Condemning the carnivalesque

This post, like a few before it, is about an academic article I’ve had published recently.  A version of this may or may not end up on the LSE British Politics and Policy blog, but in any case this version has a few things included that I couldn’t fit in with the word count – one of which is a few more words on the paradoxical semantic/pedantic point that when academics talk about a ‘new culture of intoxication’, this only makes sense because we’re talking about intoxication as drunkenness, rather than something pharmacological.  That’s the only point worth noting, really – otherwise I’d point you to the article itself, which is free to access and probably more clearly written (if in a more academic style).

Alcohol – and public policy in relation to it – seems to be a fascination in Britain not only for governments, but the media and academics.

A common academic view has been that British night-time high streets, and our drinking behaviour on them, have been shaped by a form of neoliberalism, exemplified by the perceived loosening of licensing laws – for example through the 2003 Licensing Act that supposedly ushered in 24-hour drinking.  This has taken place, it is suggested, as part of a broader trend for consumption such as drinking to replace productive work in importance to the UK economy and young people’s identities.

But this apparent liberalisation hasn’t meant that government has been indifferent to people’s drinking choices.  The neoliberal approach is characterised by its response to those drinking practices it considers undesirable: where governments with a different ‘mentality of government’ reshaped the drinking environment – for example through precisely those licensing laws that more recent UK governments dissolved – neoliberal governments have focused on the drinkers themselves, trying to change behaviour through education and social marketing such as the ‘Would You?’ and ‘Change for Life’ campaigns.

This means that governments don’t think each person’s way of laying out their own life is the best by definition, as some classical liberals might; neoliberal governments actually have strong ideas of ‘good’ and ‘bad’ drinking.  This distinction between ‘good’ and ‘bad’, though, isn’t inherent in the neoliberal approach to government.  A neoliberal approach could focus on health issues, or disorder, or indeed celebrate drinking as a valuable contribution to the economy; the difference would be in the programmes designed to educate consumers.

Both in the media and academic work it’s common to see discussions of how ‘good’ and ‘bad’ drinking are defined.  Often it’s suggested that the government has criminalised intoxication, or certain forms of pleasure.  In a recently published article I’ve argued that the concept of the carnivalesque is actually more helpful in understanding alcohol policy in England.

But what does the carnivalesque mean, if it’s to be of any use?  Carnival is a time when rituals turn the world ‘inside out’ – for example, when a peasant is made ‘carnival king’ for a day.  Much academic work on the carnivalesque has drawn on Mikhail Bakhtin.  His idea of the carnivalesque includes free and familiar contact between people, profane speech and grotesque realism, with an emphasis on the body, and attention drawn to its natural features and functions, such as sex and excretion.

One of most evocative descriptions of carnival is given by Mike Featherstone: ‘The popular tradition of carnivals, fairs and festivals provided symbolic inversions and transgressions of the official ‘civilized’ culture and favoured excitement, uncontrolled emotions and the direct and vulgar grotesque bodily pleasures of fattening food, intoxicating drink and sexual promiscuity.’  Parallels with the alcohol, excitement, (apparent) transgression, kebabs and sexual promiscuity of the night-time economy and its ‘binge’ drinking are immediately apparent.

Bakhtin in particular, though, has been criticised for taking a rose-tinted view of carnival – both in general and with specific reference to drinking.  However, he describes the way in which festivals and carnivalesque impulses were co-opted by institutions such as state and church and his analysis of Rabelais is centred on the ambivalence of profanity and carnival laughter, through which shame and triumph, death and life, are felt simultaneously.  Moreover, carnival has always been an event that has been commercialised and sanctioned by the state in some sense.  As Terry Eagleton put it, using Shakespeare’s words, ‘there is no slander in an allowed fool’.

But what’s the use of this concept in thinking about government alcohol policy specifically, as opposed to describing the night-time high street?  (And I wouldn’t be the first to do that.)  I’d argue that the strength of the concept of the carnivalesque is in this ambivalence: government’s toleration of but discomfort with certain practices.  And the carnivalesque takes us beyond ideas of pleasure and intoxication, which don’t quite capture what does actually make government uneasy.

