Drinking within limits with Drinkaware

Last week, Drinkaware published a report called ‘Drunken Nights Out’.  It’s definitely worth reading, and the analysis of drinking practices and beliefs underlying it is surprisingly nuanced and thought-through.  Perhaps that’s testimony not only to the researchers but to those who sat on advisory panels.  If you don’t have time to look through even just the executive summary, then I can recommend a summary provided by Alcohol Policy UK.

The report carefully assesses people’s beliefs, behaviours, activities, fears and motivations.  For example, it’s noted how (certain forms of) drunkenness are considered normal, that many people’s early experiences of drinking enforced an instrumental approach to alcohol (drinking to get drunk), but that even such determined drunkenness (as Measham and Brain would call it) is ‘within limits’.

It’s this last point that’s particularly interesting, because it’s noted that these ‘limits’ aren’t like the limits government refers to, and in fact are framed in completely different terms.

However, the report falls down, in my opinion, when it moves to solutions to the perceived problems.  This is partly due to the restrictions applied to the scope of the report, but it’s also due to certain assumptions applied.

First, the report sets its terms of reference by stating that it’s only concerned with what’s in Drinkaware’s remit.  In the eyes of some public health professionals, this will immediately limit its usefulness, as the key factors of price and availability are not within Drinkaware’s gift.  Moreover, it’s stated that the report takes a harm reduction approach, meaning that it’s not aiming to reduce the number of ‘drunken nights out’ so much as reduce the harms associated with them.

This statement leaves me in a slightly uncomfortable place.  I agree that the focus shouldn’t particularly be on reducing the number of drunken nights out per se.  If people want to spend their evenings (and money) on this, I can’t immediately see why it’s any more execrable than partaking in state-subsidised opera, or skiing (so long as they know what they’re getting into).  Both of those alternatives often (or always in the case of certain opera companies) involve the state paying for the choices of individuals, which is the only real downfall of ‘drunken nights out’ as identified by Drinkaware.

On the other hand, that limiting of the scope of the report doesn’t actually follow from the initial statement that it will only look at interventions that are in the gift of Drinkaware.  In fact, given the strong links between drinking, drunkenness and the carnivalesque (or simply outrageous behaviour) in the way we think about alcohol in today’s Britain, it could be argued that educative approaches would be more likely to persuade people to go out on such nights less often, than to completely change their understanding of alcohol.

This brings me back to my old frustration with the alcohol industry (though I shouldn’t lump a whole range of interests together like that).  I often agree with them, but sometimes for completely different reasons, but other times find myself hugely disappointed by their cynical, self-interested approach – and I can’t help feeling this report is too constrained by a particular way of thinking about what is appropriate for Drinkaware to do.  I don’t think in this case these limitations are due to the same calculating cynical approach I’ve seen from the WSTA and Portman Group, but rather just accepting what they already do as inevitable restrictions.

But back to the practical recommendations of the report.  First, there’s one suggestion that people with a public health perspective should be applauding.  The report notes that education initiatives should challenge the assumption that if you ‘get away with it’ on the night, there’s no long-term problem.  Once the hangover is gone, you might feel fine on each occasion, but you could be doing long-term damage to your health.  I don’t expect to see a magical intervention that can successfully defeat this assumption, given that a belief in one’s immortality is something we cling to despite mountains of evidence – but this is an appropriate target for intervention.

After this, though, my academic perspective saw a couple of key flaws in the approach.  First off, methodologically, there are problems with simply asking people what they think or do regarding drinking.  We’re actually concerned with what they do, which doesn’t always correspond exactly with what they say – particularly regarding drinking within limits or having safekeeping strategies.  Most people know that some of the best laid plans for a night out can often fall apart in reality.  You have just one more drink, and raid the money you’ve saved for the taxi home to do this, but you might well still talk about knowing your limits and setting boundaries when you describe your drinking to other people.

This then leads into the broader point around limits.  Although the report is refreshingly clear about people having limits around their drinking, it doesn’t pay enough attention to its own acknowledgement that these are founded on completely different principles to the limits the government espouses, or indeed those placed on the same individuals’ behaviour at other times in the week.

I never seem to stop citing MacAndrew and Edgerton on drunkenness and limits, and here’s another opportunity.  Basically, they compared how drunk people behaved (and were treated) in different societies, and argued that drunkenness is set of norms and is ‘learned’ as much as everyday behaviour.  To give a simple example, in some societies people became fired up when drunk, whereas in others they chilled out.

