Friday 11 January 2019

The downside of Dry January

I’ve been thinking about Dry January a lot recently.  Well, it is January.  And like every year, there’s been lots of views aired by journalists and professionals.

As usual on this issue, the person who comes closest to representing my views is Ian Hamilton.  He’s argued that while Dry January undoubtedly delivers some real positive change for many drinkers, it’s less clear whether it’s effective for the people who genuinely need to change their drinking behaviour, and it certainly isn’t designed for dependent drinkers.  He even worries that it could benefit the alcohol industry, as it distracts from those with more serious problems – who provide the bulk of the industry’s revenue.

I should start with a caveat I don’t think we make explicit often enough in discussions about alcohol policy.  People come with a personal agenda.  I like drinking, and I like getting drunk.  As far as I am aware (and that’s a very important point), this has very rarely had any impact on my professional or personal life, and certainly not in a very long time.  I like to think I’m pretty self-aware regarding alcohol, and so I’m pretty good at planning any drinking occasion so it doesn’t impact on other obligations.

I don’t have any problem admitting this enjoyment of drinking and drunkenness, and I certainly don’t see it as any kind of weakness or moral failing.

This fact that I enjoy drinking, and specifically the feeling of intoxication, is important.  Often, those who advocate abstinence either don’t understand the attraction of drunkenness, or, when they do acknowledge this, see it as somehow a less respectable or worthwhile pleasure than, say, reading a book or doing yoga.  I just can’t sign up to that idea of higher and lower pleasures, and would emphasise that a case can be made that drug-induced pleasure is in fact the ‘purest’ kind of pleasure possible in a Kantian sense (modified by Bourdieu), as it’s not instrumental or tied to pretentiousness; it’s a pleasure (for some people) simply in itself.

But sometimes it’s not just about pleasure; it’s part of some ‘deferred pleasure’ or idea of self-control that’s inevitably tied to respectability.  (There’s loads of work on class and drinking apart from my ownEmily Nicholls is particularly on how this intersects with gender.)  Drinking less to protect one’s health is a moral action in the sense that it says something about the moral schema you use to weigh up different pleasures.  For a range of reasons, at the moment I’m not in a place to feel I want to drink less.

So I’m not doing Dry January.  Conflict of interest declaration over.

If you want a clear summary of the issues with Dry January, Ian’s piece on the BMJ website is good, and I don’t want to re-hash that here.  The main weakness is that, even excluding dependent drinkers, the evidence suggests that the people who would benefit most from modifying their drinking are exactly the people least likely to start (and finish) Dry January.  Of course, like attempts at recovery, this doesn’t mean the effort was worthless.  Several unsuccessful attempts may have a cumulative impact and lead to success in the end, but it’s still not exactly a ringing endorsement, given that we’re not talking about anything approaching ‘addiction’.

And I always feel a bit sorry for the people I bump into who discuss doing Dry January and reveal they were only drinking about 10 units a week to start with.  The benefits won’t be significant, and the risks weren’t that high to start with – in fact you could argue they’re forgoing pleasure for no clear reason.  But then we’re back to the performance of respectability and the fact that some people get a positive feeling from self-denial.  (The Daily Mash is particularly good on this.)

But going back to Ian’s analysis, there’s just one point I’d take issue with, or modify slightly.  Resources aren’t particularly being found for Dry January, as far as I know.  The beauty of it (and actually the danger) is that it doesn’t require any resource or major policy change.

Locally, we’re just using social media to encourage people to consider taking a break from alcohol, and signposting them to the behaviour change support we already have in place.  Ideally it might lead to more people accessing that support, but that’s not exactly us putting additional resources towards Dry January.

The great value of the campaign, as I’ve said before, is that even for those of us not doing Dry January, it prompts us to consider whether we might want to review our own relationship with alcohol.  Perhaps the reason I have alcohol-free days and keep alcohol-free beer in the house has something to do with Dry January?  (Though personally I doubt it as I’ve been trying to keep 2 days a week alcohol free for well over 10 years now – since I started working on these issues and reading the health and policy guidance.)

This is why I’m so positive about the name and strategy of Alcohol Change UK.  I’m totally on-board with any organisation that aims to get people to reflect on their choices.

And, as I say, this is the beauty of the campaign: it’s not requiring anything of producers, retailers, regulators or drinkers.  It just prompts drinkers to think and maybe modify their own drinking.

But this is also why it’s so problematic for me.  We know that behaviour change isn’t simply about education and people making free choices.  Choices are never made in a vacuum; there’s social and economic context which makes some choices more likely based on the time and place you find yourself in – both on specific occasions and throughout your life.  The more we present drinking and the associated health and social issues as being the result of choices made by the drinker, the less appetite there will be for other approaches, based on price and availability and so forth.  I’m not saying more restrictive licensing, or minimum unit pricing should be introduced, but, as I’ve written before, it’s important that all potential approaches are considered and fully assessed.

So I’m not doing Dry January, but I can see that many people report positive effects.  If you feel you could be persuaded, read this excellent, insightful piece by CJ Flood.

My only question is whether all this attention on individual choices in early January is actually useful in reducing alcohol-related harm at a population level. As Ian suggests, the jury’s still out on that one.