Covid-19 shows life-saving policies are popular

The effort to control the covid-19 outbreak shows the public welcomes government action to protect life. Politicians might take note when formulating policies on alcohol, responsible for one in twenty deaths.

Billions of us have overnight willingly complied with often stringent laws curtailing our business and social lives, thanks to our clear understanding that doing so is saving millions of lives.

It seems reasonable to suggest that we would also gladly accept modest extra tax, advertising restrictions, and labelling and availability measures to cut millions of deaths, injury and suffering from alcohol consumption.

Far harsher restrictions are in place. Alcohol sales have been banned under lockdown laws in South Africa, Botswana, and parts of Thailand, Greenland and among a native group in Canada. The impact is uncertain.

Alcohol dependents will likely suffer the physical and mental health effects of withdrawal.Some have reportedly died as a result of “toddy” becoming hard to come by in India, largely by their own hand.

Providing support will be more challenging in coming months. Can Zoom support ever really replace a face-to-face meeting? Or might online even attract new people and offer more privacy?

Or will online help miss those who need it most? One former alcohol dependent said in a discussion that being in covid-19 isolation with a stash of alcohol would have been her “happy place”.

Like it or not, we will find out some answers in the very near future. But our exceptional circumstances will also create exceptional statistics, full of “confounders”, making them incomparable with those before.

Road accidents in places where alcohol is suddenly off-limits, for example, are likely to drop sharply. But, then again, there is going to be hardly anyone on the road. So what will the numbers mean?

The first phase of the covid-19 outbreak has shown the public welcomes decisive government action to protect health and we will gladly accommodate them. 

As a species we are adaptable survivors. And we have now shown we welcome advice that helps us survive. We might also use this time to reflect and rethink our priorities and habits.

There is room for a glimmer of optimism we might make the best of this unusually bleak situation. ■

Improv acts fast and goes online

The physical distancing needed to combat covid-19 is prompting improv groups all over to go online to retain its boost to mood, imagination and social connection.

The changeover is itself improvised. Most are using Zoom, a conferencing package which can host and record up to 100 players for $14 a month. Many standard games can be adapted to the new medium.

Enthusiasts in North America, the UK, mainland Europe and elsewhere are all getting to grips with a sudden technology shift, swapping tips and finding out what works best to keep the show on the road.

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. It is online as well as off.

Early online experiments with my own group have been modest so for. But they have revealed notable performances of Batman and Melania Trump and that it is still entertaining and inspiring.

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’s secret lies in risk and teamwork. If a teammate dries up 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, before covid-19, as a bathtub walks to the wings, I managed a solo, bent second-class train ticket from Birmingham New Street to Liverpool. Though far from completely convincing, it passed inspection.

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.

Putting improv online at short notice is unlikely to go 100% smoothly. But, if improv teaches us anything, it is that it is worth cooperating to make the best of a difficult situation. ■

A coronavirus ethos can help with alcohol

The challenge of changing our behaviour to slow the spread of coronavirus offers valuable clues about how we all might help reduce the harms of alcohol.

There are those aspects of coronavirus aware behaviour adults must master alone, like washing our hands or the remarkably challenging feat of not touching our faces.

But the most difficult ones for coronavirus are the social ones: turning down invitations, spurning warm hugs, gleeful handshakes, high-fives and knuckle-bumps.

Reducing alcohol use can be a personal struggle too, with the urge to use it to sooth ourselves or lift our mood often heightened by withdrawal symptoms. But the social aspects are even harder to halt.

We might need to pooh-pooh a pub visit, if the environment is hard for us. We might need to say no to a drink or, maybe, explain our choices to people doing exactly the opposite.

It is awkward and difficult, all of it, particularly to begin with, but it is possible. We may miss our old habits, but we can grow fond of alternatives which serve the same purpose.

We can see why invitations have to be declined. And we can learn to greet one with namaste, or foot-bump, bow or alcohol-free beer, or whatever other hygienic greeting we can devise.

In both cases we are adaptable creatures able to combine science, flexibility, imagination and empathy to reduce the harm we do ourselves and to others. 

Video: Meet the 170-year-old sobriety movement

The current wave of attention might make it seem like tackling alcohol harm is a new thing, but far from it. Movendi International has been working in the area for nigh-on 170 years, with a name change from IOGT last month the latest evolution. Its president Katarina Sperkova talks with me here about the organisation’s legacy, its values, policies and hopes for the future.

