Binge drinking as a 21st-century phenomenon

This week I know I should probably be writing about the Select Committee report on Public Health England, but sadly I haven't got time to craft something new and insightful (or even to read the report in full - though the section on MUP is interesting, and chimes with my feelings about the relative roles of industry and public health).

Instead, given that I've been thinking about the history of alcohol policy a lot lately, I thought I'd post an academc piece I wrote on a quiet afternoon at work 3 years ago, and so far haven't found a home for.  It's a bit short to be a proper social policy academic article, but I haven't had the time or inclination to work it up into something more significant.  If anyone has any comments or thoughts, I'd love to hear them.

“They’re buggering off with the bloody port-wine!”  Binge drinking as a 21^st-century phenomenon

The term ‘binge’ refers to a problematic form of drinking, rather than an attractive one, as Mass Observation noted in 1943 (p.342).  However, there is little clarity regarding what the term means in current discussions, beyond the general sense that it is new, and worrying.

The most striking discussions of binge drinking are in the media, both in newspapers and on TV.  Ladette to Lady and Booze Britain are prime examples on the TV, while headlines such as “Binge Britain’s Night of Shame” are common in newsprint.  In these discussions, ‘binge’ drinkers are generally understood to be young people who drink large quantities of alcohol in city centres before behaving in out of the ordinary ways considered unacceptable – perhaps anti-socially or even criminally.

The same picture emerges from an analysis of government approaches to alcohol policy.  ‘Binge’ drinking is a term that has been deliberately used by both the Labour and Coalition governments, and although quantity of alcohol consumed is often employed as a proxy, the key concern appears to be the altered state of norms that accompany such drinking, which is characterised by a particular approach: drinking to get drunk.

There has been a recently growing corpus of academic research on the topic of ‘binge’ drinking, which generally shares the focus on motivation in defining the phenomenon, stressing that this drinking to get drunk is a new development.  Quite what new features are of interest varies, but the contrast is drawn with a period – usually understood to have included the 20^th century prior to the 1980s – when ‘traditional’ drinking, a masculine, working-class culture centred on local community pubs, was the dominant form of public drinking (Gofton 1990).  In this environment, it is argued, intoxication was incidental to drinkers’ motivations, and drinking interactions formed part of a larger congery of social practices, including work, family, locality and other forms of leisure.  In these nostalgic academic accounts, the focus of research tends to be current young people’s drinking practices and their wider lives.  The historical comparison, though central to the argument that something is new and distinctive about ‘binge’ drinking, is often discussed only in passing, however.

The conception that ‘binge’ drinking is a new phenomenon is questionable on two levels.  First, and most obviously, does it exist at all – and if so, what does it mean in practice?  The burgeoning body of academic research referred to above suggests that many young people – though certainly not all, even of those who drink in city centres at weekends – often understand themselves to be drinking to get drunk and many consider unusual behaviour to be a desirable feature of a night out – even something that should be actively sought out.  Although it remains the case, as it was in 1943, that drinkers tend not to describe their practices as a ‘binge’, this academic picture has notable similarities with that painted by government and the media – though also considerable complexities (Griffin et al. 2009; Haydock 2009; Hollands 2002).

The second problem with these academic accounts, however, is that they claim that such practices are new.  As I suggested, exactly what is considered new varies.  In Measham and Brain’s (2005) account, for example, ‘determined drunkenness’ (a deliberate, almost calculating attempt to get drunk) is the key feature of the ‘culture of intoxication’.  In Hall and Winlow’s (2006) account, it is the broader friendship groupings, which are now the necessary means to the end of going out, rather than the drinking being the means to the end of spending time with one’s friends and cementing these relationships as was apparently the case in ‘traditional’ drinking.

Much research – including these two prominent examples – notes the importance of the wider environment to the emergence of this ‘culture of intoxication’.  Most obviously, licensing laws have changed, but alongside this there have been changes in the design of venues, the drinks available (and their prices) and the marketing of these products.  The role of the 1980s/1990s ‘rave’ culture in prompting this approach from the alcohol industry is often noted.

That there have been changes in the regulatory and broader environment regarding alcohol in the UK is undeniable, and it is certainly plausible that certain of these factors will influence drinking behaviour.  The affordability of alcohol, the licensing laws and the design of venues may all be important factors in affecting drinking cultures – and indeed, as I have argued elsewhere, government might be well-advised to think more broadly about the policy options open to it.

Nevertheless, to address the broader point first, it is not at all clear that friendship groupings and their relationship to consumption of alcohol have changed fundamentally over the past 100 to 150 years.  To begin with, it is unclear when this apparent golden age of pub friendship should be placed.  By the 1930s there is no question that, in “Worktown” at least, many drinkers felt the age of community pubs had passed, and the number that had closed was certainly notable.

It has been suggested that the tax changes introduced with the First World War fundamentally altered the nature of pub drinking, changing the affordability of alcohol, along with the more restrictive licensing laws.  This suggests that, if anything, any heyday of the British pub and ‘traditional’ drinking would be prior to this period.  On the other hand, in the nineteenth and early twentieth centuries, at the time when the Victorian and Edwardian pubs described by Hayward and Hobbs (2007) were springing up, there was concern that the influx of labour into cities had destroyed traditional rural forms of community, and there was considerable movement of people in search of work within an economy constantly in flux.  The stable communities, dominated by and centred around a single large employer, of Nottingham with its Raleigh factory* and “Ashton” as described in Coal is Our Life (Dennis et al. 1969), were always the exception.  It is hard to believe in the face of the evidence that the majority of lives – particularly for those without security of income or residence, the working class – were at any point stable and predictable in the way that the vision of the ‘traditional’ pub seems to convey.