There’s a strong case that in drug policy at least, what the government is condemning is indeed pleasure and/or intoxication.  The Observer recently published a ‘Drugs Uncovered’ special, and one article claimed that “the biggest taboo surrounding drugs today isn't taking drugs, but saying that they're fun”, while Adam Winstock has suggested that harm reduction policies would be much more effective if they acknowledged people’s pleasure in drug taking.

In a recent academic article in Addiction, Alison Ritter asked ‘Where is the pleasure?’ when thinking about drug regulation.  Fiona Measham – particularly in her work with Karenza Moore – has suggested that governments in Britain have made certain pleasures ‘impermissible’ and even ‘criminalised’ intoxication.

Measham, though, would be the first to point out how government policy has fostered ‘the new culture of intoxication’ in relation to alcohol.  Alcohol is something of a special case when it comes to drug policy – it’s one of the few recreational psychoactive substances actively endorsed by government.

Government does not accept that there is a fundamental problem inherent in alcohol, and it’s perfectly happy with people taking pleasure in its consumption.  Just think of David Cameron describing his family as having ‘a reasonable drinking habit’, or opposition from politicians from all parties to minimum unit pricing (MUP) on the basis that it would penalise people’s legitimate pleasure in drinking.

But then the standard academic position – for alcohol, at least, as opposed to other drugs – isn’t so much that no form of pleasure is permitted; it’s that certain forms of pleasure are ‘impermissible’.  And it can seem that it’s precisely an impermissible pleasure of intoxication that’s being condemned when successive alcohol strategies have defined ‘binge’ drinkers as those who ‘drink to get drunk’.

But although it might seem like a game of semantics, a genuine distinction can be made between intoxication and drunkenness.  The former implies something like a physiological change, and might be judged in the same way that impairment for driving is: by blood alcohol content.

Government concern is something more than this.  The 2004 Strategy worried about ‘the culture of drinking to get drunk’, where ‘there is little social control’.  It stated quite clearly ‘there is no direct relationship between the amounts or patterns of consumption and types or levels of harm caused or experienced’.  Counterintuitively, it’s actually this culture that is being condemned when academics have referred to ‘the new culture of intoxication’.

But it could still be argued that if it isn’t exactly pharmacological intoxication that government is condemning, perhaps it’s still a certain form of ‘impermissible’ pleasure.  However, there are two key problems with this.

First, drinkers aren’t necessarily experiencing ‘pleasure’ in the night-time economy.  As Barton and Husk have recently noted, preloading is often chosen over going straight out onto the night-time high street not simply because it’s cheaper, but because people find it more comfortable and pleasurable to drink at home in a more controlled environment and be able to have proper conversations.  But, crucially, those drinkers do still end up going out into that slightly uncomfortable world of altered social norms., attracted not by pleasure exactly but the ritual, communal, ‘controlled loss of control’ that I’d say is captured well by the idea of the carnivalesque.

But more importantly in this context, it’s not just that drinkers don’t necessarily experience this as pleasure; the government doesn’t think it’s pleasurable either.

This is best illustrated by looking at one government initiative specifically (admittedly from a few years ago).  We can see this clearly in the ‘Would You?’ social marketing campaign that ran in 2008.  Without going into great detail, the actions shown and the way in which they are portrayed are characteristic of the carnivalesque.  The world is quite clearly turned ‘inside out’, as a boy and a girl are depicted getting ready to start the night as they might end it, with plenty of illustrations of what Bakhtin would refer to as the ‘grotesque’ body complete with the flow of bodily fluids – urine, blood, vomit.

The appeal to the viewer is that ‘you wouldn’t start a night like this’, assuming not only that in everyday, sober life certain norms are shared between viewer and government, but also that such norms could and should apply to the NTE.  The adverts aren’t suggesting that drinkers should deny themselves the pleasure of this behaviour in favour of higher or deferred pleasures, or because the actions are selfish and impinge on others (the whole scene takes place within a private place where each actor is alone).  Instead, the aim is to highlight that these actions and consequences are specifically not pleasurable, and so behaving in a different way would be more pleasurable as well as sensible.

I’d like to think that, just like the distinction between intoxication and drunkenness, this idea of the carnivalesque isn’t simply a game of semantics, but has genuine implications for policy.  If we see this as the motive behind government policy, it opens out the question of whether this is an appropriate aim: should we be concerned about the carnivalesque culture, or actually should policy focus more directly on crimes and health harms?  Certainly there’s evidence that there’s a different approach developing in Scotland, and it might be worth thinking about how well that works.

