The folly of “responsible drinking”

UK health minister Matt Hancock said in parliament this week that we ought to follow his example and “drink responsibly”, as part of a contentious wider plan to use the idea of personal responsibility to ward off health problems.

Responsible drinking is the long-time boilerplate of alcohol producers used to deflect responsibility for harm that befalls their customers. But, like it or not, and many health professionals do not, the idea is prevalent and many people will instinctively connect with it.

After all, being responsible for things helps us live together peaceably for longer, deterring us from causing others needless harm and fostering mutual trust. The advantages of “being responsible” are something we learn throughout our lives, the rudiments coming to us in childhood.

We learn that being “held responsible” through customs, rules, laws and understandings allows those around us to penalise us for doing things which harm them, as we can in return. And we learn that to “feel responsible” means accepting and welcoming this kind of deal.

We also realise we often have no choice about the kind of rules we have to follow. Most of society’s rules and laws apply to us without our consent, like physics and biology. So being told to “be responsible” is largely reminder of an unavoidable fact of life.

In the context of alcohol drinking “being responsible” then means we should carry on conforming even if we are inebriated, despite the disabling psychological effects which can make it difficult if not impossible.

Taken to its limit this paradoxical injunction would mean not drinking any alcohol at all. But, if can allow ourselves a small risk of irresponsibility, we can stick to the UK guidelines of 14 UK units (140ml) a week. This keeps the chances of mishap low.

Alcohol producers and health ministers should recommend consumers stick to these guidelines directly, rather than appeal to our sense of responsibility, an emotionally-stirring reminder of our bonds with society which offers little practical help.

Responsible drinking advocate Matt Hancock, UK health minister

An unfathomable target
Responsibility is a shifting target. Even when drinking well within the low-risk guidelines it is tricky to know where our responsibilities lie. We are all held responsible and feel responsible for things in many ways which often overlap and conflict.

We might rush to the supermarket and reach for a bag of coffee on the top shelf so impeding an elderly shopper, an oversight for which we might feel responsible and offer sincere apologies. We might then resolve to be more careful before attempting such manoeuvres in future.

Learning opportunity taken, we might then walk from the shop with the bag of coffee hidden under our coat, fully aware of it being petty theft. But we might argue we were charged for two bags rather than one the last time we and prioritise our need to leave to conduct a life-saving operation.

Then, driving to work, we might swerve to avoid an oncoming vehicle, hitting the wing mirror of a parked car. We feel we were not responsible for the damage, but still leave our details for the owner of the parked car to make an insurance claim, knowing we are legally responsible.

Responsibilities are, then, attached to actions and events in different ways with different weights by different people and institutions, through different, rules, laws and customs, depending on circumstances and our own mental and physical limitations. Clear-cut cases are an exception.

This makes attaching responsibility a fascinating topic consuming large amounts of human effort. Armies of sociologists, lawyers, psychologists, philosophers, journalists, commentators and historians try to do it. We should doubt our chances of drawing definitive conclusions alone.

A sense of responsibility does and should help guide our behaviour, along with our self-interest and ideals. But it is there to regulate our relationships not our consumption of things. And it is particularly unsuited to be a yardstick for our consumption of a social, psychoactive drug.

Aim for environment
No amount of repetition can change the inadequacy of our sense of responsibility as a mechanism for protecting our health. An enhanced capacity for responsibility is more likely to be a welcome result of low-risk drinking than the other way round.

We can help ourselves and others by fostering our own micro-environments around alcohol drinking: We can limit to a low risk level; We can avoid difficult and risky things if ever inebriated; And we can learn techniques to feel carefree without drinking alcohol.

We could replace “drink responsibly” with new two word mantras, like “drink carefully”, “drink mindfully” or “find alternatives”, more likely to encourage healthier decisions around alcohol. Joining online clubs and finding support groups can help refocus on priorities.

Responsibility is not an effective way to reach alcohol goals, but fulfilling our responsibilities is among the likely rewards of low-risk drinking. We can adopt clear, effective strategies to improve our mental and physical health, even if health ministers do not. ■

The limits of alcohol’s laughs

“Analysing humour is like dissecting a frog. Few people are interested and the frog dies of it,” as amphibian-loving American Elwyn ‘EB’ White cautioned in the 1940s.

But we should cast such fears aside. If getting an eye-full of an annecdote’s inner workings means it snuffs it, then we just have to create another. Humour is not a finite resource.

And the dissection of one frog, even if it proves fatal, can improve the survival chances of millions of others, just as the expiry of the mother-in-law joke strengthened humour as a whole.

We need not hesitate to take a closer look at what makes alcohol humour tick, while seeing what else it might teach us.

A frame for mishap
So, then, what is so funny about being drunk? Its engine is, of course, quite simple: Alcohol partially disables our brains causing us to make questionable decisions and clumsy movements.

Typically jokes around alcohol involve finding fun in these effects, perhaps an ill-fated move on the dancefloor, a nap on a train, a loss of balance or some cringeworthy faux pas.

The more difficult question is why these mishaps are fair game while few of us would laugh at the misfortunes of people disabled in other ways? Why the exception?