In terms of how these relationships compare to today’s, if all that is meant by the idea of community is the ‘congeries of interests’ and ‘social experiences’ described by EP Thompson (1968: 939), then it is hard to argue that these have disappeared.  As I have argued elsewhere (Haydock 2010), class distinctions and communities, cemented by cultural practices, are alive and well within the night-time economy (see also Hollands 2002), and indeed the work of Hall and Winlow themselves is filled with acknowledgements of the importance of class in determining people’s social options and the prevalence of cultural distinctions within the night-time economy.

However, the argument of change is deeper than this; it is about the instrumental nature of friendship within today’s economy.  Hall and Winlow argue that today’s young people know less about each other than their predecessors did, and interact primarily through signifiers of consumption rather than production, with long-term relationships through work no longer being commonplace.  Although, as I have suggested, there is an element of nostalgia to these claims – friendships in the past were deeper and today’s social interactions are a “theatrical simulation of traditional forms of communality” (Winlow and Hall 2006: 186) – my aim here is not claim whether one form of social interaction or friendship is better, or to be longed for; I simply wish to consider whether or not two such different forms can realistically be posited.  Fellow drinkers in the pub, whether in the 1930s or the 1880s, did not necessarily work for the same company or in the same trade.  The community that existed and can be understood in terms of class was cemented through shared situations and practices, rather than strictly shared occupations or workplaces themselves, and such shared backgrounds are common amongst groups of drinkers today.  Moreover, although debates abound regarding the changing nature of work and leisure time in industrial and advanced deindustrialised economies, a holistic view of relationships, friendships and class as expounded by EP Thompson or Pierre Bourdieu (1984), for example, acknowledges the importance of practices that can broadly be considered consumption throughout, at the very least, the nineteenth and twentieth centuries.

Of course, it could be argued that the nature of communities and the centrality of production relations meant that leisure in the pub was not so separated from work as it is today, in a ‘binge’ drinking culture where the aim is understood to be getting ‘annihilated’ (Griffin et al. 2009) – away from everyday relations and relationships, especially those related to work and family.  As Winlow and Hall (2009), following the pop song and the advertisement for the lager Carling, put it, drinkers are ‘living for the weekend’.  The paying of wages might be cited as one prime example of the way in which pub life was tied to work.  It cannot be denied that this practice at the very least has died out, more or less, but the apparently new opposition between drinking and work relates to the second, broader point of what is new regarding ‘binge’ drinking: drinkers’ motivations.  Do current ‘binge’ drinkers approach alcohol in a fundamentally different way to those from the past?

The historical work on drinking cultures in Britain is perhaps surprisingly thin, when considering the nineteenth and twentieth centuries.  Brian Harrison’s (1971) landmark study, despite its broad title – Drink and the Victorians – analysed the Temperance movement specifically, while more recently John Greenaway (2003) has analysed political discussions of alcohol since 1830, and James Nicholls (2009) has looked at broader public discourses surrounding alcohol and drunkenness.  There is much less material considering how those who were actually engaged in the apparently problematic drinking thought of alcohol and themselves.  There are excellent historical sources, of a variety of types, that refer to alcohol consumption, but these have not been synthesised, and there is no identifiable single source.  As with issues of the carnival and carnivalesque more broadly, it is difficult to access accounts from drinkers themselves rather than observers (see Easton et al. 1988; Stallybrass and White 1986).

However, this material from observers is valuable.  Although government states that one of the key features of ‘binge’ drinking is that those involved drink to get drunk, such drinking is also defined by its consequences; not only health damage, but more notably behaviour.  This behaviour is understood to be out-of-control, violent, irrational and dangerous to both the drinker and others.  This sort of behaviour, and the idea that alcohol offers ‘time out’ from normal everyday requirements, is not confined to twenty-first century Britain (see, for example, MacAndrew and Edgerton 1970).  A cursory read of The Pub and the People will reveal that such ‘breakdown’, festival or carnivalesque behaviour was certainly not unknown to “Worktowners”.  If the concerns with ‘binge’ drinking are sex, violence, irrationality, public disorder and incapability due to alcohol, Christmas Eve in the late 1930s before World War II can illustrate these as well as any Saturday night in a city centre in 2011.

Therefore, I strongly challenge the assumption that ‘binge’ drinking is a new phenomenon.  While the economy may be organised along different lines from the late-nineteenth or early-twentieth centuries, and the design of pubs, licensing laws and alcohol advertising may all have changed, it is highly questionable that young people’s approach to alcohol is fundamentally altered, or that their formation of friendships is conducted on a different basis.  Further, more detailed research would be required to assess nineteenth- and twentieth-century drinking cultures in more detail, but at first sight at least it seems that the appreciation of ‘fuddled joy’ (Smith 1983) of drinking alcohol and the temporary ‘breakdown’ (Mass Observation 1943) offered by weekend nights out in the pub, accompanied by music and hot fast food, with the possibility of sex, are not new.

*I'm referring here to Alan Sillitoe's brilliant novel Saturday Night, Sunday Morning, from which Rob Hollands' Friday Night, Saturday Night takes its name (I assume!).

Here are some fun sections from The Pub and the People - I assume I'm not in breach of copyright by posting them, but let me know if so.  Do go and buy the book - it's not expensive and it's entertaining and informative: http://www.faber.co.uk/catalog/the-pub-and-the-people/9780571250950

 

 

  

 

"In a litter of broken glass and bottles, a woman sits by herself, being noisily sick" made me think of these two famous photos (though neither of them features a women actually being sick)

References

Bourdieu, P., 1984. Distinction: A Social Critique of the Judgement of Taste. Nice, R., Trans. London: Routledge.

Dennis, N., Henriques, F., and Slaughter, C., 1969. Coal is our Life: An analysis of a Yorkshire mining community. London: Tavistock.

Easton, S., Howkins, A., Laing, S., Merricks, L., and Walker, H., 1988. Disorder and Discipline: Popular Culture from 1550 to the Present. Aldershot: Temple Smith.