Alternatively, if the problem really is the carnivalesque, we’d probably make better policy if the debate was clear and open about this being its aim.  It might also be a useful concept to use to think about illicit drug policy – or does the government only need to make this sort of distinction between responsible and irresponsible consumption when the substance is legal?

And given that my analysis is all of public documents and statements, it might be worth thinking about whether this is how government officials really think about alcohol policy: the concerns of policymakers and the reality of the process might be quite different from these statements designed for public consumption.  But all the same, I’d still say it’s useful to think about things in these terms.

Alcohol and larger hopes

I don’t usually write particularly personal blogs, and I’m occasionally mocked for my slightly po-faced attitude to Twitter – it’s for my professional life and interests, while I use Facebook for the personal.  Striking this balance is, I think, more important for politicians, who feel the need to present a ‘human’ face through public (social) media, than for academics and civil servants (like me) who can more easily divide their personal and professional lives.

But today I do want to write something a bit more personal (or perhaps self-reflective would be more accurate) but with clear implications for policy – and I think it’s important because of the original purpose of this blog to contribute to informed and open debates around policy.

The prompt for this post is the slightly odd conjunction of reading and old blog post by Will Davies on Boyhood by chance today, and then an IAS newsletter noting Labour’s commitment to introducing public health as a fifth licensing objective.  These two together got me thinking (yet again) about why policymakers get interested in alcohol and other people’s drinking.

Fundamentally, this is the point Jon Foster made to me recently in an exchange with me on Twitter.  I was wondering whether it was right to say someone should necessarily reduce their alcohol consumption simply if they’re drinking more than healthy guidelines, if they’re not dependent.  For me, the health consideration and a doctor’s advice are only a part of what a utilitarian might think of in terms of a cost/benefit analysis: do the positives of taste, intoxication and (possibly) social interaction outweigh the health risks?  One factor perhaps shouldn’t trump the others.  Jon, though, was unequivocal that, yes, that individual should drink less.

We can argue whether this is best labelled a ‘moral’ injunction (as I think Henry Yeomans would, given his recently published book), but it’s certainly something normative that hints at some Aristotelian idea of the good life, even if that’s perhaps unconscious or not fully formed.  It’s the old dilemma for liberalism of higher and lower pleasures.

And here’s where Will Davies’ stuff comes in.  He sees in Boyhood and My Struggle something of an acceptance of ‘conservative communism’ through the family – in the words of Billy Joel (which Davies certainly doesn’t use), we’ve ‘found that just surviving was a noble fight’.  Davies finishes his commentary, though, with a message of sadness: “What is moving and saddening in both Boyhood and My Struggle is the beauty and failures of such ‘communism’, but this is also partly about the lack of any larger hopes beyond the struggling through.”

Well how is this blog personal, as I promised (or threatened)?  Jon Foster is arguing that people should drink less on the basis that there are (not in his words) ‘larger hopes’ to life beyond the pleasures of (relatively heavy) drinking.  And the same thing occasionally occurs to me: I try to judge my actions (particularly professionally and politically) by the somewhat naïve adolescent question: ‘am I making the world a better place?’  At some level my political views are based on the idea of improving the ‘lot’ of a wider public than I think contemporary politics manages, and my professional work – whether for the council or as an academic – could be seen as aiming to improve the situations in which people find themselves making decisions about their lives.

But in fact I don’t have any of the certainty of Jon Foster or those brandishing new year’s resolutions or personal achievements on Facebook.  I’d like to think there’s ‘larger hopes’ than sex and drugs and rock and roll (and fame and fortune for their own sake), but I’m not quite sure what those are for me, beyond opening up possibilities for other people to achieve their larger hopes.

And this does have some kind of relevance to policy, because it explains my slightly strange, ambivalent attitude to alcohol policy and public health of both supporting public health aims and dismissing them, almost simultaneously.  I defend my own right to drink ‘excessively’*, and there’s no doubt I find it pleasurable, but that’s partly a result of my past experiences and the society I’ve grown up in.  At the same time, I do hope that there are some larger hopes, and that people can find these for themselves rather than automatically resorting to alcohol as a source of pleasure, as those in my particular cohort seem to have done.**

So as Dry January continues, I can only drink to other people’s health and hope for a more healthy debate on alcohol policy, where we can admit that our underlying values and principles shape the policy positions we take.