And the ‘limits’ were different too.  Even when apparently blind drunk and on a drunken rampage, a reveller in one society found time to apologise to a researcher – acknowledging that his actions were ritualised and the outrage shouldn’t apply to a visitor.

These sorts of limits aren’t what Drinkaware is talking about in the report; they’re wider and more fundamental.  They are not about whether you set yourself the limit of four drinks or five on a works night out, but instead whether murder, drink driving or domestic violence when drunk is acceptable.

These sort of limits aren’t just individual; they’re influenced by broader issues like the legal framework surrounding alcohol.  That doesn’t mean Drinkaware can’t do anything about them, though.  And more importantly it has serious implications for the solutions proposed in this report.

The report makes the same mistake as the ‘Would You?’ campaign, which I’ve written and spoken about a number of times at conferences and in academic articles: it suggests that education campaigns should remind people that ‘they would not accept such behaviour outside the context of drunken nights out’ (p.10).

This is irrelevant.  The whole point of ‘drunken nights out’ is that these evenings operate under different norms to the everyday.  To tell someone they wouldn’t accept this behaviour outside of a drunken night out is just to remind them that’s why they go on these nights out in the first place.

I’d suggest that a more appropriate response is to stress certain absolute lines.  Looking at the work of MacAndrew and Edgerton, or indeed our experience in recent decades in the UK, we can see that certain things can be branded unacceptable regardless of drunkenness.  The claim shouldn’t be that you wouldn’t do something sober, making the comparison between the two scenarios; it should be simply to state that certain behaviours are unacceptable regardless of context.  We’re perfectly capable of holding onto certain norms when drunk, and there’s no reason to think this approach shouldn’t be considered within the scope of Drinkaware.

This might seem like a semantic distinction, but I think it’s crucial, and does reflect a genuine misunderstanding on the part of the report’s authors.  It’s not just that such strategies wouldn’t be effective; it’s also that it would be sad to apply everyday norms to all aspects of human life, and that’s what the general philosophy of ‘you wouldn’t do this sober’ suggests.  There are some benefits and pleasures in drunkenness and carnival.

What's new about neoliberalism?

A while ago I wrote about an academic article I’d had published that suggested successive governments’ alcohol policies can usefully be labelled neoliberal.  The reason this was worth saying, I suggested, was that some policy commentators have talked about policy entering a new phase since 2008, as confidence in market mechanisms and individual rationality have faltered in light of the crash and recession and there’s been an increasing emphasis on community-focused interventions through developments such as Blue Labour, Red Toryism, and David Cameron’s idea of the Big Society.

The first step in this argument is to note that governments have loosened regulation of the alcohol industry, particularly through the 2003 Licensing Act, but also well before that, from the 1980s on.  Phil Mellows has suggested that the Beer Orders can be seen as neoliberal, as (however misguidedly) they sought to open up the market to greater levels of competition.

But in itself this could just be liberalism.  The same arguments about competition were made in the nineteenth century in terms of the Beer Acts.  What made these more recent developments neoliberalism, I argued, was the peculiar way in which government was clearly panicked about alcohol and worried about particular types of drinking.  Alcohol strategies were published by successive governments, and millions of pounds were spent on advertising campaigns to persuade the public to Know Your Limits, know your Units, and behave on a night out in a sober fashion.

This can be seen as neoliberal because it isn’t based on a belief that a person’s own way of laying out their life is by definition the best for them.  Rather, the government thinks it knows best, and it’s unhappy about the results produced when British people (who are born to binge?) are invited to binge.

For most of the twentieth century, the response by government to such a feeling of unhappiness would have been to change the environment that seemed to produce that outcomes – hence the Central Control Board (CCB) and the retention of relatively restrictive licensing laws even after the end of the First World War, more or less through to the 21^st century.  It’s not really important what this period is called (some would question the term ‘expansive liberalism’ which a few social policy academics use), but it’s clearly quite different to the approach to alcohol policy taken by successive governments in the past 30 years.  In this more recent approach, the market is taken as given, and it’s the individual drinkers who are told to change.

