Saturday 24 November 2018

The iron law of prohibition

I recently wrote about Johann Hari’s book Chasing the Scream.  It’s an unusual thing for me to do to focus so much on another person’s work, and because I enjoyed reading it and felt it had lots of important insights and stories, I felt bad criticising it.  But I’m about to write about it again.

When I was reading the book, I folded down pages or underlined sections that I thought were either interesting or misguided.  Somehow, in my initial post, I missed one key point, which I think is a slightly misleading claim about the potential of legalisation of substances.  I’m going to analyse that, but then argue that nevertheless legalisation may be the right policy.

So, what did I disagree with?  Well, it’s not really Hari’s point; it’s a commonly made claim about how prohibition increases the strength of the drugs.  Hari refers to it as the ‘iron law’ of prohibition.  The point is that if you’re having to smuggle things, then you want the most efficient way of doing it – which in the case of alcohol means spirits rather than beer: a truckload of whisky will satisfy more people than a truckload of beer.  The same could be said of fentanyl today: it’s so potent that it’s much easier to transport than heroin.

This argument is often trotted out by people who want to legalise cannabis, noting that today’s cannabis (often questionably referred to as ‘skunk’) is stronger than what used to be available 20 or more years ago.

And yet whisky wasn’t created by prohibition, and hasn’t become obsolescent in societies where alcohol is legal.  Moreover, people didn’t just drink these things neat; there was a growth in cocktail recipes as people sought to mask the taste.  The transport was separate from the consumption.

And the ‘gin craze’, however accurate as a description of drinking in 18th century Britain, wasn’t driven by prohibition but by availability and affordability.  Hari would also say it was driven by the misery and dislocation of rapid urbanisation.  As I wrote previously, we don’t need to – in fact we shouldn’t – look for a single universal cause of substance use issues.  There isn’t one.

In my original piece, I questioned Hari’s claim that ‘relatively few of us want to get totally shit-faced’ (p.230), given the phenomenon of ‘determined drunkenness’.  Here, I want to stress that associating the level of ‘problem’ with the ‘strength’ of a drug is misguided.  Does whisky lead to more problems than beer?  It’s hard to say.  Certainly not everyone who drinks whisky gets drunk, and it’s perfectly possible to get ‘shit-faced’ drinking only beer – I’m living proof.

And if you’re looking for an efficient way to get ‘shit-faced’, it’s not necessarily the ‘strongest’ drink that you choose, but often the cheapest – like white cider, which is a creation not of prohibition, but our slightly arcane tax system.

A clearer ‘iron law’ of prohibition for me wouldn’t be that it creates the strongest or most dangerous drugs (tobacco and alcohol companies are perfectly competent at that); it’s that the strength and general composition of the drugs is uncertain.

I’m not saying that prohibition doesn’t sometimes increase the strength of drugs, or at least limit our choices, but it’s not an absolute ‘law’ – whereas lack of information (which is a key cause of overdose) is.

Also, strength is not the only determinant of problems.  If we’re talking drunkenness we can’t only blame spirits.  And if we’re talking violence, beer is again often to blame.  And we could probably blame wine for a good number of ‘alcohol-related’ illnesses where there has perhaps been very little violence or drunkenness, but the health harms of alcohol have come home to roost.

And this gets us to something of a choice about prohibition or legalisation.  I don’t want to get into the detail of the debate, partly because a lot of it is supposition, and depends so much on what regime is introduced to regulate substances, what the prior culture of the area is, and so on.  Not all countries that allow alcohol have the same levels of alcohol-related harm – even if they have the same pricing and availability.

As always, I could focus not so much on how legalisation would reduce harm for consumers, but for how it would be game-changing for people involved in the production and distribution of drugs, where violence is endemic and whole states have lost their monopoly on the legitimate use of force.

And looking at the consumer side of things too, taking the example of alcohol, we can suggest that there might be higher rates of drug-related illnesses in the long term for consumers, but there would be less crime and violence.  Alcohol-related crime is generally because people are drunk, but most drugs don’t tend to encourage this – or there’s no reason they should.  The crime on the consumer side for these substances tends to be acquisitive to fund drug use, but this doesn’t happen so much in relation to alcohol (particularly not any more) now alcohol is, in relative terms, so cheap.