And maybe my confused position is in fact an alcohol policy fit for our time, if Will Davies is to be believed:

“The Culture Wars are not over, and have not been won by either side.  But we are exhausted by them.  We are now at the stage of muddling through, hoping still for justice, but perhaps making do with the form of conservative communism that the family can still offer.”

Perhaps the pub is another institution of this conservative communism, with its communal space and practices, the rounds where we don’t calculate or ‘settle up’, and the drinking without explicitly aiming for intoxication – a place where we’re just muddling (or fuddling) through.  And that's not such a sad thought to start the year with.

*In different forms and to different extents depending on the occasion, but generally in breach of the recommended guidelines.

**Although I’d have to do some more careful analysis to prove it, we represent something of a bulge in the figures for drinking, which has declined since we hit our mid-20s, as the 18-24 year-olds since haven’t drunk as much, and have continued not to drink as much as they’ve got older.

The paradox of ecigarettes and health

Another day, another strange article about ecigarettes from the health sector.  This time it’s Annabel Ferriman from the BMJ writing about the recent VIP TV advert.

I thought the ad was strange and in poor taste, but I certainly can’t see how, for example, it appeals to children when it’s almost as far from fun cartoon flavours as it’s possible to be – and at other times that’s exactly when ecigs have been said to be targeting kids.

However, I don’t want to go over old ground on this, and there are ecig ads like this E-Lites one that make me uncomfortable too.  The brief point I want to make here is about a paradox in this kind of concern about ecigs.

Ferriman – like me to be honest in the case of the E-Lites print advert – is uncomfortable with the impression that ecig advertising might attract people (back) to smoking.  Now that seems relatively unlikely, especially given the stats the ONS has just released about smoking and ecig use, but at the same time it could be argued that although so far ecigs haven’t attracted non-smokers, and don’t seem to be increasing smoking rates, up to this point that kind of advertising hasn’t been employed, so we should be cautious about its possible effects.

But here’s the paradox.  According to this logic, manufacturers of ecigs should appeal only to existing smokers.  But if they’re going to do this targeting, they’ll need to rely on the one thing that separates smokers from non-smokers: smoking.  And yet as soon as there’s some attempt to link this new product with smoking, some members of the health community seem to cry foul and claim that, in Ferriman’s words, this is ‘thrusting the habit back in my face’.

The whole attraction of ecigs as a harm reduction tool is that they are similar to smoking, given what we know about visual and physical cues being important elements of habit and addiction.

Of course there’s the possibility that ecig manufacturers could somehow attract consumers without making the product attractive, and target smokers without linking ecigs to smoking, but I can’t easily see how.  I just can’t see how any approach to ecigs can be developed that maintains their effectiveness as a safer alternative to smoking while being acceptable to critics like Ferriman.

Should drunkenness be a crime?

This week a report by Alcohol Research UK and the Alcohol Academy has been published, looking at how it might be possible to improve use of the existing law on serving alcohol to people who are drunk.  I think it’s fair to sum it up (extremely briefly) as noting that there aren’t many prosecutions under this law, leading to a discussion of whether this law could be employed more actively to deal with some of the problems Britain might be said to face in relation to alcohol.  It’s well worth a read in full, as an example of clear, careful, open and pragmatic writing on alcohol policy.

Phil Mellows has written clearly and sensibly, as usual, on the practicalities of enforcing the law, and likened drunkenness to love: it’s hard to pin down in scientific terms, but you know it when you see it.  Rob Pryce wrote briefly about the purpose of having a law that effectively bans drunkenness, asking whether we should focus on the actual offences or harms, rather than some proximate causes.  My interest falls somewhere in between the two.

The whole issue, if we’re interested in thinking about whether this law should exist, and how it should be enforced, revolves around a balancing act: do the pleasures and benefits of drunkenness outweigh the risks of people hurting themselves and others.  Don’t imagine this is an easy policy decision.

A useful example is this context is legislation around driving.  We don’t simply have offences of causing harm while driving, or even driving dangerously (even if no-one was actually hurt); we also have an offence of driving while under the influence of alcohol – regardless of any other factors.