For one, inebriation is typically temporary, so jokes around it seem less cruel than if it was life-long. And the negative consequences are mercifully often only minor, though that is largely down to luck.

We also tend to see drunkenness as self-willed and so its consequences too. This is partly true. But also our ability to regulate alcohol intake is often impaired by alcohol intake. That is nobody’s fault.

And we can truly say that laughter is not always cruel. It can be empathetic too. At a conference for blind people delegates became entangled in the hotel’s yuccas in the lobby, but none of the laughter I saw was cruel.

There are absolutely no hard rules, humour is dynamic and particularly open to invention, while tone and context are also as important as content, as is how we are invited to laugh. But by no means all of it can hit the mark.

Fresh payoffs
And while some gags bite the dust, alcohol shows spontaneity and social connection reliably induce laughter. And we can, thankfully, experience the same effects without alcohol, as we do in improv, singing, music or dance.

And being bit more picky about our alcohol laughs guards us too. We need not feel we deserve mockery for alcohol-related misfortunes and we can avoid mocking someone more worthy of compassion.

Questioning alcohol’s place in humour, while going against the grain, can offer insights into ways to be just as carefree, creative, connected and taken by absurdity, only with less chance of adding to our list of woes.

Whichever way you slice it, humour is better when it is for our benefit rather than at our expense. ■

Update: Alcohol strategy rift remains over conflicts of interest

 

There was no narrowing of the rift in the UK’s bid to tackle alcohol harm, which sprang open on Monday when a government health agency went into partnership with an alcohol industry-funded campaign, despite hearing strong opposition to the conflict of interests.

The “drink-free days” campaign will be entirely paid for by Drinkaware, an organisation receiving 92% of its £5.4m annual income from alcohol producers and others with interests in selling alcohol. It has committed to spend over £1m on the campaign this year.

“We will work together with any partner that speaks to the evidence and shares the same commitment,” Public Health England (PHE) told Alcohol Companion. “We brought our public health expertise and track record on delivering behaviour change campaigns.”

Drinkaware says it shares the same “aims and principles” as its new public sector partner. But it did not answer when asked if it would risk donors’ business interests to achieve public health goals? Critics conclude this is because of a conflict of interests.

Head of the Wine and Spirits Trade Association Miles Beale also would not say if his association’s members would continue to contribute to Drinkaware if the organisation’s work threatened their business interests. The alcohol industry wants “long-term customers”, he says.

PHE head Duncan Selbie said he would be “fiercely vigilant” about Drinkaware’s governance. Many, however, remain horrified. “As a profession, this potentially brings public health into national ridicule,” wrote one commentator on Twitter.

Sir Ian Gilmore, PHE adviser no more

A group of 40 health organisations, led by the Alcohol Health Alliance, objected to the deal last month. “We hoped they would see sense,” said one insider. AHA head Sir Ian Gilmore resigned as a PHE adviser this week and his tobacco counterpart John Britton may yet follow.

Drinkaware “misrepresents evidence and frames alcohol harms as solely an individual responsibility issue”, says Mark Petticrew, a long-time critic. The new venture “normalises the role of the alcohol industry in influencing public health”.

In particular Petticrew says Drinkaware downplays cancer risk as part of a wider strategy to neuter health advice to protect shareholder returns. A PHE evidence review has acknowledged potential problems of this kind.

PHE and Drinkaware say they will do separate evaluations and peer reviews of the campaign. Portman, the alcohol industry outfit which created Drinkaware, drew conclusions at odds with the findings of a joint health labelling study this year.

This site revealed Portman unilaterally dropped official health guidelines from its voluntary labelling standard in October. The attempt to restore them is led by the Department of Health and Social Care, but the PHE looked at the evidence and came down in favour of health labelling.

“Using labels to include information about the health risks and harms associated with alcohol can be implemented with relatively low-cost and will have a wide population reach,” the PHE’s review said in its 2016 review.

Few health professionals quibble with the idea behind “drink-free days”. Having two or more days a week without drinking alcohol may help older, steady drinkers cut down. It is already part of the Chief Medical Officer’s drinking guidelines.

A PR campaign for the idea began on Monday. This will be backed up with national radio and digital advertising which will direct people to a dedicated site. The Drinkaware board has yet to decide on budgets for 2019 and 2020.

Among the reasons the PHE gives for its partnership with Drinkaware is that the alcohol-business backed site had 9m unique visitors in 2017, an unaudited figure taken from Google Analytics. Most, it says, arrive from an organic search for an alcohol-related term.

“This is the first step in reframing our relationship with the alcohol industry,” PHE said its head, Mr Selbie. Some are finding the route being mapped out a more enticing prospect than others. ■

 

Is there “no safe level” of alcohol drinking? | BBC World News

Is there “no safe level” of alcohol drinking? I spoke to BBC World News about a Lancet report which reinforces much of what I say in Alcohol Companion. ■

Alcohol linked to nearly one-in-ten deaths among under 50s


There is no safe level of alcohol drinking, something linked to almost one-in-ten deaths in adults under 50 globally, says a study published today in 
The Lancet. Continue reading “Alcohol linked to nearly one-in-ten deaths among under 50s”

Low/no-alcohol World Beer Awards winners 2018

Germany remains a country kilometre ahead of the rest of the world in low-alcohol brewing, scooping up 17 of the 34 awards given to beers of this type at the World Beer Awards 2018 (see table). Continue reading “Low/no-alcohol World Beer Awards winners 2018”

Be wary of “persistent hangovers”

Feeling crummy more than a day after an alcohol session should give us pause for thought.