Key points:

  • “We can see a boom in coming out as a person who has a problem with alcohol and being confident in talking about it.”  [1m47s]
  • Reasons for the name-change: “There are very few members in the organisation that understand what a ‘good templar’ is. They have never been part of any order.” [4m15s]
  • “IOGT [the name adopted in 2006] was difficult to explain. … People were asking what it is? We didn’t have any good answer. We really needed to move away from that name.” [4m57s]
  • On the use of ritual and regalia. “I have never experienced it as a member and I have been active in the organisation since 1999.” [6m29s]
  • The number of member organisations with such practices “I would count them on one hand” [6m51s]. The practices are important for them as part of a recovery process.
  • On being an umbrella organisation: “We are not taking active steps in finding individual members.” [10m13s] It might assist in creating an organisation when one does not exist.
  • The situation in the global south, “It reminds us very much of the situation in 1851 in the US [when Movendi began].” [13m43s]
  • 14 out of the UN’s 17 sustainable development goals are “negatively impacted by alcohol harm”. [16m57s]
  • Areas where it has a negative impact are: Poverty, gender-based violence and sexist advertising undermining gender equality, access to water.
  • What does “alcohol prevention” mean in the organisation’s catchline? “What we are talking about is to reduce harm caused by alcohol, or prevent harm caused by alcohol. … It is definitely not a prohibitionist term.” [20m16s] 
  • The phrase also includes recovery because people who recover “create alcohol-free space”, which influenced people around them. [21m54]
  • “We do not interfere in people’s personal choices. What is important for us is what a society offers to people.” [22m50]
  • Have we got another 170 years of this same story? “I have a very strong belief this is about to change. … I think it has already changed.” [25m17s]

Dry January is a vital part of the alcohol debate

The difficulty of putting a lid on our alcohol drinking for a month or more provides us with important understanding of alcohol and the often bewildering public debate around it.

How can we understand the impact of advertising, taxation tweaks or the complex interplay of mind, body and environment? The answer is, by experiencing them ourselves.

Having an ad for our favourite tipple pop up just as we managed to ignore the urge to pour ourselves one helps us understand how advertising stimulates alcohol demand.

The effort we need to make to swerve the alcohol aisle in the supermarket or the offie shows how availability is a challenge to those wanting to limit their consumption.

How can we understand the social pressures to drink alcohol without at some point trying to rebuff the alcoholic ribbing of our friends, family and colleagues?

Opening our wallets to find folding money in there on Sunday morning shows us in no uncertain terms that increasing alcohol prices increases the incentive to cut down.

So it is that Dry January, and all similar short-term quitting initiatives, offer valuable first-hand insight into the key elements of the policy discussion around alcohol.

It allows us to feel first-hand the challenges faced by anyone looking to reduce their alcohol intake, difficulties experienced most intensely by those of us most deeply affected.

Dry January and the like establish a valuable common ground of shared experience which can inform an often off-putting discussion which, nevertheless, has huge potential to improve health and well-being.

The exercise of quitting alcohol, albeit often temporary, connects a personal assessment of the benefits of changing our own alcohol habits to something far wider.

A DIY quitting exercise was fundamental to my writing. Alcohol’s complex challenges need to be tackled with empathy as well as analytical thought.

Wider understanding provides the platform needed for informed alcohol policy. Dry initiatives go a long way towards informing us on every level. ■

Alcohol: Why not all use millilitres?

We could make alcohol health guidelines easier to picture, calculate and compare internationally by giving them all in millilitres.

We measure oil, water and every other liquid in metric units, so why use 20-odd different units for alcohol?

It is like a throwback to the bygone days in which Europe operated on a bewildering array of measurement systems.

An account of a medieval journey might mean converting the Finnish virsta (Russian or Swedish) to the Rheinland miele

This week’s new proposed weekly guideline of saw us scrabbling for the definition of the “Australian standard drink”.

Once converted to 125ml it could be compared easily to the UK one of 140ml, itself normally given in local units.

Offering it to begin with in millilitres would avoid this process, allowing consumers and nerds a ready-made comparison.