However, in this context, counterintuitively, the offence of speeding is a more relevant comparison.  By definition going at a certain speed in particular areas is defined as dangerous.  The point is that we don’t always focus on just the harmful outcomes when creating laws and regulations, and in certain contexts that seems perfectly natural.

[I should acknowledge that the report was talking about the offence that bar staff might commit by serving people who are drunk; that’s not quite the same thing as making it an offence to be drunk, but it makes it offence to make people drunk, which for some purposes is much the same thing – particularly when there’s a dedicated offence of being drunk and disorderly.  The relevant point is that public drunkenness is condemned, as I discuss in a minute.]

Having thought through the issue in this way, I’m much more sympathetic to the law than I was when debating it with the authors of the report and others on Twitter.  Then, I was taking much the same position as Rob Pryce in asking why drunkenness should be an offence in itself.  However, on balance, I think I still oppose it.  I think there are a couple of issues that set it apart from drink driving or dangerous driving.

First, what is the nature of the relationship between alcohol and dangerous driving, health or crime?

The reason we ban drink driving is that, regardless of norms or morals, people’s response times fall when they’ve been consuming alcohol, which makes them less safe drivers regardless of their intentions or motivations.  By contrast, I’d suggest the relationship between alcohol and violence or other crimes is not so straightforward – and this is Rob’s point to some extent.  Drunkenness is ‘learned behaviour’, as I never tire of pointing out, and so there’s no inevitable causal link in the same way as alcohol damages reaction times.

The case of health concerns is slightly different.  Drunkenness might be a good proxy for quantity consumed, which reflects likely health harm, and thus someone should perhaps stop drinking for their own good as much as anyone else’s.

But here we face issues of liberalism.  It’s my business if I harm my health through drinking – and the only challenge is if there are shared (NHS) costs associated with that.  But once certain activities are deemed problematic, there’s something of a slippery slope, as so many illnesses have patient decisions at some point in the causal chain and thus could somehow have been ‘avoided’.

The second issue is more fundamental.  It relates to how, with each alcohol policy decision, we’re balancing positives against risks to the drinker and others.  There are huge risks with people driving drunk, and it’s hard to endorse someone taking pleasure in the act of driving specifically while drunk on a public road.  It’s quite a different thing to condemn drunkenness not while being in charge of a car, but while simply being.  There are some definite - and I would argue legitimate - pleasures relating to being in that state, though not everyone will enjoy it and some will draw the line of pleasure at different points.

At the same time, though, just like the risks of driving while intoxicated aren’t just about someone’s own driving, but their ability to respond to other hazards or mistakes, so it could be argued that there are greater or different risks associated with being drunk in a public space with other drinkers than at home.  Hence it’s not illegal for you to pour yourself another G&T, but it is if Wetherspoon’s staff do it for you when you already seem the worse for wear.  It's illegal to drive at 40mph in some areas, but not others.

So where does that all get me in my views on serving people alcohol when they’re already ‘drunk’?  I don’t think I’m quite convinced the law should exist, but equally it’s not as straightforward as I’d initially thought: there is a case that says we ban everyone from doing certain things like driving over 30mph in a built-up area on the basis that there are risks regardless of your abilities as a driver and even if the proportion of accidents would be relatively small if we drove at 40mph instead.

Maybe, given the time I’ve given to sceptical conservatism lately, I should put my money where my mouth is and agree with the pragmatism of what is a clear, measured report looking for ways to use existing laws and regulations to address what most people would agree are problems.  Just don’t trample too hard on the carnivalesque – the fictional experiences of Pentheus and Neil Howie don’t bode well.

On the irrationality of drug policy

The reports on drug policy released last week by the UK Government have prompted a raft of interesting responses.  One of the wider interpretations is Desmond Manderson’s piece for The Conversation.

He takes a different perspective from much commentary by going back to basics and asking what prohibitive drugs laws are for, arguing that ‘the legal structure of drug laws is not an attempt to regulate or solve a problem, but on the contrary an attempt to dramatise a worldview’.  That is, prohibition reflects the desire for there to be clear lines between right and wrong and for authority to be able to enforce this.