As others have outlined, in order to ensure there is no black market, the legal price for drugs needs to be relatively low, and of course a potential consequence of that is use increasing, along with associated harm.  That’s what we can see with the growth in alcohol consumption in the UK from the 1960s to 2004.  Various factors combined to make alcohol consumption increase as it became more acceptable, more affordable, and more available.

So is the price worth paying?  Well, for me, as I’ve said, the benefits for producer countries and those involved in the drug trade are clear.  But for consumers and those around them it’s potentially more of a mixed bag.  But I’m still prepared to say it’s worth it – just not because of the ‘iron law’.

Again, without going into the detail (other people can do that better than me), I see this as a question of whether we would prefer the situation today where for consumers and producers life is (to quote another political theorist) nasty, brutish and short, to the situation under legalisation where we’d probably see some higher rates of chronic conditions such as cancer (which we’ve seen with increased alcohol use).  I’d prefer the latter.

That life is nasty, brutish and short for some people isn’t the result of particular substances, even when they’ve been strengthened and adulterated by prohibition.  The nastiness is the result of the wider structures, which can be changed.

Friday 23 November 2018

In praise of fellowship

Last night I went to my first ever Alcoholics Anonymous (AA) meeting.  It was an open meeting, specially put on for Alcohol Awareness Week.  I’ve been meaning to go to an open meeting for years, and there are opportunities every month, but (like so many things) it’s only getting a date in the diary that made me do it.  I was encouraged that a number of other professionals were there too, representing local support and care organisations from midwifery to probation.

I found the meeting genuinely moving – but of course I would.  Who wouldn’t, hearing stories being shared not only from two regular meeting attendees, but also someone who attends Al-Anon – the sister organisation of AA that supports people whose loved ones have issues with alcohol.  The moving thing wasn’t simply those testimonies, but something about bringing home the human side of my job.  I don’t mean this in the way we often do: slightly patronising, remembering there are ‘service users’ not just numbers in spreadsheets.  I mean something about real human connection.  One person who is alive speaking to another.  I know this sounds both cryptic and trite, so I’ve tried to write something here that explains what I mean.

Sitting in the room, I felt like I was somehow back in the past.

Writing that on its own makes me feel like I’m perpetuating a stereotype of AA, of people sitting in a cold, damp church hall, wearing unfashionable clothes, drinking flavourless coffee.  My experience was far from that.  The coffee was decent, the room was warm, modern and comfortable – and I’m certainly in no position to comment on anyone’s dress sense.

What I mean is that the kindness, community and somehow ordinariness reminded me of the stability and community of my childhood.  I felt like a weight had been lifted.

I tried to explain this afterwards to someone else there, but failed.  I said that sitting there, listening to people’s stories, made me think (as I have about social work in the past) that, done well, this kind of fellowship and community and the genuinely mutual aid it offers would be of benefit to most people.

Of course, the person I was speaking to reasonably and carefully explained two things.  First, that these groups were open to and designed for people who had issues with alcohol.  Second, that these ‘issues’ were of a particular kind – as a doctor quoted in the ‘Big Book’ that I picked up there stated: ‘the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class … These allergic types can never safely use alcohol in any format at all’ (p.xxviii).

I hope I’ve always been respectful to this point of view.  To praise the general principle of mutual aid isn’t to deny the special nature of ‘alcoholism’.

But here’s where I may have been slightly less respectful.  I get caught up in intellectual games and the pleasure of having a neat (ideally slightly unexpected) position when I write about alcohol and other drugs – though I nearly always end up sitting on the fence somehow.

The intellectual game that fascinates me is the classic discussion of structure versus agency, as sociologists would put it.  Or in terms of alcohol problems, does the issue lie in the person or in the bottle – and I like to say that things are complex, nuanced, shades of grey.  (In work, by contrast, I generally tend to want to know ‘the answer’ and get on to ‘do something’.)  This interest in nuance (or fence-sitting) has led me in the past to question whether ‘addiction’ really exists, and to emphasise that if ‘alcoholics’ exist then they are a small sub-section of the group of people who have problems with alcohol, and if we get too caught up in defining ‘addiction’ we’ll fail to pay attention to the whole range of people who are struggling.

So I’ve not really had too much time for this concept of a particular ‘class’ of ‘alcoholics’, as the quote in the ‘Big Book’ puts it.  (Though re-reading some of my old pieces this morning, maybe my love of ‘nuance’ has meant I’m more reasonable than I think.)  There are certainly those who see the use of terminology like ‘alcoholic’ as not only stigmatising but limiting people’s autonomy and potential for recovery.