It’s possible to say that the 20^th century was unusual in terms of the restrictions put on the alcohol trade, but I’d argue that such a position is misleading.  Retail of alcohol has been licensed for centuries, and it was only for rare periods of history that numbers of pubs, inns, taverns, alehouses and so forth were determined solely by market forces.  In fact, schemes comparable to the CCB were in operation in a range of towns at various points in the early modern period, on the basis that directly controlling the numbers of licences wasn’t enough; the profit motive should also be removed from licensees’ day-to-day operations.*

So far, so neoliberal.  And yet, writing recently about the particular context for England’s apparently neoliberal alcohol policy (it unsurprisingly involves the carnivalesque, in case you were wondering), I was reminded of James Nicholls’ work on liberalism and alcohol policy, and his broader work on the history of alcohol policy, which notes how many of the same arguments and dynamics crop up again and again – if in slightly different forms.  This reminded me that there isn’t a single ‘liberal’ position in relation to this unusual substance, alcohol.  TH Green was a liberal who advocated prohibition, while this was anathema to JS Mill.  Perhaps we could see the 20^th century as a form of watered down (or beered up?) TH Green style liberalism, and the current period as Millian?  (This post owes much to James Nicholls.)

The distinction between the period from 1915 to the 1980s and the time since then is, in my account, that both had clear view of how people should drink, and accepted the free(ish) market wouldn’t produce these, but the solutions to this perceived problem were different.  The first sought to change the environment in which people made their drinking decisions; the second sought to change the people.

The latter might sound distant from an idea of pure, classical liberalism that values individual judgement, but is in fact remarkably similar to the views of Adam Smith or Mill.  They accepted that there were higher pleasures, or that the desire for drunkenness was a bad thing – but argued that education, exposure to alternative pastimes and changes in working conditions would be better solutions than limiting the numbers of alehouses or prohibiting the sale of alcohol altogether.

Hasn’t that been the hope of Labour and Coalition policies?  Drop MUP but keep funding Units, Would You and Change for Life to show people the ‘better’ life they could have?

Maybe this neoliberalism isn’t so new after all.

*See the chapter by James Brown in this excellent book.

The old news of sobriety orders

Here’s my second post inspired by Keith Humphreys, this time covering the recent announcement of sobriety tags for certain alcohol-related offenders in London.  (It’s worth noting at this point that a similar scheme was introduced in Strathclyde some time ago, though that’s not mentioned in the mayoral press release.)

The rationale for the policy is explained clearly here, but its application to a wide range of offences initially made me feel uneasy.  In the US, from what I can tell, the schemes were run – in the first instance at least – to address drink driving offences.  Setting aside the thorny issue of fixing an exact ‘safe’ limit of alcohol, people are not allowed to ‘drink and drive’, and when they do the restriction has generally been of their driving rather than their drinking.

There’s actually no reason why this shouldn’t be reversed if it’s more effective.  It’s not necessarily true that these individuals are bad drivers when sober, just as they may hurt no-one when they drink unless they drive.  To fully forfeit one right is no more arbitrary than forfeiting the other, since the precise offence is the combination of drinking and driving, not either on its own.

The requirement to stay sober fits, though, because of the specific nature of the offence of drink driving: we have a specific, apparently ‘objective’ limit on blood alcohol concentration, over which a person is not allowed to drive.  Driving while ‘drunk’ is an offence in itself, banned on the basis that there is a direct physiological/pharmacological relationship between alcohol consumption and impaired driving.  Without the alcohol, there is, by definition, no drink driving.

We know this is not the case for violence and other crimes.  Not everyone in every culture is more likely to become violent or commit a crime when drunk; the way we behave when drunk is learned and more conscious than we might think (given that we react in similar ways when we’ve drunk a placebo).

Combined with the way the offences are defined, this means that we just can’t say for an individual who commits an offence while drunk – as we can for drink driving – that without the alcohol there is no offending (of this specific nature).

Of course the same sort of principle already underpins Drug Rehabilitation Requirements (DRRs) or Alcohol Treatment Requirements (ATRs), which are used as part of community sentences now, and which I’m very much in favour of.  These are handed out where the courts feel the offending is drug- or alcohol-related.  However, those should do far more than simply stopping an individual drinking; they should look at why they drink or use drugs and why they commit crime.

I agree with Keith Humphreys that people frequently recover from drug and alcohol use without accessing specialist services, and this new initiative offers them an incentive to kick start that process regardless of any related treatment requirement, but the relationship between drinking and offending more broadly isn’t quite so straightforward as drinking and driving.  It’s clear the scheme designers are aware of this, as they have excluded domestic violence offences from those listed as suitable for tagging.

I’m not against the scheme, but when it’s looked at in some detail – it will be supervised by probation and those on the programme will be offered alcohol advice and treatment – it’s apparent it’s not a huge innovation, but simply a technically more effective ATR, and almost identical to DRRs, which already involve drug testing.  To be fair to Humphreys, it’s the technical and procedural innovations he stresses, but it’s certainly far from the revolutionary or radical initiative some have painted it, whether in favour or opposed.