Gofton, L., 1990. On the Town; Drink and the 'New Lawlessness'. Youth and Policy, 29, 33-39.

Greenaway, J., 2003. Drink and British Politics since 1830: AStudy in Policy-Making. Basingstoke: Palgrave.

Griffin, C., Bengry-Howell, A., Hackley, C., Mistral, W., and Szmigin, I., 2009. 'Every Time I Do It I Annihilate Myself': Loss of (Self-)Consciousness and Loss of Memory in Young People's Drinking Narratives. Sociology, 43 (3), 457-476.

Harrison, B., 1971. Drink and the Victorians: The Temperance Question in England, 1815-1872. London: Faber and Faber.

Haydock, W., 2009. Gender, Class and 'Binge' Drinking: An ethnography of drinkers in Bournemouth's night-time economy.  Thesis (PhD). Bournemouth University, Poole.

Haydock, W., 2010. "Everything is different": Drinking and Distinction in Bournemouth. In: Wellard, I., and Weed, M. eds. Wellbeing, Health and Leisure. Eastbourne: Leisure Studies Association, 67-84.

Hayward, K., and Hobbs, D., 2007. Beyond the binge in "booze Britain": market-led liminalization and the spectacle of binge drinking. The British Journal of Sociology, 58 (3), 437-456.

Hollands, R., 2002. Divisions in the Dark: Youth Cultures, Transitions and Segemented Consumption Spaces in the Night-Time Economy. Journal of Youth Studies, 5 (2), 153-171.

MacAndrew, C., and Edgerton, R. B., 1970. Drunken Comportment: A Social Explanation. London: Thomas Nelson and Sons.

Mass Observation. 1943. The Pub and the People: A Worktown Study. London: Faber and Faber.

Measham, F., and Brain, K., 2005. "Binge" drinking, British alcohol policy and the new culture of intoxication. Crime, Media, Culture, 1 (3), 262-283.

Nicholls, J., 2009. The Politics of Alcohol: a History of the Drink Question in England. Manchester: Manchester University Press.

Smith, M. A., 1983. Social usages of the public drinking house: changing aspects of class and leisure. The British Journal of Sociology, XXXIV (3), 367-385.

Stallybrass, P., and White, A., 1986. The Politics and Poetics of Transgression. Ithaca, NY: Cornell University Press.

Thompson, E. P., 1968. The Making of the English Working Class. Harmondsworth: Penguin.

Winlow, S., and Hall, S., 2006. Violent Night: Urban Leisure and Contemporary Culture. Oxford: Berg.

Winlow, S., and Hall, S., 2009. Living for the weekend: Youth identities in northeast England. Ethnography, 10 (1), 91-113. 

A future of compromise and the long shadow of temperance

I’ve been thinking about compromise in alcohol policy a lot recently.  There’s two main reasons for this.

First, I’ve been reading Robert Duncan’s Pubs and Patriots, in which he paints a picture of late-nineteenth and early-twentieth century debates as characterised by ‘antagonistic squabbling’ between the trade and the temperance movement.

This adversarial approach has something in common with the second reason I’ve been thinking about compromise.  As I’ve discussed before on this blog, I think the current policy debate is unhelpfully adversarial between health and industry.

One of the remarkable things about most of the twentieth century (merely coincidentally the period before I started drinking), is that alcohol wasn’t a huge or controversial public policy issue in the way it is today.  Indeed, although there was concern about lager louts and something of ‘binge’ drinking, James Nicholls’ work suggests that the panic (not necessarily a moral panic) really sprang up in light of the Labour government’s proposals to expand licensing hours with the 2003 Licensing Act.

There’s all sorts of reasons behind this change – and public health campaigners would point out that the increased panic fits reasonably neatly with consumption and harm figures going up, and these have largely followed affordability indices.  There are serious questions to be asked about the reliability and validity of the figures used, but it’s reasonable to think that alcohol is more affordable for most people than it used to be, and affordability affects consumption.

However, there isn’t an inevitable direct linear relationship here.  Over history people have tended to consume more alcohol during boom times, but this doesn’t always hold and consumption doesn’t always keep heading up.

The key thing I was reminded of when finishing Pubs and Patriots was the comparison that can be made with the Second World War, when alcohol was not such a prominent political issue.  Robert Duncan would probably argue that policymakers had come to their senses and freed themselves from temperance prejudices.  However, you could also point out that actual consumption per head was much lower in 1939 than 1914.  That is, objectively the ‘problem’ had been dealt with.

I’ll stick my neck out and take the classic sensible historian’s approach of suggesting that in reality it was a bit of both.

It’s not simply that affordability and availability changed; more than that the WW1 reforms helped shape the culture around alcohol – and the industry arguably played a crucial role in that, or at least in how this was taken forward in the inter-war period.

David Gutzke has written about ‘Progressives’ reforming the pub in the inter-war years to make it more respectable and reduce the blight of drunkenness.  I don’t want to get into the debate of whether this was done out of moral conviction or rather sensible positioning for both economic and reputational reasons; I just want to suggest that similar ideas are circulating today, with the idea that the retail trade at least could be encouraged to develop a food offer and the sort of ‘upmarket’ environment that fosters what would a hundred years ago have been called ‘respectable’ drinking.

In some work, attention has been drawn to the ways in which ‘traditional’ pubs might have a role to play in toning down young people’s drinking by offering a more supervised environment than either drinking at home or in ‘vertical drinking’ style establishments.  Similar ideas about the value of the pub to local community have been promoted by the BBPA, linked to the idea of ‘the pub is the hub’.  In fact fostering cohesive communities can be seen as something that could promote public health.

That is, pubs could have a role in promoting public health.

I’ve written before about the idea of engaging the industry (especially at a local level), and I get the feeling that the same ideas of collaboration and dilution of principles are being played out today as 100 years ago when state purchase of the industry was mooted.  This was seen as something like a partnership with the devil by some temperance campaigners, much as legalization of drugs today might be viewed.