The alcohol response of our brains changes depending on our alcohol exposure over the past few hours and days and, less obviously, that over the last few months and years.

In our student days and early twenties, for instance, many of us might drink enough to move our brains into the outer regions of dependency, where our neurons misbehave when alcohol free.

No klaxon accompanies this shift so we may never know it happened. And our recovery from it can happen without us knowing too, with our drinking levels falling as our circumstances change.

But we can also inch into dependency at any time if we drink heavily for long enough, perhaps triggered by friends, a trauma or Christmas. We can unwittingly inch out of dependence again too. But we can’t rely on it.

So how do we know where we stand? It is not easy. If we drink less than the UK guidelines of 14 units (140ml) of alcohol a week for months, there is little chance of a problem. If not, we can’t be so sure.

We can look for clues, however: If we binge-drink, the classic pattern of the enthusiastic “social drinker” in northern Europe and North America, then our recovery after a heavy one is a good place to look.

Overlong aftermath
Having routine hangovers means we are not looking after our brains very well and could eventually face difficulties. But discomfort within the first 24 hours is a normal reaction to an alcohol overdose.

But feeling meh more than 24 hours after an alcohol session is something else. We might think it is a “prolonged [or delayed] hangover”, but it is not an overdose rebound, but a reaction to absence.

We have, in other words, some degree of withdrawal. We might sweat, have headaches, feel grumpy, tense, forgetful or nauseous. If we have anything more than the mildest discomfort we should go and see our doctor.

“Two-dayers”, as this phenomenon is sometimes dismissed, are potentially a sign we are flirting with alcohol dependency. Nobody wants to find this out, but the sooner we do, the easier it will be to reverse.

Avoiding heavy alcohol use for three months to a year is typically enough to be rid of it. Making this change on purpose is not always easy, but we can get help from our doctors and online and offline support.

If we stick to it we can reasonably expect clearer thinking, better memory, improved and more stable mood and better sleep. And, on a more practical level, we can substantially cut costs and so improve our finances.

Looking out for “persistent hangovers” or “two-dayers” can enable to look past unhelpful folk wisdom and misinformation to identify a potential problem, a crucial step in improving our long-term wellbeing. ■

Continue reading “Be wary of “persistent hangovers””

Alcohol: Take courage from competence

Like England’s footballers, who overcame a decades-long inability to win on penalties, we are better off finding our courage through practice, not through alcohol.

Sports sponsorship, like Budweiser’s backing of the World Cup, and thrilling advertising images reinforce the phoney link between alcohol and courage, despite codes barring it being done explicitly.

Alcohol plays no part in the confidence of sports people, or anyone else. We all know it, but facts are not what advertising is about. Advertising connects feelings, not facts, in this case tension and alcohol relief.

Our pre-scientific alcohol lexicon provide a flimsy barrier to prevent this powerful emotional linkage. The phrase “Dutch courage” contains only an oblique reference to the Netherlands to trigger suspicion.

Own goals
Lingering misgivings about the Low Countries, alas, do little to prevent our behaviour from being influenced, so we often turn to alcohol to cocoon ourselves from anxiety and even use it to assuage our excitement.

This is doubly ironic, if not more. We watch sport stars perform feats of skill with amazing calm, focus and concentration, while consuming a substance which interferes with our ability to emulate them.

Alcohol inebriation slows our brain function, reducing our competence in activities requiring us to use our brains. This includes practically everything, even sleep.

And, of over the long term, using alcohol tends to fuel our fears and anxieties and lengthen jumpiness after stressful events, whether they end badly or well.

Practice kills nerves
The competence we developed in our jobs and sports mean we are rarely gripped by nerves. Experience teaches us, like professional sportspeople, to know our limits, estimate risk and gauge the chances of success.

Our biggest worries typically revolve around the more haphazard world of our social lives. We often worry about our ability to converse, make friends, find partners and, heaven forbid, give a speech.

We are often first faced with these types of challenges at the same time as we have our first chances to drink alcohol. And they often remain paired thereafter, seemingly inextricably linked.

Alcohol reduces our awareness of distractions which might interrupt our flow, but it does not give us any new skills. We can make fluent, jovial, spontaneous conversation just as well without alcohol. Even dancing is possible.

Social situations which do not enforce alcohol drinking are a help, though not necessary if we can slip under the radar. Like practising penalties, socialising without drinking will eventually bring results.

Liberty includes the freedom to think clearly

Restricting alcohol use can dramatically improve our decision-making, the key to our personal freedom.

Our choice to consume alcohol is often coerced, through social pressure and misleading ideas. And alcohol reduces our ability to assess our options. Continue reading “Liberty includes the freedom to think clearly”