The key difference from DRRs is, of course, that those ‘drugs’ by that definition are illegal, and so it doesn’t seem so unreasonable to require someone not to be using a particular substance.  Although the argument of the Adam Smith Institute that the tags are a novel infringement of civil liberties falls down somewhat given that ATRs have been around for years, perhaps what’s really highlighted is this inconsistency: we really feel that it’s an Englishman’s right to drink beer.

And so we’re back to Virginia Berridge again: I wouldn’t start from here.  It’s maybe not helpful to have that feeling of a right to beer, if indeed that’s what’s going on.  Unfortunately, policy has to start from here.  A liberal argument can be made that action should be focused on the offences, not the alcohol, but the idea of limiting people’s access to certain factors that influence their offending behaviour if they tend to commit crime is pretty well established.  I’ll be interested to see not just the evaluation of the project, but whether whatever government is in power after next year’s election feels the scheme is something it should endorse nationally.

Licences for heroin?

Two (not particularly recent) articles by Keith Humphreys, former White House drug policy advisor, caught my eye last week.  I’ll be blogging about them separately, as they’re not particularly related.

First, as I’ve been thinking about drug policy over the last week or two, I was interested in the idea that heroin overdoses – or those relating to opioids more generally – aren’t actually to do with the relative purity of street heroin.  This is one of the key planks of legalisation campaigns: users will be safer when they know what they’re consuming.  I’d say this argument still holds, given the discussion of deaths related to ‘legal highs’ in my previous post, particularly the idea that PMA might be implicated in many of these, and few people are deliberately choosing to consume this drug.

However, this raises questions for my current view on drug policy, which suggests that, at least in an ideal world, we’d have something not too dissimilar from the legal but highly regulated market advocated by Transform.  Since I started working for a DAAT, I’ve felt (possibly unreasonably) that sometimes while the arts might sometimes have been condemned for celebrating drug use, academics have sometimes abstracted it such that the associated problems seem to disappear.

Those from Transform would probably argue that most of the problems associated with drug use are the result of the criminalisation of possession and supply, and I’d largely agree, but I have a separate fear.

I fear that if drug other than alcohol, tobacco and so forth were legal, I’d be more inclined and able to use them than I am now.  That might not be a bad thing – if I substituted cannabis and ecstasy for alcohol, or a low dose of amphetamine for coffee.

I’ve been wrestling with the idea of overdose, though, which would be highly unlikely in any of these cases.  You could respond by pointing out that alcohol is legal and yet plenty of people ‘overdose’, but that’s not a justification for opening up the door for another drug to do the same.

A certain liberal mentality wouldn’t have a problem with this: if the overdose risk comes from taking too much or mixing with other drugs, and everything’s clearly explained and labelled, it’s simply a poor decision by that individual.

However, the Darke and Farrell paper cited by Keith Humphreys suggests that quite a lot of us are that poor at making decisions regarding opioids (possibly because we get addicted to them, which – for my money and Mick Bloomfield’s – amounts to more than simply an ingrained bad habit).  Addiction, if it means anything, means someone isn’t great at decision-making, particularly when that specific substance is involved.

This is the old debate about liberalism and drugs, brilliantly covered by James Nicholls in relation to alcohol here and here (and which I’m going to post about soon again).  I won’t do full justice to those issues here, but suffice to say I think that in principle there’s no reason the government shouldn’t intervene in this sort of situation, and regulate or ban certain substances.

Maybe the answer, though, isn’t as complicated as it seems.  As some harm reduction advocates never tire of pointing out, there’s never been an overdose death in a supervised consumption room.  We sometimes forget the different ways alcohol is regulated (for consumption on and off the premises), and that these could be tweaked and applied to drugs.  Most advocates for legalisation tend not to forget this.)  And the regulation of all drugs wouldn’t have to be identical – we currently regulate caffeine, alcohol and tobacco very differently from each other.

So perhaps the solution is relatively simple: for drugs where there is a notable risk of overdose, consumption would have to be on-premises, but for other substances, off-licences could be developed.

Of course the argument could be made that illicit opioids would continue to flourish, because people would want the hit without the medical setting – but then again logic suggests licence design could be based simply on the safety of the facility, not levels of comfort and welcome.  Think of CCB or ‘improved’ pubs, which were designed to be respectable and comfortable in order to engender a certain culture in relation to alcohol consumption.

The problem is that such an approach does feel like it would encourage opiate use, which I’m just not entirely comfortable with.  The approach of these sort of schemes is that the state sanctions consumption, but with a certain level of austerity, or restraint.  Although I am strangely attracted by such schemes, I’m not convinced they’re effective or sensible – particularly in relation to certain drugs.