Having now been to a meeting, though, I feel I’ve been a bit too cold and detached in my assessment.  It’s the same way I feel, on reflection, about the things I’ve written saying that the 2016 Psychoactive Substances Act could, in the long term, be helpful for UK drug policy debates.  The problem with intellectual games, abstract principles and ‘long term’ policy debates is that they’re not human, they don’t feel.  (In the long run, we are all dead.)

The most revealing moment in the meeting was, for me, when various people spoke about ideas of ‘God’ and a ‘higher power’.  This is one of the most debated features of AA, and the one many sceptics leap upon to discredit or disengage with it.

One person explained that, sitting in a church, he wouldn’t feel like he was surrounded by people who understood him, whereas in AA he knew ‘these were my people’.  This is a bit like a phrase I remember Mark Gilman using a few years ago when he came to speak in Dorset, describing an ‘alcoholic’ as someone who has ‘got the spots’ – but it’s also something more.  It’s not just sitting in a room with people who have the same condition or ‘illness’ (many of us have done that at one time or another, and it’s not always useful or fulfilling); it’s about the sense of fellowship.  As someone else explained, for her the ‘higher power’ was something outside of, beyond, herself: the other people in the room.  This is the human, feeling element that I am somehow too easily able to switch off when analysing or writing.

The term ‘alcoholic’ is used in this context without shame or judgement.  It’s seen as a description of a ‘class’ of people, and this ‘class’ isn’t simply defined by alcohol consumed.  It’s a class for whom, as one person put it to me afterwards, just stopping drinking isn’t the solution – in fact, without some wider support, that can often make things worse.

Of course, such people are not the only people who suffer harm from alcohol.  And we need to be flexible in our idea of ‘rock bottom’ (and whether someone actually has to hit it to find recovery).  But it’s hard to sit in that room and feel anything but warmth and admiration for what this fellowship – these people – have done and continue to do.

So going to the meeting helped me remember another way of being in the world.  Somehow more relaxed, more grateful, more structured.  There are various reasons I feel I’ve lost that recently.

But it also made me consider my own drinking.  I’ve not got very far in reading the ‘Big Book’, and so I keep coming back to that section at the beginning by a doctor – William D Silkworth.  There’s a revealing sentence that opens a paragraph describing the nature of ‘the alcoholic’: ‘Men and women drink essentially because they like the effect produced by alcohol’ (p.xxviii).  I certainly do.  I drafted this post last night, and was already envisaging the train back from London on Friday night where I’d enjoy a couple of cans of ‘train beer’.

I’m not suggesting my drinking is ‘alcoholic’, but two things in the past week have made me question my relationship with alcohol.

One was meeting staff and PhD students when I went back to Bournemouth University last Friday to teach a session on ‘controversial cultures’.  Discussing ‘binge’ drinking culture as potentially controversial, I was asked if there was something in the British psyche that means we can’t drink sensibly.  Thinking of James Nicholls, I argued that there isn’t a single, fixed British drinking culture and, anticipating this week’s Alcohol Awareness theme, I emphasised that ‘change’ is possible at a population as well as an individual level.

And the second moment was last night at the AA meeting.  The description of how drinking, for some people, was a way of avoiding the discomfort of living, the anxiety of navigating the world, the awkwardness of being oneself.  (These are all poor phrases to represent what people actually described.  I can’t represent their eloquence in my writing.)

This is why I drink too.  It takes the edge off.

And this, generally, is why people use any drug.  As I remember Wulf Livingston arguing persuasively at NDSAG, much drug use can be seen as functional in some way, even when it’s part of what would generally be labelled ‘misuse’: if the drugs weren’t serving some purpose, people wouldn’t use them.  Perhaps in the long term there’s a better solution, but drugs, too, are a solution of sorts.

Most of us just don’t reach the point described by several people at the meeting, where they were so tired of the repeated pattern of using/drinking that they no longer wanted that life (and therefore no longer wanted a drink because they knew how that ended).  For those of us still drinking, we’ve decided at some level that the benefits still outweigh the costs.