In such an interpretation, policymakers are seen as being ‘afraid’ of ‘a “permissive” world in which such bright lines cannot be drawn’, making them act ‘like men possessed’.  I’d suggest instead that drug policy is a good case study of how nuanced and complex policymaking can be.

Think of harm reduction measures – and Manderson laments how these are undervalued in drug policy discussions.  Needle exchanges in Britain are a good example of pragmatic policymaking, conflicting with other elements of policy and broader ‘world views’, but somehow working.  Needle exchanges are state-funded facilities that – in one interpretation – facilitate law-breaking.*  But they were established by a Conservative government, and reveal that it is Manderson who is thinking more in terms of ‘bright lines’ than the politicians.

Politicians, in practice, often take a classically conservative view of the world.  That is, they are cautious about fundamentally reshaping policy.  Sometimes this is seen as the result of them being captured by the civil service or focus group findings, and it can lead to the feeling – expressed in relation to Prime Ministers at least from Harold Wilson to David Cameron that they have betrayed their party and the true believers.

Many laws and policies are not followed absolutely.  Whenever anyone (like Peter Hitchens) complains that drugs policies are not enforced, I wonder about driving and the possibility that there might be some people who have not been prosecuted on occasions when they have gone over the speed limit.

The reality of the situation regarding drug laws is not that politicians are ‘possessed’ or even necessarily ill-motivated.  It’s that they would argue – as Paul Hayes does – that drug policy in the UK isn’t disastrous, and there’s huge uncertainty around the potential effects of changing the law.  Yes, the current arrangement is a fudge and a fiction, but that’s the nature of policy and law, and any change is indeed a gamble.

It’s the politicians that are much more comfortable with this idea of inconsistent yet pragmatic compromise than detached academics and commentators.  It’s just possible that an illusion is sometimes better than perfect rationality.  This isn’t to say that we couldn’t improve drugs policy, or improve the debate by being open about the compromises involved, but I’d suggest that the decision-making politicians aren’t possessed – unless it’s by the spirit of Burke or Oakeshott.

*Technically, the offence in relation to drugs is possession rather than use, but the point that there is a conflict with wider world views still holds.

On the merits of blanket bans

This morning there have been two reports released by the Home Office: one on ‘legal highs’ and one on broader ideas of drug regulation.  I was asked to comment on these by Radio Solent, and I thought I’d post some quick thoughts here.  (At the time of writing, the full reports weren't available; only an embargoed press release with some quotes that I'd been sent.)

This isn’t a comprehensive response, but it did get me thinking about drug regulation more generally – a topic I’ve touched on before here and here, for example.  You can listen to one of the interviews in full here (with me starting at 2mins 50secs).

What’s being proposed is some form of blanket ban on ‘legal highs’, as opposed to the reactive banning done at the moment, through Temporary Class Drug Orders, and then adding substances to the list within the Misuse of Drugs Act.

The first advantage of this sort of blanket ban would be consistency with other substances.  At the moment, problems emerge by virtue of the special status unwittingly granted to ‘new’ substances.  People may be tempted to choose these over more established substances, which isn’t a great idea because everyone – from users to medical professionals – knows less about them compared to more established drugs.  Also, and this is something that was put to me by an interviewer yesterday, the apparently ‘legal’ status might be introducing certain people to drug use who wouldn’t otherwise consider it.

This second point isn’t necessarily a problem, unless that drug use is seen as dangerous and/or immoral.  However, that brings us back to the first point, which is that on balance I’d rather people were using cannabis than ‘synthetic’ cannabis, for example.  The advantage of a blanket ban is that, setting aside the detail, it sends the message that these substances aren’t endorsed or legal – and that’s one of the key potential problems with the current inconsistency: even where these substances are now illegal, they’re still marketed of and thought of as ‘legal’, and therefore (I’d suggest) at some level safe and endorsed.

Of course, the reality of the policy may prove problematic: will the government really be able to enforce a ban, and how will that affect research into new drugs and chemicals?  (Although the government has said before that controlling substances doesn’t inhibit research, I’m sure David Nutt would have a different view.)

We can predict pretty confidently that in reality, the government won’t be able to enforce a ban any more than it’s already able to enforce bans on use of heroin, cocaine, cannabis and any other illicit substances – particularly with the emergence of the ‘Dark Net’.