All policy is of course compromise, as there are many competing objectives, and so for my money this doesn’t sound like such a bad idea – especially as it’s not clear that the adversarial approach has led to better policymaking

Looking at the local area I’ve researched, however, the opportunity for this sort of compromise vision is somewhat limited.  You could argue that Bournemouth’s very reputation as somewhere that has moved from ‘blue rinse to hedonism’ illustrates the problem.

Part of the town’s construction and appeal as a ‘respectable’ nineteenth-century resort was that it didn’t have pubs and licences generally in the town centre.  The train station was even deliberately placed far from the beach in the hope that this would deter day trippers and those who couldn’t afford the cost of a carriage ride into town.

This made it, in a sense, an ideal location for the growth of the night-time economy – it wasn’t a question of remodelling pubs; this was almost a tabula rasa.  As a tourist resort, this worked, and the prevalence of (arguably bland) chain pubs, bars and clubs makes sense when you realise that a key part of the customer base is people who are just coming for the one night: people feel more comfortable going into a venue where they know what they’re going to get, rather than a gamble on a local variant.

My research has drawn attention to how this apparently bland, homogenised high street is in fact anything but in the eyes of the customers themselves: they have very clear ideas about the differences between venues, drinking practices and people.  However, there’s no denying that in academic and policy circles there’s an interest in moving away from what is seen as a concentration of binge-oriented venues.  Academics, consultants, local authority officials and elected council members all talk about ‘diversity’ and ‘food-led’ venues – and even the value of the traditional pub.

But Bournemouth town centre doesn’t really have any ‘traditional’ pubs – and certainly none with a real heritage feel.  And that’s where there’s a potential sharedinterest between tourism, leisure and public health – selling a resort as aplace of wellness.

So Bournemouth’s selling point of the nineteenth century – of a place of moderation, wellbeing and health – might actually limit its ability to move away from the ‘binge’ economy of the late 20^th and early 21^st centuries.  Now there’s an interesting legacy of temperance and apparent moderation.  Perhaps moderation in all things should have included a few pubs too – and in the spirit of moderation, maybe working together in the future wouldn’t be such a bad idea?

Disclaimer (20/02/2014):
Just to clarify, I'm not suggesting here that I support the idea of wellbeing in tourism, or that I think Bournemouth should go down this route as a way of 'selling' itself as a resort.  In fact, I've written an academic paper somewhat criticising the aspiration of 'civilising' the town that local members seem to have.

I'm more interested in the ways that pubs could be mobilised to support what is sometimes seen as a neo-temperance approach to pleasure and tourism - and how nineteenth century temperance and respectability has perhaps made that idea more difficult in Bournemouth.

Beyond a ratchet model of drug policymaking

Today I read a ‘for debate’ academic article published in Addiction: Alex Stevens and Fiona Measham arguing that current British drug policy operates according to a ‘ratchet’ process, whereby the tendency is for restrictions and controls to be applied, and this is a one-way street as the restrictions are (almost) never downgraded.

Stevens and Measham obviously feel the need to justify the article, as they acknowledge that many people will feel the argument is so obvious it doesn’t need an article dedicated to it.  However, it might seem necessary in light of the reclassification of cannabis downwards (before it came back up) and the coverage of Peter Hitchens in the media arguing that there has been no war on drugs.

The analogy of the ratchet is chosen because (in general) the argument is that once action is taken, it’s unlikely that it will be scaled back later.  However, in itself this is not negative – or perhaps even worthy of comment.  If we believe in a particular approach or action that is being ratcheted up, we can see this as progress in a consistent (and positive) direction.

The reason Stevens and Measham see the ratchet as a critique is the direction policy is heading in: towards control and prohibition.  This, they suggest, is not an effective evidence-based approach for reducing drug-related harm.  That is, the ratchet trend direction is more important than evidence, which is only used (through ‘absorption’) when it fits the pre-determined narrative and policy direction.

This direction of travel is towards something Stevens calls ‘toughness’.  It is more important for policymakers to be seen as ‘tough’ than for them to demonstrably reduce harm.

There are two key elements to the article, then.  First, the ratchet model of policy development.  Second, the idea of ‘toughness’.

Importantly, neither of these implies or explains the other, so while this might be an accurate description of UK drug policy I’d suggest it doesn’t get us any closer to understanding why the policies are developed in the way they are.  (To be fair to the authors, they don’t suggest they’re trying to do this in what is of necessity a very brief article.)

Answering this question of why UK drug policy formation follows this process would, like the distinction between ratcheting and toughness, probably require two sorts of approaches.

First, on the ratchet concept one would need to think through ideas of policy competition.  Maybe there’s some inflation-style model of policymaking, whereby political parties outbid each other and find it hard to step out of the terms of debate.  I don’t know much about these sorts of models of policymaking – that’s something I’d leave to the likes of Paul Cairney and Vittal Katikireddi.

But as I suggested, I don’t find the ratchet model something that would necessarily need changing in itself; it’s what we’re progressing towards that might be questionable – and in the field of drug policy this seems to be an emphasis on policy methods (prohibition, restrictions, criminalisation of new psychoactive substances) rather than policy aims.*

So we need to think about why these policy methods are attractive, even if they’re not really reducing harm.  And here we get to the bit of policy analysis that I find fascinating: attitudes to drugs, pleasure and health.  I would suggest that the fundamental principle driving the direction of travel is the view that substances seen to alter mind or body are considered suspect and unnatural – particularly when they relate to sensory pleasures.  This, I should point out, is something I think Stevens and Measham would agree with – Fiona Measham has actually written a book chapter entitled ‘The criminalisation of intoxication’ and Stevens has blogged about the morality underlying Peter Hitchens' claims regarding evidence.