And I don’t just mean a small glass of wine over dinner.  I haven’t tried many drugs, but for the moment I can certainly say that alcohol is ‘my’ drug.  I respect that this isn’t true for everyone (or even most people), but fundamentally I struggle to genuinely understand why people wouldn’t like the feeling of drunkenness.  Why, if there were no commitments tomorrow, wouldn’t people always say yes to another drink?

But sitting in that room, I wondered about that.  Is it a healthy, happy approach to life: when I can, I try not to be fully conscious or present?

Just like my writing, I wonder if my drinking is an attempt to show off, to be special.  Am I trying to be one of Steve Earnshaw’s intellectual, ‘existential alcoholics’?  (Just without the courage of their convictions to be truly destructive.)

And that brings me back to that starting point, which could be seen as simultaneously undermining and celebrating the principles and practices of AA.

(Wait for it, but just so you’re warned, this is the supposedly clever conclusion bit I always aim for when writing a piece like this.  In this case part of me is thinking that it’s particularly clever because I’m being self-referential and self-critical given that I’ve recently been questioning Johann Hari’s claim that the opposite of addiction is connection, and yet here I am praising connection as a solution to addiction.)

The value of AA, to me, is this reminder of the ‘miracle’ of an ‘ordinary’ life, and the benefits of ‘fellowship’.  These are amazingly special things, affirming the value of AA – and yet they are also surely universal (as much as anything can be), which leads me to question how ‘special’ this approach really is.

But although we could all perhaps learn from AA, and despite the fact that this ‘class’ of ‘alcoholics’ aren’t solely defined by their drinking habits, there remains something unique: fortunately most of us are never placed in situations so extreme that we have to think in this way.  And this is perhaps where all of us can take a moment to express what was so fundamental for so many people in the room last night: gratitude.

Tuesday 20 November 2018

The disease of black and white thinking about addiction

Today (#OurDay) I was at an event in Bournemouth where we were discussing how we could get the different services to work efficiently and effectively together, when there’s decreasing resources at the same time as many of the people who need support are facing increasing challenges, such as unstable housing, complicating health conditions, unemployment, benefits cuts and so on.  As one person described it, it’s a ‘perfect storm’.

This isn’t news, and although the suggestions made by staff were excellent, I want to focus on some conversations I had outside the main discussions – over lunch.

The first thing to note is that despite the astonishing passion and dedication of these staff, who are quite simply not paid enough, the environment they are working in is taking its toll: those decreasing funds and increasing challenges mean people are struggling to see that they’re genuinely making a difference.  Is it just pushing water uphill?  At one point do you decide to stop propping up a system you don’t believe in?

And that brings me onto a bigger point about beliefs that I want to focus on here.

I was surprised that there was still considerable passion not just in the delivery of treatment, but in the recovery / harm reduction debate.  I had naively thought we’d buried the hatchet, but it’s very much alive in terms of how people see the decisions that different organisations and clinicians make.  In a sense, that’s not surprising, though, and it’s partly the fault of commissioners (and politicians) for doing one of two things.

First (and this is my own typical failing) we’ve sometimes been guilty of ducking the issue, of imagining that just saying things like ‘evidence based’ or ‘Orange Book’ will dissolve any conflict.  It won’t.  We should be savvy enough to know that there’s plenty of wiggle room in NICE and PHE guidelines, and there’s always that black box of ‘clinical judgement’.

Second, and conversely, we’ve sometimes been too definite.  Sometimes issues have been presented as ‘black and white’, with a proposal being ‘right’ and all other options ‘wrong’.  No wonder, then, that as the goalposts seem to be moved staff feel betrayed or lied to: if the previous policy was ‘right’, surely this one is ‘wrong – or vice versa.

We should all be a little more cautious when ‘selling’ policies, and open and honest about our motivations and the limits of our knowledge.  (We should also obviously be careful not to introduce any genuinely ‘wrong’ policies in the first place.)

The problem is that when someone is presenting something as a black and white issue, and you’re not sure you agree with their position, it’s easy to get caught in that same binary way of thinking – when what I’d prefer with most of this is to suggest that there isn’t a single right approach, and if we want to talk about services that are tailored to the client, we need to genuinely listen to them.  A one-size fits all approach, whether from a self-proclaimed ‘recovery’ or ‘harm reduction’ perspective is likely to be unhelpful for a number of people.

If this all sounds a bit cryptic, that’s fine.  My real point is something almost trivial about the theory of addiction.  (Which of course is never cryptic.)