And here’s where the other report comes in.  That’s a review of evidence on how national drug policies relate to levels of use and harm.  That is, whether decriminalising use on the one hand, or introducing harsh penalties on the other, can change a country’s levels of drug use by.  From my sight of the press release scan, it looks like there isn’t really much in it: the harms depend on other factors.  As the report puts it: “We did not in our fact-finding observe any obvious relationship between the toughness of a country’s enforcement against drug possession, and levels of drug use in that country” (p.47).

In some ways, this is an argument for a sort of natural conservatism: why change the regulations, given that they’re irrelevant.  (This is interestingly not the minister’s take.)

I’m actually more interested in what the publication of the report says about the possibility of mature policy debate in this country.  Drugs policy is an area where thinking is not clear – or at least not generally conveyed clearly in public debates.  The report itself falls into this trap, solemnly declaring that we should have policy based on ‘evidence’ and talking in favourable terms of treating drug misuse as a health problem rather than a criminal one.

But these sorts of statements are close to meaningless in themselves.  As long as these drugs remain illegal, drug policy will always be a criminal as well as a health matter – and much of the criminal issues relating to substance wouldn’t be affected by decriminalising possession: if you still need to steal to feed your habit, I can’t see how that’s going to change by decriminalising the act of possession.

And evidence – as I’ve said before – doesn’t tell you what policy to implement.  That’s based on moral and political principles, and will be the result of a trade-off.

The advantage of this report, and the debate today in Parliament, is that they might actually open up some genuine debate about those aims and principles.  When Norman Baker says that policy should be based on evidence, this isn’t quite the right phrase – but there is definitely wrong with policy debates around drugs.  I think ‘legal highs’ (and e-cigarettes) could be the most important and interesting things to come along in recent years to promote an open debate that really gets to the root of what government should be interested in when it comes to psychoactive substances.

As Virginia Berridge points out, there are bound to be historical accidents and anomalies that shape approaches to different substances, but at the same time it would be nice to feel that there is conscious deliberation going on and to have some open debate about what makes alcohol, tobacco, coffee and all the rest different from ketamine, marijuana, heroin and all those other substances that the government has declared to be unacceptable.

So far, the conversation has only been about decriminalisation, and that’s where advocates of a more liberal policy would have to make a choice: is this a sensible first step in the right direction, or does it endorse what is fundamentally an unjust and unworkable system?  (You can see Steve Rolles and Julian Buchanan go over this ground pretty much every day on Twitter.)

Of course, one thing we often forget in these debates – and I haven’t touched on yet here – is how harms from drugs don’t only relate to users, but also producers and distributors of drugs.  That is, one of the biggest problems of making the drugs trade illegal is not the users in the UK, so much as the lives of those in producing countries, where crime undermines the state (think Mexico or Afghanistan), or those involved in production in the UK, who are often victims of trafficking.  It’s a great shame when this is ignored in favour of a somewhat parochial debate about UK heroin or cocaine users.

However, it’s not often I feel optimistic about policy – but today I’d rather focus on the positive (if only to distract from my tiredness at having got up stupidly early).  If a government can raise these issues shortly before an election, then surely there is hope that we can have that grown up debate, which would be a good thing regardless of your views on drug use.

Medication and Recovery - Magic Pills and Methadone

This week there’s been a lot of media fanfare around the ‘magic pill’ that’s going to save thousands of ‘mild alcoholics’.  I’m not usually in favour of putting things in quotation marks, but in this case it’s almost obligatory because the fanfare is quite clearly over the top.

I don’t particularly want to write about the weaknesses of this approach; that’s been done very well by Niamh Fitzgerald and Matt Field here.  Also, although it’s tempting, I don’t want to analyse all the misunderstandings behind articles such as this by Hugh Muir in the Guardian.

What I am interested in is what the fervour says about how public debate around alcohol and drug use is able to sustain apparent contradictions in understanding different substances.

For the past few years – at least five – the field of drug treatment in the UK has been grappling with the issues of ‘medication’ and ‘recovery’.  What does it mean to ‘recover’ from a ‘substance misuse disorder’ (and what is one of these anyway?) and what role can and should medications like methadone play in that process?