Of course there are other elements to this trend – and there may be mileage in thinking about what Stevens and Measham refer to as the ‘thoughtworld’ of policymakers.  Civil servants, it could be argued, are likely to recommend policy approaches that have a significant role for government (and thus civil servants), whether through conscious calculation or, perhaps more likely, simply familiarity.  Control or prohibition might be such approaches – but then it would be hard to argue that legalisation and regulation of drugs like alcohol and tobacco doesn’t provide significant employment and funding to the state.

So, I’d suggest the ratchet framework doesn’t actually get us that much closer to the stated aim of the article: to ‘help us to use evidence and public deliberation to fit drug policies more effectively to the prospects of reducing harms’.

The key battleground is really over the definition of these ‘harms’.  Peter Hitchens might see himself as a lone voice, but there remains an assumption – at least in terms of what it is acceptable for politicians to say and do publicly – that intoxication in itself is harmful.  Until that position is challenged head-on I can’t see the ratchet mechanism changing.

*This isn’t to say that governments are genuinely committed to enforcing prohibitionist policies.  Peter Hitchens could be said to have a point that much of drug policy is more about rhetoric than effects – and in fact that’s something Stevens and Measham might agree with.

MUP as a lightning conductor

New year, same old alcohol politics.

Just as I was thinking I hadn’t posted for a while, as this blog is generally responsive and there hadn’t been many alcohol news stories worth thinking about (I’m not touching Dry January – read Pete Brown if you want anyone’s opinion), we all start talking about minimum unit pricing again.

I can’t quite bring myself to address the points people have been making, whether it’s Sarah Wollaston in the Telegraph, Anne Perkins on the Guardian website, or the Dick Puddlecote blog.  There’s a ridiculous claim that the Sheffield modelling is ‘deliberately contrived junk science’, and on the other side it’s suggested that Diageo shouldn’t sponsor a cocktail lounge at the Tory party conference – as if having a free drink might make a serious politician beholden to the alcohol industry.

Being the academic I (like to think I) am, I’m more interested in the fact that, yet again, we’ve focused on MUP.  This particular policy seems to have been the lightning conductor for all the concerns and debates around alcohol policy in the last few years.  After an interesting discussion on Twitter a few months ago, thinking about how the coverage and debate around MUP has been different in Scotland as opposed to England, I thought I might post something on here about why MUP has been so important and divisive in the public policy debate.

The first and most obvious point as to why it has caught the imagination is that the idea of a single, relatively straightforward solution is always attractive.  MUP has managed to capture the imagination as the solution to the alcohol ‘problem’.

Of course, it can’t be the single universal solution, and there isn’t actually an ‘alcohol problem’ – if there is any problem, there’s certainly more than one: crime, nuisance, acute health harm, chronic health harm, addiction, and the list goes on.

In fact, each one of these issues isn’t a single ‘problem’ in any case.  Along with others, I’m sometimes guilty of suggesting that addiction is no respecter of class and background.  This is certainly questionable when we look at what factors might make us think of particular forms of substance use as substance use disorders, and who might be most likely to achieve recovery, but more than this, not everyone’s ‘addiction’ is driven by the same factors, and some people (like it or not) may not feel they will always be an alcoholic – and may even feel comfortable enough to drink again.

MUP raises all those old issues around addiction, health, drunkenness and so on, but without them being explicitly named – and that’s why the debate focuses so much on this initiative, because it somehow is able to channel whatever concern about policy any person has.

As I’ve said any number of times before, public health tends to operate at a population level, and MUP can be seen as a policy that does this: it is (ostensibly) universal, rather than being targeted at particularly problematic individuals.

Although MUP can also be seen as targeted – David Cameron was keen to say it was an initiative to address ‘binge’ drinking, while the Sheffield research suggests it will hit (or benefit) the hardest drinkers hardest – the key point is that it targets the substance, not individuals.  This is one of the key reasons it excites public health campaigners and worries those whose business it is to sell alcohol.  ‘Alcohol is no ordinary commodity’ is a mantra of the public health community, and challenges the more free market view that alcohol is just another consumer product.

Thus the initiative gets straight to the two fundamental points that alcohol policy is based on: individuals’ current behaviour is irrational, and the state has a role in correcting this.

The way this is understood in England in relation to MUP can be seen as different to two relevant comparisons: Scotland, and Licensing.

It was the Scotland comparison that first interested me: I was told that in Scotland the policy debate hadn’t revolved so completely around MUP.

Although this might be the case, an analysis of the arguments for and against MUP in the media suggested that advocates for MUP didn’t often present it as part of a broader package of alcohol policy initiatives.  More importantly, though, the key context was statements regarding ‘Scotland’s heavy drinking culture’.

The article, along with other work by the same team, suggests that for MUP to be seen as appropriate, the concept of problematic drinking at a population level needs to be conveyed, rather than the current emphasis on ‘binge’ and youth drinking (which is what David Cameron did in England).

That is, the context for MUP discussions is possibly already more focused on population consumption in Scotland than it is in England.  Alcohol is possibly more acknowledged as problematic for all (Scots).

Where discussions around alcohol misuse are broadened out in England, the reference point tends to be simply an alternative problematic group – most recently the baby boomers, but at other times middle-class professionals.  The problem is not alcohol, but those drinking it: the middle classes who dare to ‘think they know better than health experts’.

The other difference is with licensing debates.  MUP quite clearly isn’t simply focused on the visible, night-time economy that so dominates media coverage (‘bench girl’ ends up illustrating almost every article on alcohol, or her neighbour in patterned tights – until the 2013 fashion for ‘nose in glass’).  Licensing can be – and is – framed in terms of nuisance to others, crime and disorder (and also the inconvenience to police shift patterns).  These are all factors that relate to someone’s drinking harming other people.

This is why MUP is so controversial: it’s not just about stopping me hurting other people; it’s apparently about stopping me hurting myself.