In my experience of discussions about ‘addiction’, certain high-minded academics critique the ‘disease model’ of addiction, and possibly even the whole concept.  Then they are advised that the disease model, as championed by NIDA, is valuable because it helps stop addiction being stigmatised.  If people are ‘ill’ rather than ‘bad’, then surely there’s no reason to marginalise them and not offer reasonable healthcare and support?

It always feels to me that critiques of the disease model are therefore labelled as abstract, idealistic, and not in touch with ‘real’ politics or treatment.  This is brought home even more by the close links between the disease model and the ideas of fellowships like Alcoholics Anonymous.

Of course this is naïve on two counts.

First, academics can also have lived experience.  Marc Lewis, who co-wrote one of the pieces linked to above, makes no secret of his.  Indeed, it’s his experience that led him to a different perspective on the issue.  And more broadly, these aren’t simply abstract, academic debates; they can shape policy and treatment.

Second, the idea that being ‘ill’ isn’t stigmatising is absurd.  Any number of diseases and illnesses have been considered moral failings, or simply dangerous and therefore stigmatising, from leprosy to cerebral palsy, to HIV to name just a few.  We don’t manage to treat everyone who is ill with dignity.

Is the disease contagious?  Is it somehow caused by someone’s ‘lifestyle’ (or that of their parents)?  These are key questions not just for the stigma surrounding addiction, but many other illnesses.  And they’re not easy to answer.  (If recovery is contagious, then isn’t addiction?)

But it seems to me that this remains the frame of the debate: brain disease a realistic, pragmatic, stigma-reducing idea; critiques perhaps well-intentioned, but abstract and academic.  Criticising the disease model is seen as a hobby of abstract academic thinkers not grounded in the real world.  (Maybe that’s me being oversensitive, but stick with me.)

That’s why I was surprised to hear critics of ‘harm reduction’ (self-confessed advocates of ‘recovery’) also criticising the disease model.  But of course this made perfect sense.  For them, the reliance on methadone (and an emphasis on ‘optimal dose’ in the Orange Book that is relatively high compared to much practice) represented a medicalising of addiction based on a disease model.  If you diagnose a disease, our standard medical approach is to prescribe, well, a medicine – in this case methadone.  But methadone is nothing like an antibiotic, or steroid.  It doesn’t in itself fight an infection or reduce swelling; it feeds a physiological dependency.

I don’t really want to get drawn into the details of this debate.  It would take too long and the evidence isn’t always perfectly clear.  It would also mean conducting a debate in ‘bright lines’ when the reality is a little more muddy.

I just want to pause on this point: recovery advocates can also be critics of the disease model.  This is of course completely coherent, and maybe it’s only me who’s intrigued, but it highlights that these debates aren’t simply black and white.  If we had to choose a ‘side’ between ‘harm reduction’ or ‘recovery’ we might find ourselves alongside with some people we don’t agree with regarding the very nature of ‘addiction’.

An overly prescriptive idea of ‘right’ and ‘wrong’ approaches to treatment actually contains the seeds of its own downfall.  If your enemy’s enemy is your friend, you’ll find that, actually, we’re all friends.  We shouldn’t be choosing sides.  Not when there’s bigger battles to fight – like that perfect storm.

Monday 19 November 2018

Alcohol Change: The Voice of Moderation?

Today the new charity formed out of the merger of Alcohol Concern and Alcohol Research UK has been launched.  You might remember that when this merger was first announced I was pretty sceptical that it could work.

I felt that fundamentally the two organisations had different visions that were basically at odds with each other.  Alcohol Research UK sought to improve knowledge and information to help reduce alcohol-related harm, while Alcohol Concern sought to eliminate alcohol-related harm altogether.

These might only be seen as matters of degree, but the idea of a world free from alcohol harm is as utopian as the UN’s claim that we should create a ‘drug free world’.  Given what we know about alcohol, the only way to guarantee you won’t suffer any harm related to it is not only for you not to drink, but for no-one around you to drink.  A world free from alcohol harm means, in reality, a world free from alcohol.

The new organisation – Alcohol Change – defines its vision as being a society where there is an end to ‘serious alcohol harm’, and envisages bringing this about by improving knowledge, policy and treatment, and therefore changing cultural norms and drinking behaviours.

