t think we’ll ever agree while we see things in black and white.  Increasing the price of some alcohol isn’t about making it ‘unaffordable’, as Lewis Robertson would have us believe – but equally, because it’s about making it a bit less affordable, it will have some effect on lots of drinkers.  And while that effect is more likely to be felt by heavier drinkers whatever their class/income, it’s still true that the poorer you are, the more likely you are to be affected by these price changes.

And we shouldn’t seek some resolution to the ongoing debate of whether the ‘problem’ with alcohol sits with the substance or particular individuals.  (I recommend reading Ron Roizen on this from a US perspective.)  That’s the old argument of structure versus agency.  As Marx (almost) put it, we make our own decisions, but not under circumstances we’ve chosen.

So here’s my summary (at the risk of repeating myself and others not just wwithin this post but over a number of posts):

  • There are a number of problems that can be associated with alcohol.
  • They are not all best described as ‘alcoholism’ or even ‘alcohol problems’.
  • However, the control or removal of alcohol might help lots of them.
  • There are infinite potential causes of and influences on these problems.
  • There are many potential solutions.
  • MUP is a potential solution for some, but not all people and problems.

And I’d like to leave you with a final, embryonic thought that needs some development of its own, which I’ll do maybe some other time.

Over the past few weeks I’ve been thinking a lot about the idea of complexity.  There was an article in The Lancet about how seeing a problem as ‘complex’ can lead to inaction in addressing it, as it’s seen as to difficult or unmanageable.  (For those from a treatment background, think of ‘complex’ individuals, or dual diagnosis.  For policy wonks, think of ‘wicked’ problems.)  Then I came across an article from a few months ago about how in policy debates industry representatives often employ the idea of ‘complexity’ to block activity.

In my day job, I try to cut through these discussions of ‘complexity’ to focus on what we can actually do, but of course on this blog I often find myself, possibly in a self-indulgent way, taking the academic high ground by complaining that things are more complicated or nuanced than some commentators would have use believe – as I’ve just done here in discussing MUP!

So obviously my solution is compromise.

I’d suggest that at the same time as embracing the complex, uncertain balance of structure versus agency, and the myriad of problems associated with alcohol, we should also grab hold of some simplicity where we can.  In fact, if done right the acknowledgement of complexity can lead to greater clarity.

Let’s think about what this might mean for the issue of alcohol policy and MUP.

I’d like to see a debate where MUP is seen not as the only show in town, and not particularly linked to other interventions.  As I’ve suggested, lots of academics and policymakers like to see things as interconnected and part of systems.  This is of course true, otherwise sociology wouldn’t exist and we’d probably study something like individual-ology.  (Or perhaps just psychology.)  But we’re sometimes guilty of making connections that aren’t relevant.  Not all ‘alcohol’ problems are the same, or even particularly connected.  I’d like to discuss MUP simply on its own merits, without a consideration of whether focusing on it detracts from arguments about whether treatment systems have enough resources.*

As I’ve already admitted, I’m guilty of this.  When I’ve spoken about Dry January I’ve usually highlighted my concern that this focuses too much attention on individual solutions.  As Ron Roizen points out, although public health advocates might think they’re avoiding stigmatising ‘problem drinkers’ by suggesting that alcohol is an inherently problematic substance, the flipside is that those without problems can then reasonably explain that because they don’t have any issues with this terrible stuff, they must have good self-control and have employed the right strategies – and we’re back to ‘alcoholics’ being ‘flawed consumers’ where the issue lies with them.

There is no escape from these binaries unless we simultaneously embrace complexity and reject the idea of single solutions.

*This is a link to an excellent post by Phil Mellows.  I’m linking not because I’m critical; I completely agree that we need to look upstream to the root causes of alcohol problems (that’s exactly what I’m trying to say in the bullet points above).  But I want to make it clear that we can have MUP for population-wide reasons, for example, without seeing it as a trade-off against treatment for dependent drinkers.