And this ‘feeling’ is actually important.  As Virginia Berridge points out, whether we like it or not, we start from a particular cultural and historical setting that affects how different drug policies are viewed – and in fact how they would be responded to – not only by politicians and the media, but (potential) drug users, who are not acultural rational automatons.

It turns out, then, that one quick blog post can’t resolve this complicated issue.  Never mind, there’s always the new guide by Transform to read.  Maybe that’ll give me a few more ideas.

Ambitious for an informed debate

It’s hard to convey quite how frustrated I was by Sunday’s Centre for Social Justice report on alcohol and drug treatment – and quite how much of a gift for this blog it is.  I won’t really do it justice in this post, as there’s so many gaping holes and misleading inaccuracies in it that I can’t begin to address them all here.

It’s worth mentioning in passing, though, that the much-trumpeted idea of ringfencing an allocation of alcohol tax for rehab could be counterproductive.  The likelihood is that this would come to be seen as the funding for alcohol treatment, meaning that current allocations might be dropped – certainly by local authorities keen to raid public health budgets to ease the pressures of the graph of doom.

There are two key issues I want to focus on here, based on the prominence given to them by the press release and CSJ reps in their media appearances.

First, that residential rehabilitation is the only way to achieve ‘full recovery’.  This sort of argument hinges on one’s preferred definition of recovery, and the adoption of this buzzword in the 2010 Drug Strategy and subsequent Strang Report just papered over the cracks within the sector: the ‘methadone wars’ are far from over.  As DJ Mac suggested, the way the report is written is hardly conducive to the dialogue and persuasion that would be required to genuinely transform drug treatment successfully.

Almost more fundamentally, though, the report presents a conclusion without any basis in evidence.  The only reference for the effectiveness of res rehab is the 2012 NTA report The role of residential rehab in an integrated treatment system, but this largely endorsed the position of most local authorities in using res rehab for a minority of individuals.  It even stated: “For every ten people who go to rehab each year, three successfully overcome their dependency, one drops out, and six go on to further structured support in the community.  Of those six, two overcome dependency with the help of a community provider, at least two are still in the system, and at least one drops out.”  That is, res rehab is not some magic, universal solution, and in fact often treats those who are more stable to begin with – the most challenging and chaotic are those who drop out, and it’s community treatment services that are left to manage them.  Rehabs, the NTA report said, are better at treating those with alcohol dependency than drug addiction – but then this is true for community services too.

There is no doubt that even a six month stay in a res rehab, if successful, is a better option than 10 years on methadone in the community, but it’s not immediately clear that this is a direct choice funders, commissioners or service users can make.  As DJ Mac argued, we do need a debate about how drug and alcohol treatment services should be organised, but it needs to be constructive.  It’s not just that the press release was confrontational; I heard Chip Somers promoting the report on Radio 5 (43 mins into the link) claiming that it’s basically impossible to get state-funded rehab at present and there are waits of years.  I just don’t know where this is true.  There is something of a ‘postcode lottery’ in the sense that policies will be locally-determined, but many facilities would count up to half of their clients as state-funded, and not all local allocations for res rehab even end up being spent.  This is just not as simple as there being a local (or national) policy block on accessing such services – and that’s if we even accept the effectiveness of such services in the absence of clear evidence.

Second, the report makes some big claims about drug-related deaths, which were picked up on by the media.  The first thing to note in this respect is the big picture: whether we’re looking at general drug poisonings or the subcategory of ‘drug misuse’ deaths, it’s very hard to argue that we’re seeing anything approaching a crisis:

Source: ONS, 2013

(I should point out that this second graph is from the 2013 St George’s report on drug-related deaths,  because this is what’s cited by the CSJ in theirs, and that’s what I’m working from throughout the rest of this post.)

More than this, however, the analysis given is just cherry-picking to illustrate a point.  Last year, the CSJ was concerned about the growing number of deaths involving methadone – and this surely still underpins their opposition to opiate substitution treatment, expressed in the latest report.  What they’re concerned to do in the report is paint drug use as a continuing major problem despite declining use of heroin.

NPS (new psychoactive substances) are the particular choice for this report.  If you were cynical (unlike me) it might occur that this is a useful focus, because it’s so difficult to predict how use of and harms from these substances will develop in the coming years, making panic-inducing speculation possible.