This is where the argument is attacked in terms that state either it’s my right to drink myself to death.  However, this is to look at alcohol as an individual rather than a population issue.

This isn’t just about aggregating risk – the point that not everyone is harmed by alcohol in the same way, so we shouldn’t target the alcohol, but the at-risk individuals (or nobody, as the health consequences are something of a lottery).

If I hurt myself, that doesn’t happen entirely without effects on others, however indirect.  People do not exist in isolation from a wider drinking culture, and that drinking culture does not exist in isolation from regulatory structures.

It is revealing that discussions of licensing often place emphasis on the 1915 reforms that are seen as forming the basis for the regulations that were in place until 2005.  These reforms were justified not so much in terms of reducing nuisance as ensuring that people didn’t drink so much as to be ineffective workers – and therefore hamper the common endeavour of the war effort.  That is, licensing needn’t always be a tool focused on a narrow definition of ‘harm’.  North of the border public health is now a licensing objective alongside the issues of nuisance and crime.

It could be argued that in relation to drinking public health is a misnomer: this is all about private health, and we’re not engaged in a war effort, so the comparison is irrelevant.

However, there seems little doubt that drinking styles are communicable, so perhaps rather than working with ideas of ‘passive drinking’ to suggest that drinking harms others around us in ways we don’t always see, public health campaigners might be better starting from the point that drinking is social, and that’s actually why it’s a public policy issue.  Maybe substance misuse isn’t such a non-communicable disease after all.  (Though that isn’t an original thought.)

That’s a bigger argument for another day – about the very question of whether one man is an island – but the point is that it’s not an argument that can be solved by looking at MUP as an issue in isolation.  There are broader political, philosophical and ideological questions distilled into this policy proposal, and they can’t be resolved simply by re-hashing the same old complaints about the nature of the alcohol industry or the fallibility of econometric modelling.  First off, it’d be nice to have some clarity about what problem MUP might be trying to solve.  To be honest, I’m not sure what that BMJ investigation adds…

Informed Choices?

On this blog I mostly write about alcohol or drug policy, as my academic research has focused on ‘binge’ drinking and my current main job involves commissioning drug and alcohol treatment services.

However, for a couple of years between 2009 and 2011, I worked for the Russell Group.  I’m somewhat ambivalent about this.  I enjoyed some elements of the job, and felt I could make a positive difference on, for example, immigration policy.  For whatever reason (and I was grateful for it), I mostly focused on access to university, community engagement and immigration.  Other elements (fortunately those I was less involved in) made me feel uncomfortable – tuition fees, for example, or business engagement to a certain extent.  And of course the Russell Group is a lobbying organisation, so we’d always be keen to present our institutions in the best light.  Given the title of this blog is ‘Thinking to Some Purpose’, and my passion is for clear, open, honest policy debate, you can imagine my discomfort with that.  And I’m no salesman.

One of the biggest benefits of the work was acquiring some expertise on higher education policy.  Given that I work at a university some of the time now, having that perspective can be useful.  (Although most of my detailed knowledge has faded and become out of date anyway.)

HE policy is one of those areas where ‘thinking to some purpose’ is in short supply.  There’s all sorts of posturing that goes on, and a lack of clarity around issues like student finance.  One of these areas is school qualifications, and it’s this issue that brought back my work on ‘widening participation’, as access to university is called – and prompted me to write this post.

On Saturday, I spotted Stephen Jones tweeting about an article reporting Michael Gove wondering whether the definition of ‘facilitating subjects’ at A-level is too narrow.  The concern seemed to centre around one particular subject: economics A-level is not on the list of ‘facilitating subjects’.

Of course, this raises the question of what on earth is a ‘facilitating subject’.  Well, the definition seems to come from the Russell Group’s guide to A-level choices: Informed Choices.

[Now I should declare an interest here.  I was involved in responding to lots of queries concerned parents and teachers (and indeed university staff) sent through to the Russell Group when Informed Choices was first published.  And in fact, I get a credit in the acknowledgements, although I only really remember proof-reading the document.]

Importantly, the guide is fundamentally a summation of the entry requirements and recommendations of different courses at Russell Group universities.  People often misunderstand the idea of facilitating subjects, when it’s all very clearly laid out in the guide.  They are not ‘hard’ subjects; they are subjects that keep open the most opportunities at university.

It’s for this reason that History and Maths make the list, but Economics doesn’t.  To take an example, the closest thing Oxford has to Economics (Economics and Management) doesn’t require Economics A-level; it does require Maths.  OK, so you’re only ‘highly recommended’ to study History A-level to study the subject at Oxford, but the E&M page doesn’t say that about Economics.  And we know that Maths is required for any number of university courses.  (I’m not going to put links here; it only takes a quick browse of entry requirements for a few courses.)

Basically, choosing Maths over Economics at A-level keeps open more options for university study – and that’s all that Informed Choices is telling people.  Informed Choices states that it’s not making a hard/soft distinction between A-level subjects, and in fact explicitly chooses economics as an example of a subject that lots of people would consider Economics a ‘hard’ subject.

This idea that not being on the ‘facilitating’ list is somehow a slight on that subject is a complaint I remember from a whole range of school and university staff (mostly about their own particular subject).  Quite often it was possible to point the university staff to the entry requirements set out by their own department.  Religious Studies, for example, isn’t on the list because (again, taking Oxford for consistency) it isn’t required to study Theology at university.

Of course, there’s an argument that the entry requirements of universities are too narrow, but that’s not the same as saying the list of facilitating subjects is too narrow.  And it would be hard to make that argument for Economics, given that Maths is definitely more helpful for university Economics – and certainly for all those science subjects that Economics wouldn’t help with much at all.  I say this as someone who did Economics A-level myself (which is only of relevance because in the Evening Standard article Michael Gove is quoted as saying it was his only A-level as he mostly did Scottish Highers).