You can read about Alcohol Change’s proposed approach in a kind of ‘state of the nation’ report released to coincide with Alcohol Awareness Week.  I just want to pick out a few gems and talking points from this that have made me eat humble pie: I think that maybe the staff and Trustees at Alcohol Change have managed to do what I thought was if not impossible then certainly highly challenging.

First, there’s a paragraph in Alan Maryon-Davis’ introduction that I think should be shared with every journalist and political commentator ever considering discussing alcohol policy:
There is nothing inevitable about the way we drink, how we behave when drinking or how difficult it is to access the support that can help turn lives around. Research shows that the majority of dependent drinkers recover, that heavy drinkers can make new choices, and that the social and cultural environment in which people drink can and does change. Change is possible for individuals, and it is possible for society. (p.1)
Far too often we view drinking habits as unchanging and unchangeable: we’ve been drinking too much as a nation since well before William the Conqueror arrived.
‘Drinking in particular was a universal practice in which occupation they passed entire nights as well as days. They consumed their whole sustenance in mean and despicable houses, unlike the Normans and French, who in noble and splendid mansions lived in frugality … They were accustomed to eat till they became surfeited and to drink till they were sick. The latter qualities they imparted to their conquerors.’ William of Malmesbury, 12th century

But that raises the inevitable question: if change happens, and we can shape it, what sort of culture should we be aiming for?  And this is where the ideas of knowledge, information and choice come through strongly and, for me, positively in the Alcohol Change document.

I’m generally sceptical about health and behaviour change programmes based around ‘choice’ because they tend to ignore (or at least downplay) the level to which people’s choices are structured by the situation they find themselves in: who their parents are; where they live; how much money they have; the job they have; the personal relationships surrounding them; and so on.

But this document doesn’t duck this issue; it notes the importance of culture and norms in shaping our preferences and expectations, and how these in turn can be shaped by policy levers.

The changes in alcohol consumption shown in the graph above were partly down to some short and medium terms factors – both conscious policy decisions and the simple fact of a dire economic situation – but they cast a very long shadow, with alcohol consumption for most the twentieth century remaining at historically low levels.

And the policy point is made with a bit of nuance too.  As I’ve argued elsewhere, too often policy discussions focus on exciting new initiatives – such as minimum unit pricing – at the national or even international level.  In reality, there’s massive variety and impact generated by local decision-making – but somehow Town Halls are seen as less interesting than Whitehall.  It’s refreshing, therefore, to read a strategic document that emphasises the importance of engaging with ‘local government … commissioners of treatment services [that’s me!], the police, local planning, and all the other local stakeholders with a role in reducing alcohol harms’ (p.11).

For me, this document seems to have got the approach just right.

There will of course be campaigners who feel that ‘serious’ is a weasel word that dilutes the utopian aspiration of a world completely free from alcohol harm, and the focus on knowledge and information is a naïve concession to the evil industry of ‘big alcohol’.  And conversely there will be libertarians who see the emphasis on culture change as beyond the scope of reasonable activities, which should allow people to pursue their own choices.

For me, that’s the ideal position for a new charity like this to be in.  I’ve complained before about the polarised, adversarial approach that often characterises alcohol policy debates – ‘public health’ versus ‘the industry’ – where both sides have some valid points but neither is listening to the other.

There will always be these voices at either end of the spectrum, and there’s little value in duplicating one or the other – a simple approach to balance will mean both are heard (or at least given the opportunity to shout over each other).

The value of Alcohol Change should rest in being a different voice, not associated with a partisan position but as a trusted messenger and ‘truth teller’.  And in playing that role – rather than simply being a vocal, idealistic (even utopian) campaigning organisation – it may find its ideas and proposals are listened to more seriously than either of the two extremes.  As so many alcohol researchers and lobbyists have noted, there is great power in being able to define what the ‘moderation’ is.  Alcohol Change can position itself as the voice of moderation in more ways than one.

The last time I wrote about this merger, I summed up my scepticism with a reflection on my personal feelings – valuable because so often (as drinkers, professionals or campaigners) our views on alcohol are shaped by personal experiences and beliefs.  I said that while I would be keen to work for Alcohol Research UK, I just couldn’t see myself being a good fit with Alcohol Concern, given its hardline, lobbying approach.  I don’t know whether it’s praise or not, but I can honestly say that Alcohol Change looks like the sort of organisation I’d enjoy working for.