Certainly, deaths related to NPS have increased, and the CSJ focuses on this, hence all those headlines about NPS deaths being about to overtake heroin.  The thing is that their analysis doesn’t improve our understanding of the situation regarding substance use in England today.  In fact, it could be argued that it is actively misleading.  NPS deaths are compared with those from heroin and morphine – but why not opiates as a whole, if methadone-related deaths were such a concern last year?  It might be suggested that pointing out the decline in methadone-related deaths wouldn’t fit with the big narrative based on how terrible methadone is, given that last year’s figures relating to heroin and methadone appear to have been an anomaly.

The crucial thing to note here is that the opiates are the single most common psychoactive drug group associated with deaths.  In fact, heroin and morphine deaths accounted for a higher percentage of the total in 2012 than 2011 (by 5.1%).

As an aside, I’m talking about drug-related deaths, but it’s worth pointing out that when the CSJ talks about drugs causing deaths, they have a tendency to count the cases where particular drugs were noted in the toxicology report, rather than where a specific substance was listed as a cause of death.

First off, the CSJ uses just four years of data, covering 2009 to 2012, so long-term trends might not be apparent.  More than this, though, for their extrapolations they only look at two years compared, taking the change from 2011 to 2012.  In the timescale of legal highs this is quite a while ago, and just one year in what could be seen as a rapidly changing field.

I say it could be seen as a rapidly changing field, because if the CSJ had conducted the same analysis last year, rather than noting a 43% increase in deaths were the individual had NPS in their system, they would have seen no change at all.  Both 2010 and 2011 saw 68 post-mortem toxicology reports citing NPS.  (An increase could have been argued if ‘cause of death’ were considered as the key variable, however.)

You could say it would be hard to predict next year’s figures based on a line of development like this:

That’s precisely what the CSJ report did though, and what was picked up by the news headlines.  The supposedly newsworthy comparison, as I mentioned above, was with heroin and morphine deaths.  Initially, it’s hard to see how the NPS deaths would outstrip the others:

However, the extrapolation on one year produces a convergence:

There’s an interesting choice made here: the extrapolation isn’t linear; it’s exponential.  That is, there’s compound interest on the increase, such that if NPS deaths carried on increasing in this way although the figure of 400 seems believable for 2016, it’s hard to imagine 1,166 in 2019 or 1,663 in 2020.  This isn’t to say these figures aren’t possible, but there’s no explanation as to why just one year’s change is taken as opposed to an average over the period, and why this is then compounded rather than treated as a linear function.  The strangest thing about the whole process, though, is that actual figures for 2013 are due out on 3^rd September.  We don’t have to predict; we can know.  Why not just wait for a couple more weeks to make the estimates more accurate?

However, there is no doubt that whether we look at the ‘toxicology’ or ‘cause’ figures, there has been a rise in ‘NPS’ deaths in the period.  What isn’t so clear is whether these are due to what most people would think of as ‘legal highs’ – or indeed whether the substances would be covered by the interventions later proposed.

The increase in toxicology figures from 2011 to 2012 (on which that extrapolation is based) wasn’t down to mephedrone, or anything ‘legal’.  In fact, the bulk of the increase was down to PMA.  Toxicology reports citing PMA rose from 5 in 2011 to 19 in 2012.  But PMA isn’t a novel substance, having been available at least by 1970, and a Class A substance in the UK since the Queen’s Silver Jubilee.  It seems to generally be sold as ecstasy, so it’s not even that users understand it to somehow be a ‘legal high’.  That is, these deaths have little or nothing to do with head shops, as far as we can tell – and yet the recommendations of the report relating to ‘legal highs’ focus on head shops.

Another category of drug that rose was benzofurans – from 1 to 9 – and methoxetamine – from 1 to 6.  Both of these are now illegal (though in the case of methoxetamine, only since 2013 – after the period covered by these data).

Given that the concerns expressed regarding ‘legal highs’ are how to police ‘head shops’, and it would be quite straightforward to stop head shops selling any of these substances, I’m not sure how the concerns and proposed solutions fit the identified problem.  Of course, it might be that head shops continue to pose problems, simply with a new set of drugs – but the CSJ report would have to explain why that’s likely to be the case.  It would probably need new data that illustrate how things have developed since the banning of the relevant substances (and indeed how banning makes any difference whatsoever, given the apparent importance of PMA), and should acknowledge that comparing just two years’ data isn’t the most secure basis for an extrapolation.

Both issues – of NPS deaths and residential rehabilitation – highlight my concern about not just the tone of the CSJ report but its basic accuracy.  We do need a constructive debate, and that requires not only open dialogue, but clear, honest discussion of the evidence.  The CSJ report offers neither, which is at best disappointing.  At least it keeps me busy though.