This is the point of the much referenced Strang Report, called, in fact, ‘Medications in Recovery’.  (Though as I said to someone who sat on the panel – though I didn’t know at the time – that was all a bit of a fudge anyway, since although we can all agree that ‘recovery’ is a good thing, the word itself only begs all the crucial questions that still need answers.)

Anyway, the upshot of this great debate is an increased emphasis on the importance of psychosocial interventions – or ‘talking therapies’ as they’re more commonly known – in fostering recovery, and a concern that long-term medication doesn’t really amount to ‘full recovery’.

To add to this feeling of moving away from medication, the trends in drug use – and therefore need for treatment – suggest that fewer people are using opiates like heroin, and there’s an increase the relative importance of drugs like ‘legal highs’ (or ‘new psychoactive substances’) that don’t fit a model of substitute prescribing in the model of methadone for heroin – in fact they often don’t fit any model of prescribing at all.

I’m not saying the shift in emphasis away from methadone maintenance is right or wrong – or that the way this has played out is the same everywhere – but the key point is there’s been a crucial shift in emphasis in public policy debate.

This shift actually ties in quite neatly with broader trends in medical policy so emphasise ‘social prescribing’ rather than imagining medicines can sort everything.  Of course this opens up a can of worms as to whether it’s fair to characterise GPs as ‘pill pushers’, but this is a definite direction of travel in primary care policy discussions, only amplified by current concerns around antibiotic resistance.

You might even make links to broader public policy trends.  Methadone maintenance works on the principle that if you get rid of physical cravings for a drug, someone won’t need it, and therefore should be well-placed to stop using it.  But behavioural economics – which underpins the popular ‘nudge’ theory of public policy – reminds us that we don’t necessarily act on the basis of what we ‘need’ or what’s ‘good’ for us.

It’s in the context of this mood of public debate that Luncbeck has emerged with Nalmefene – or Selincro, as it’s marketed.

It’s worth noting at this point that Nalmefene is actually an opioid antagonist, similar to Naltrexone, which is used to treat heroin users.  That is, it blocks the receptors that give opiates like heroin their pleasurable effects on the body.  It’s precisely this sort of intervention that opiate treatment in Britain is (arguably) moving away from.

One explanation for the fanfare, then, is simple business logic: pharmaceutical companies see an opportunity in the public concern about (non-dependent) drinkers, and so manufacture a relevant product, which fits particularly well with the fact that the UK market for opioid agonists and antagonists is likely to shrink in the coming years.  A ‘pill’ that’s similar to what’s been used for opiate treatment can now be used for alcohol treatment, just at the point when the general feeling is that alcohol treatment services need to be expanded (probably at the expense of drug services designed for heroin users).

I think there’s something more to it than that, though.  This isn’t just about Lundbeck putting out a press release and there being a slow news day.  Nalmefene is genuinely more likely to find favour than similar drugs designed for people with issues with substances other than alcohol.

I think the fact we’re so interested in this ‘magic pill’ at the same time as think tanks as varied as Demos and the Centre for Social Justice talk about the importance of ‘character’ and how drug users ‘have a responsibility to work towards their own recovery’ to take ‘responsibility’ for their own recovery, and the Conservative Party announces the idea of ‘benefits cards’ for those with substance misuse issues, points to a distinction made between alcohol and other drugs.

This distinction is also infused with a notion of class – as the idea of benefit cards makes clear.  It might be worth asking whether – if the aim of these cards is to protect families from the impact of parents diverting resources ‘to feed their destructive habits’ – the same protection should be afforded those in families not receiving benefits.

Regardless of this policy question, though, there is a difference in who is expected to show self-reliance and not be medicated by the state, and who we think might benefit from the ‘magic pill’.  The latter are drinking half a bottle of wine a night, apparently – and the very choice of drink to illustrate the problem says something about the way it is understood.

If we think back to the idea that the shift away from methadone maintenance might dovetail with the principles of behavioural economics, in fact the opposite could be true: you could argue that a pill to deal with cravings fits perfectly with the idea that we’re weak-willed, irrational beings – we can’t be trusted to moderate our drinking simply through reason and self-control, so we need a pill to do it for us.

The question is: who gets a magic pill and who has to demonstrate self-reliance?  I’m not sure the answer doesn’t depend on the substance being used and the status of the user.