In this context, I worry about schools minister David Laws – an economics graduate – who finds the fact that Economics isn’t on the facilitating list ‘perplexing’.

However, the complaint of the student cited in the Evening Standard article is broader than this.  Kiki Ifalaye is quoted as suggesting: “Because economics is not a facilitating subject it inclines students to steer away from it. [The list] doesn’t take into consideration their skills and individuality and aspirations. It should be broader.”

In this question, we get to the heart of the matter, and why I’m posting on this blog: what are A-levels for?

The facilitating list is only there to facilitate a wide range of options for university study.  It’s written by a set of universities, not schools, employers or the government.  However, it is now used bygovernment as a way of ranking schools.  Given that the list is only about university access, judging schools by it only tells you about the choices and achievements students make in terms of getting into university.

But schools don’t simply exist to provide universities with students.  Although it could be argued that a higher proportion of 18-year-olds are going to university now than in the past, a higher proportion of young people stay in education to age 18, and so A-levels and other post-16 qualifications can’t simply be seen as entry exams for university.This is particularly relevant given that universities are set to have a much larger role in setting A-levels.  The right choices to get into a Russell Group university might not be the right choices for someone leaving education after A-levels.

Moreover, they might not even be the right choices to get into other universities – many of which I’d see as considerably better choices, especially for certain subjects.  It’s the old unease about the Sutton Trust concentrating on Oxbridge.

Therefore, although some students might be wise to be guided by Informed Choices, it’s not even relevant for all university applicants, let alone all A-level students.  It should not be seen as the gold standard of study.

And this is where the complaints of the Economics, Religious Studies and Sociology teachers make sense.  Personally, as a sociologist of sorts I’m sometimes inclined to think sociology should be a mandatory subject at school – and I’d do all I could to encourage people to study sociology (though I don’t know very much about the A-level course in practice, having only browsed through some online study specifications).

If Informed Choices is discouraging people from studying subjects they’re interested in and would likely serve them well in the future, then that’s a bad thing.  But I don’t know that this is the Russell Group’s fault.  If anything, it’s the government’s fault for playing on the old ‘hard/soft’ subject stereotypes.  As with so much Coalition policy, what’s favoured is what the politicians are familiar with, rather than looking at the broader picture and the evidence available.

Alcohol or soma

This week, David Nutt has garnered considerable attention for his idea of ‘hangover-free’ alcohol.  Phil Mellows has, as ever, written brilliantly about this on his blog.  I’ve been thinking about some of these ideas for a few days now, and I haven’t got anything neat to say on the subject, but there are a few thoughts bubbling round my head that I wanted to get down.  I just hope some of them are interesting…

Phil talks about how Nutt misses the point a little by thinking of alcohol solely as a psychoactive substance – not all drinking is to get drunk.  And more than that, even the drunkenness people might be aiming for isn’t a simply chemical reaction; it’s socially constructed, to use an awful phrase.  Being ‘drunk’ doesn’t mean the same thing to every person.

Phil’s point is partly that there’s all sorts of elements of elements of drinking that aren’t just about alcohol as a chemical, so Nutt’s safe intoxicant couldn’t really directly replace alcohol.  He argues that alcohol is linked with broader taste, and is central to the ‘connoisseurship’ surrounding drink.

There’s something to this that I hadn’t quite appreciated before (partly because my research has tended to focus more on drinking to get drunk than connoisseurship).  You can think of the act of drinking as more ‘natural’ than various other ways of taking drugs (smoking or injecting, for example), but it isn’t just that – you could still drink a David Nutt ‘cocktail’.  Rather, the alcohol we drink only exists through the drink.  This sounds like sophistry, but there’s a serious point.  We (mostly) don’t make alcohol in a lab and then add it to cocktails.  Instead, the alcohol is generated through wine-making or brewing and so forth.  The alcohol in wine doesn’t exist separately from the wine.

This is different from saying that nicotine is part of tobacco.  In other examples the drug exists in the product prior to any processing (nicotine in tobacco) or is deliberately created in itself (in chemically derived products like the new ‘legal highs’).  Grapes aren’t alcohol until they’re fermented, and in fact when they’re fermented they’re not alcohol, they’re wine as a whole.

It’s this relationship that allows for the connoisseurship apparently completely unrelated to intoxication.  And it’s for this reason that the connoisseur requires the alcohol, because without the alcohol there is no wine or beer.

On the other hand, although one can prefer one type of e-cigarette to another, it’s hard to elevate the debate above the most pleasurable mode for delivering a drug.  You can almost – but not quite – say the same thing for tobacco.

And here’s where we run into trouble.  Phil’s point holds when he’s talking about beer and wine in particular, but as he notes it’s not so applicable to cocktails.

On the other hand, given that sensations of taste will be affected by other substances in the mix, and taste, preference and intoxication are all affected by wider surroundings and beliefs, it’s still hard to draw that line between natural and unnatural intoxication.

What the whole debate does do is highlight some people’s discomfort with the very idea of intoxication, regardless of whether it can be seen as natural.  I was most taken by Graeme Archer writing that the ‘whole point’ of alcohol is the hangover.  Now there’s obviously some (not very) poetic licence going on here, but the logical hole is astonishing.

He argues that hangovers are necessary for people to grow up and become proper adults who moderate their drinking.  His primary problem with drinking seems to be ‘crowds of rowdy drunks’.  To begin with, although it’s not uncommon, I never cease to be frustrated by such failures to pick on things that are actually problematic to society, rather than simply being personal irritations.

And this is where the issue lies.  Archer worries that ‘guilt-free, hangover-free inebriation would deliver squadrons of such anti-beauty’.  But it’s not clear why hangover-free should equate to guilt-free – unless, of course, that person has done nothing wrong…

One should feel guilt if one has done something with negative consequences.  Bizarrely, Archer thinks that without the hangover, there will be no such negative consequences, and therefore drinking will be problematic:

Such lessons (of self-control) cannot be learnt if choices become consequence-free: to drink must be to volunteer oneself for risk.