Budget day and the de-normalisation of drinking

I started writing this post thinking it would be the opposite to most of what I write on here, which tends to be material that – with a little more evidence, research and finessing – I think could be turned into academic work.  However, by the time I was a decent way in, I realised that while this was journalistic speculation, it was inevitably tainted with the overthinking and reliance on abstract concepts that characterises my academic work.  So apologies for that.  I’m hoping that it might still have something of interest in it.

For some reason, on Thursday morning I was reminded of a particular clip in a news item about Ken Clarke’s sacking in the Cabinet reshuffle.  He was drinking whisky while giving the Budget speech.  Drinking alcohol on this occasion isn’t actually unusual; in fact, it’s traditional.  Disraeli drank brandy and water, while Gladstone preferred sherry and a beaten egg (not to my taste, I have to say).  This changed when Gordon Brown was Chancellor, and neither of his successors has dared break with his example of drinking water.

This single example could be seen as very particular, and driven by one specific individual with his own history, preferences and fears.  However, it fits with broader trends.  Phil Mellows has written about the demise of the lunchtime pint, and I’ve experienced this even in the time since my first office job in 2005, when alcohol was happily drunk at lunchtime meals.

On Wednesday, I realised how much I’ve internalised this new norm.  I went for lunch at the (CAMRA-award-winning) local social club (the Colliton Club, which is in the building used as the model for Lucetta’s house in The Mayor of Casterbridge).  Although I’m often tempted by the thought of lunchtime drinking when I see the range of beers on offer there, I was genuinely shocked to see orders for beers and wines being made by a group of people dressed smartly enough to be staff on their lunch break.  They probably weren’t at work, as lunchtime drinking is so frowned upon, but the point is that my automatic reaction was, bizarrely, one of shock.

This is a reaction that sits oddly with the common conception that alcohol has become more normalised in British society – that it’s available at school discos and fêtes, or while you’re having your hair cut.

Although it’s hard to argue that the postwar period was one where Britain had a wonderful relationship with alcohol (despite lower rates of liver disease, drink driving deaths were much higher) there are aspects of this culture, which included the lunchtime pint, that aren’t too bad.

To understand this, I’d like to invoke my pet concept, the carnivalesque* – though actually this doesn’t tell the whole story.  Although it’s often said that Britain is a nation of incorrigible boozers, in fact not only do national drinking patterns change significantly over time, but alcohol can be understood in a range of ways depending on the context.  So, the Christmas at Blackpool drinking described in The Pub and the People is very different to the everyday drinking that those same people did on a regular Wednesday evening.  The lunchtime pint – or Budget whisky – is quite different from the Friday night Jägerbomb.

Or is it?  I’d suggest that one of the reasons we see lunchtime drinking as odd now is that current public debate can’t handle the distinction.  The lunchtime pint is seen as a step towards oblivion.

This is partly the unavoidable result of drink driving campaigns – it is true and quite right that we should be wary of driving after even just one drink.  But this isn’t just about the dangers of intoxication; people think of the glass of wine after work in much the same way – only positively.

As I argue elsewhere (or at least try to, in articles under review), the idea of the carnivalesque is crucial for government, drinkers and the industry in distinguishing between different types of drinking.  However, underlying all these forms of drinking is the idea that alcohol is an intoxicant.

This might seem uncontroversial, and the sign of good alcohol education.  Organisations like Transform are always trying to highlight this, and I’ve done the same when T in the Park  supposedly banned ‘legal highs’ – except for the fact that it’s sponsored by the biggest of them all.

But such a view has a tendency to take the ‘drug’ out of context, and imagine intoxication as a pure process, when in fact drunkenness, at least, understood as a form of behaviour, isn’t this.  In contrast, it’s this distinction that is at the heart of the carnivalesque – it’s about something more than pharmacology; it’s about norms and culture.

And it’s here that the carnivalesque comes into its own.  My working theory is that, even if not everyone’s drinking in a carnivalesque way, now more than ever alcohol is associated with the carnivalesque, since our idea of intoxication is so imbued with this.  The lunchtime pint is, at some level, not seen as qualitatively different from the Friday night blow out.  The glass of wine after work doesn’t simply signify a ‘keying’ of a change in time; it’s also seen as a ‘release’ from the everyday – which is at the same time something more than pharmacological.

There are advantages to this, to be sure, but it’s also worth pondering the point that while the lunchtime pint and the Chancellor’s whisky became unacceptable, we all started drinking a bit more.

