Guideline labelling’s welcome return leaves open question

Health minister gives UK the alcohol industry until September to introduce health guideline labelling

I have joined calls for official health guidelines to appear on all alcoholic drinks labels since revealing that they had been dropped from the UK’s voluntary code in my reporting in late 2017.

So it is welcome news that the government is pressing for the official guidelines to return in September (see video), albeit two years after they were quietly dropped.

It seems extraordinary that robust, scientific information about the safe consumption of a product could ever omitted from packaging, so undermining our right to make informed choices as consumers.

If official health guidelines do reappear on labels in September, as the government hopes, some can be forgiven for looking back and wondering whether self-regulation is an effective way to safeguard consumers?

The responsibility for such concerns about the current system of regulation lies with the alcohol industry. ■

The key alcohol theme of 2018: dementia

Dear Reader

This year offered a steady stream of confirmation of the merits of low-risk alcohol drinking, reckoned to be less than 14 UK units (140ml) a week.

There was also welcome reassurance that not drinking alcohol at all, which many find the easiest form of low-risk drinking, comes with no added risk.

But the biggest news was confirmation of a massive underestimate of alcohol as a factor in dementia. This too was followed by confirmation that low-risk drinking should spare us from it.

It is a discomforting finding, no doubt. But it also offers hope that changes to our drinking habits can spare millions from mental health problems, as I wrote here.

Thank you for your support over the last year. I wish you a happy New Year’s Eve and a great start to 2019.

Yours faithfully

The upsides of improvising

Acting on-the-hoof almost invariably leads to the outrageous and absurd, as politicians have ably demonstrated, but improvising for on an amateur basis is enjoyable and rewarding.

Google, PepsiCo and McKinsey have accepted improv theatre classes can help pep-up employees’ communication skills and teamwork. And it seems likely to help our mental health and substance use.

Improv groups are springing up all over the place, making it easy for anyone who wants to give it a try. Go online and you will find sites offering exercises, games and directories of local groups.

The secret lies in being ready to take a calculated risk. If a teammate dries up during a scene we have to be ready to jump in and take over without knowing what it is we are going to do when the action restarts.

Accepting this is hard. I, for one, am far more used to holding back in the face of uncertainty. Settling for the first thought that comes to mind is very uncomfortable, or possibly I should say “anathema”?

But it also makes sense. If we were to abandon our teammates to the merciless spotlight, we too may soon find ourselves alone, helpless, blinking, mind blank, dry-mouthed, will to live leaking away.

Funny warm-up games are key to coming good with this, breaking down barriers to making a selfless save, while also helping with listening, timing, attention, spacial awareness and short-term memory.

So, as a bathtub walks to the wings, I manage a solo, bent second-class train ticket from Birmingham New Street to Liverpool. Though far from completely convincing, it passed inspection.

And working as a group we learn methods to create impromptu scenes, establishing characters, their relationships, a location and goal. The trick is to add and not subtract, the dictum being “Yes, and…”.

We often shy away from taking harmless risks in real life. So, doing it for fun is helpful, not least because more often than not it works out. And the chances of success increases with practice.

It also helps to learn it is not really a disaster when something does not work smoothly. And it can even be better. Yes, and… there is always a way back, typically thanks to timely assistance from our teammates. ■

Millions readying for Dry January 2019

As many as 4.2m people are planning to go alcohol-free in January 2019, according to a YouGov poll, being on course to enhance their drinking choices all year round by doing so.

“Dry January can change lives. We hear every day from people who took charge of their drinking using Dry January, and who feel healthier and happier as a result,” said Richard Piper, head of Alcohol Change, the charity behind the initiative.

A survey of 2018’s participants, reckoned to number over 3m, found: drinking fell from an average of four days a week to three; drunkenness fell to twice a month from three times; eight out of ten felt more in control of their drinking; nine-in-ten saying they saved money.

People can sign up for Dry January online, receiving support from a website, app and a new book on taking a month-long alcohol break, called Try Dry.  ■

Be wary of “persistent hangovers” this Christmas

Feeling crummy more than a day after an alcohol session this Christmas 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.

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” this Christmas”

Dry January lets us see the benefits of low-level drinking

“Sober sprints” like Dry January are a chance to experience the many payoffs of low-level drinking to ourselves and others, transforming them from abstract knowledge into a practical method for improving our mental, physical and financial well-being.

A scientific outlook, and the healthy scepticism that goes with it, are no reason to ignore the need to form beliefs we can apply. Such beliefs provide us with a rugged, reliable and reassuring guide, like a pocket compass.

Some important science does not need to be kept so close at hand. This has little to do with its scope or even its complexity. It has more to do with the demands our belief in it places on us.

Accepting the sun-centred view of our galactic neighbourhood or the mind-boggling basics of quantum theory require an enormous leap of the imagination, but our belief they are true is rarely tested.

Few doubt the sun will rise tomorrow, because this scientific likelihood simply reinforces our experience. And we are unlikely to come to much grief if we occasionally imagine the sun going round the earth or that photons are particles and not waves.

Small wonders
Keeping a firm grip on earthbound, everyday findings is a far bigger challenge for us. The more humdrum the topic, the more difficult it can be, and no more so than when the subject is what we choose to eat, drink or smoke.

We connect with these subjects physically, emotionally and socially, forming an intimate relationship managed by our astronomically complex brains. The statistical results of understanding this relationship often confound our intuition.

As self-centred animals we are fairly hopeless at connecting with statistics, a type of scientific result especially open to manipulation. And, given a choice, we will tend to believe our senses over numbers on a chart.

But the solid statistical evidence of the long-term harm of, say, trans-fats, alcohol or tobacco smoke require us to alter our behaviour or they are are no use at all. We need to embrace beliefs that allow us to benefit.

Beliefs provide the motivation to be wary of tempting forbidden fruit and are even more helpful because we may initially suffer for heeding scientific advice, as we do with nicotine or alcohol dependency.

Truth endures
It may seem to be an impossible to establish facts in our argumentative “post-truth” world. But in the case of alcohol, about which I write, appearances belie broad agreement.

It is hard to maintain a low alcohol intake. Beyond this it fuels anxiety and depression, interferes with sleep and memory, increases the risk of heart and liver disease, cancer and contributes to all manner of accidents and blunders.

Science also indisputably shows there is an effective remedy to minimise alcohol-related problems, one offering large financial, emotional and health returns: to moderate or, more simply, to stop drinking alcohol.

Believing any initial suffering is common, will disappear, and be rewarded makes any hardship far easier to endure. So the dramatic, scientifically-recorded improvement of tens of thousands of people who have done it already is immensely reassuring.

More broadly we might look to evidence that sacrificing the euphoria-on-tap we can get from alcohol tends to help us achieve robust, long-term happiness. Happiness, as people experience it, has been found to be distinct from euphoria.

It is not always easy to do what science says is best for us, especially when people try to deter us. Having scientific beliefs at hand, like a pocket compass, makes it far easier to stay on course. Sober October offers a chance to develop them. ■

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. ■