If drinking is consequence-free, then I don’t really see any need to be worried about it.

It could be argued that there are negative consequences that aren’t immediately apparent from alcohol – particularly long-term health damage – and the hangover acts as a warning for these.  However, this doesn’t seem to be Archer’s problem.  He’s more concerned that we make an appointment with reality, which we won’t do if we become intoxicated, which implies becoming ‘infantilised’.

That is, it’s not about negative consequences at all; it’s about the intoxication.  This is bad in itself.

Once the drug is stripped of its ‘connoisseurship’, and laid bare for all to see as an intoxicant, it’s seen as problematic.  Far nobler to live in a reality that isn’t ‘cushioned’.

And here’s the point.  This article, with its (self-confessed) inconsistencies and gaping logical holes, highlights the background noise to alcohol policy discussions.  Although the talk is about, in Archer’s words, the idea that ‘drinking is bad for the individual and for society’, possibly with reference to health and crime, this is often a debate about whether it’s acceptable to get drunk.

Hangovers aren’t a reminder that you’ve done something terrible the night before, or even much of a warning of future health problems; they’re simply a sign that you drank some alcohol, and probably got intoxicated.  And what’s so wrong with that?

And actually, I find that the hangover’s over by Monday – but guilt (where my actions have actually had negative consequences) doesn’t disappear so quickly.  I just can’t see how waking up without a hangover would stop us ‘being forced to live with the consequences of our actions’.

Who is responsible for alcohol policy?

I know I’ve written about the involvement of the alcohol industry in policymaking before, so as with most of my posts, there’s a risk of repeating myself – at least in some of the themes I’ve discussed.  However, I do think there’s something to add.

A couple of weeks ago, the journal Addiction published an editorial arguing that the alcohol industry should be limited in its involvement in public health policymaking – or at least that’s what the article claimed to be saying.  It was suggested that if the industry feels it should be an equal partner in public health policymaking, then the public health community should surely be able to influence winemaking, business practices and so forth.

The editorial itself includes some questionable points, such as citing alcopops as a prime example of ‘product innovations that have high abuse potential’, given that this isn’t really supported by the evidence I’m aware of.*

However, I’m concerned with some more fundamental and general issues.

It could be argued that the ‘us and them’ characterisation of policy positions isn’t helpful – I’ve suggested before that particularly at a local level (and partly because ‘the industry’ isn’t a monolith) this sort of confrontational approach is unhelpful.

There’s something else here too, though.  Throughout the editorial, it’s unclear whether the focus is ‘public health policy’ or ‘alcohol policy’.  The two are not synonymous.  If we understand ‘policy’ as something that government does (whether at a local or national level), the broad view is that it applies when things could be better – when there are perceived problems otherwise.  This position doesn’t require a liberal perspective; rather, it’s simply stating the obvious: government has a policy on the basis of something it would like to see (almost by definition).

In the case of alcohol, as I never tire of pointing out, there is a myriad of (perceived) problems that policy might be looking to address.  Some relate to health, some to disorder or crime, some to nuisance or littering, some to moral offence.  (And that’s not an exhaustive list.)  Note that health is only one of these elements, and even then it’s not always clear whether concerns with alcohol consumption are appropriately classified as public or private health issues.

The regulation of alcohol, therefore, is not (solely) public health policy.  It is also economic policy, community policy, justice policy and so on.

Where policy discussions have, to my mind, failed in recent years is the tendency to look for a single solution, namely minimum unit pricing (MUP).  Although it might be viewed as a classic public health policy, with its population-wide approach affecting availability, it has not been presented as such by the government.  Both in the 2012 Alcohol Strategy and in other statements, MUP was presented as a targeted measure to address ‘binge’ drinking.  ‘Binge’ drinking, as defined in these instances, is not about health so much as crime and disorder – it’s about drunkenness, not long term health effects.

This makes a broader point, which I promise is not intended to be facetious.  Alcohol is a cross-cutting issue.  There is no single government department that can or should take complete ownership of it.  Although the challenges posed by alcohol for policymakers can sometimes seem unique, this particular issue at least is universal in the sense that all policies have an influence beyond the boundaries of their parent ministry.  Education policy does not only affect schools; agricultural policy does not only affect farming.

So, health is not the only aim or concern in alcohol policy, and even a policy with only health aims will influence other spheres such as the economy.  It is unhelpful to simplify alcohol policy as a ‘struggle’ between industry and health, ignoring other policy interests and stakeholders.  The question is not simply one of profit versus health.  To use the wording of the Addiction editorial, ‘the heart of and soul of alcohol control policy’ is much more complex than that.

*You could stretch the point and suggest that perhaps alcopop marketing attracts young people to alcohol, and they only choose cheap beer, white cider or vodka because those are cheaper.

NOTE

I should add the caveat that I had mostly written this post before reading this somewhat misleading article by spiritsEUROPE, which states that someone’s level of ‘consumption per se is not the problem - behaviour is.’  This is misleading because both total amount consumed and the pattern in which this is consumed are relevant.  There also seems to be some confusion in the article about whether individuals’ consumption is being discussed, or average consumption across a population (which I’ve talked about before).  This article, unsurprisingly, sees a role for the alcohol industry – but as I’ve written before (and flagged up to spiritsEUROPE) this shouldn’t imply this sort of tactic of misdirection around the evidence base for public health interventions.

The point in the editorial that industry actors may seek to deny the effectiveness of restrictive policies is therefore well made.  I don’t want to suggest that the industry is well placed to comment on control policies; simply that control policies, even if alcohol is viewed only in a negative light, are not simply the realm of public health alone – most obviously the criminal justice system has a clear interest in shaping these.