Alcohol might be more available and more visible than it used to be, and people might drink it every day, but it’s still far from ‘everyday’.  It doesn’t seem to be just another ‘ordinary commodity’ to the British public.

*For more detail about the carnivalesque, you could read one of my articles, but basically I mean drinking that’s public, exuberant, with different norms to everyday life.

Kidults and the old school beer

Phil Mellows yesterday pointed out one of the latest Portman Group judgements, which had to decide whether the names and labels of various beers were in breach of the code.  The names were: Cat Piss; Dog Piss, Bullshit; Dandelion & Birdshit; Big Cock; Grumpy Git; Arse Liquor; Lazy Sod; Puke; Shitfaced; Yellow Snow; and Knobhead.

I could just leave you with the link to the judgement (which also shows the labels), and allow you to giggle – or snort, as Phil did.

However, one bit of wording in the judgement caught my eye, given the one-trick-pony nature of my academic work at the moment.

“The Panel was concerned, however, that frequent references to scatological humour, defecation, urination, genitalia, vomiting and other bodily functions could prove particularly attractive to under-18s.”

If you added violence to this, it’s basically a description of the carnivalesque, which characterises Rabelais’ work, which is then drawn on by Bakhtin, and in turn drawn on by people like me (or this research team) to describe current town centre drinking.  (Flippant, but I don’t see young people eagerly reading Rabelais…)

I don’t want this post to turn into a detailed discussion of the codes used by the Portman Group and Advertising Standards Agency in relation to alcohol, but after reading this I started to flick through other recent judgements.

Perhaps unsurprisingly, a common feature of these is the feeling that products are appealing to children.  This isn’t just in a simple way, such that bright colours or fruit flavours are condemned.  A school has been condemned for brewing a beer to commemorate its 100^th anniversary – since there was then an unavoidable association between alcohol and the education of children.  Most bizarrely, the judgement stated: “while acknowledging that the school had taken steps to conceal the product from the pupils during school hours, it could not control children seeing the product if it was taken home by a parent.”

To me, this highlights the inconsistency of the Portman Group approach.  Public Health advocates complain that advertising and licensing ‘normalise’ alcohol consumption, and worry about alcohol being available in locations they feel it’s unusual and unnecessary, like cinemas.  It’s exactly this sort of worry that lies behind the condemnation of associating a school with beer – and yet the Portman Group represents manufacturers who do precisely this, and would argue that normalising isn’t a problem – alcohol is perfectly normal, but should be drunk ‘responsibly’; it’s only the errant individuals that need to be targeted.*

Obviously this isn’t an original or particularly interesting thought.  The strange role of the Portman Group is acknowledged by both (self-defined) ‘sides’ of the alcohol policy debate.  I just found the condemnation of a celebratory beer very strange – particularly when it’s an industry-related body doing the condemning.

The more general theme of complaints to the Portman Group  – as in the case of ‘Cat Piss’ beer – is that the drinks themselves would be appealing to children.  However, this is a line that is increasingly hard to draw, when UK drinking culture is carnivalesque (with the world turned upside down you can leave responsible adulthood behind) and where ‘kidult’ themes are common.

The suggestion is made in one complaint that a WKD ‘cauldron’ is irresponsible because:

“Halloween is widely recognised as a children focused evening, in particular with dressing up and trick or treating. The presentation of this product alongside the promotional posters, table talkers and mobiles would resonate with U18’s and make the product attractive towards them.”

But this isn’t simply about the evil alcohol industry appealing to kids. 

This distinction is hard to draw.  Is childhood the first thing young adults think of in terms of Halloween?  Possibly not; it’s probably now dressing up and parties.  There it is again – the kidult theme.

As we are in a culture where lots of the things adults are attracted to are child-like, the assumption behind this is that we need to encourage a culture that is sensible, staid and certainly sober.  I’m not sure I want to live in that world.  There are all sorts of problems with kidult themes – not least the way it potentially works both ways, with children wanting to be adults as well as adults wanting to be children – but to see it as a problem when alcohol simply reflects the society we already live in seems like backwards logic to me.

It’s noticeable that the Portman Group rejected the claim that the WKD cauldron was appealing to children (though it noted that alcohol content of any drinks in it would be unclear) while the school anniversary beer was condemned.  I’m not sure which way I’d have preferred the decision to go.  Maybe the answer is that neither should be condemned, and alcohol shouldn’t be seen as the carrier of all moral value.  Just something to think about.

*To be fair, the report linked to here isn’t an industry report, but it’s a good expression of the philosophy behind the approach that opposes population-wide interventions (like minimum unit pricing) in favour of targeted measures.