It would make recommendations more intuitive too. We can imagine 100ml far more easily than a bespoke unit.

The volume of alcohol is a good guide too, giving a direct picture of the number of molecules it contains, so its effects.

Using millilitres as a standard means only needing to do a one-step calculation to work out a dose, not two or three.

The alcohol present in a drink is just a drink’s alcohol percentage by volume multiplied by its volume. That’s it.

So, for example, in 500ml of 5% beer there is 0.05x500ml of alcohol, or 25ml. 

One large continental lager is, then, a fifth of the Australian weekly low-risk guideline total of 125ml.

Using alcohol specific units, by comparison, we might have two more stages, perhaps converting to mass on route.

We need not drop local units, which some may find helpful, but we could easily add the equivalent amount in millilitres in brackets.

This would be a simple way to reduce barriers in a field in which international cooperation is essential. ■

Little or no alcohol is a good move for our mental health

Consistently drinking little or no alcohol is a solid foundation for our mental health. So why don’t we say so?

Alcohol worsens and causes common aggravations like low mood and anxiety, while prolonging our recovery from traumatic events. So why would we make our lives harder?

There is not a one-size-fits-all alcohol guidelines for mental health, but the UK’s low-risk guidelines of drinking no more than 14 units (140ml) a week is, perhaps, a reasonable starting point.

Avoiding drinking entirely can be easier than trying to drink little. So a “sober sprint” like Dry January could be a good way to begin a long-term low-risk drinking lifestyle.

Finding our bounce
Developing an ability to cope with life’s slings and arrows of outrageous fortune without drinking alcohol tends to be better for our mental health in the long term.

Drinking alcohol has the opposite effect, worsening our mood and increasing our anxiety, although it may seem otherwise. This misleading impression can make it hard to go without it.

This misconception can mean we drink heavily when we suffer more significant traumas, and this may mean we start developing side-effects when we are alcohol-free, including low mood and anxiety.

Drinking more than a small amount of alcohol increases our chances of suffering more psychological discomforts. We are all likely to feel better for reducing this risk.

Drinking little or no alcohol is the best way to spare ourselves such needless mental anguish in the long term. This applies to everyone, regardless of our current drinking habits.

Lost in vaguery
This simple message is seldom clearly expressed. We tiptoe around it rather than simply telling people a simple fact which might spare them discomfort.

Counsellors and other caring professional are often loath to say it to clients, though the reasons for this reluctance are not easy for an outsider to understand.

Some say they do not want to “label” their clients, something they prefer to leave to the medical system. Perceived labelling, they say, would imperil the client-counsellor relationship.

There would also be, one counsellor says, legal risks to giving such advice too. Instead, then, counsellors prefer to point clients with alcohol worries to their GPs.

But patients often do not want to talk to their GPs. And GPs too can be squeamish about talking to their patients about our alcohol drinking, again for fear of dropping a clanger.

Put it straight
Wariness is understandable. But sensitivity should not get in the way of relaying simple information that can help us. The stigma around this advice is born of misunderstanding.

Observing that little or no alcohol drinking provides us the most reliable platform for better mental health applies to us all, regardless labels. ■

Alcohol education is essential

Knowledge is necessary to inspire, shape and sustain positive change, with its dissemination providing the conditions for this change to occur. Alcohol is no exception.

We cannot require anyone to learn about alcohol, no more than we can require them to learn about physics or the Brontë sisters, but everyone should have the chance.

An accurate understanding of alcohol based on scientific research offers a solid basis for us to safeguard our wellbeing, both as individuals and as a society. 

Regulating alcohol prices, availability and ads are more effective as direct interventions, but education is necessary for these measures to be designed, justified and accepted.

Increasing the alcohol knowledge base of politicians, citizens and the media are preconditions for the implementation of effective alcohol policy. 

An asset for individualists 
A coherent understanding of alcohol is far better for us as individuals than relying on traditional rules of thumb, enabling us to avoid a wide array of misfortunes.

Those informed about alcohol can help themselves and others to avoid mistakes. Informed people can better help those who suffer alcohol harm and become a positive influence.

An understanding of the reasons for guidelines and regulations makes them far more likely to make people take heed than blind trust or irritation born of confusion.

The effects of alcohol are inherently misleading. We are bombarded by misleading ads with flimsy regulation and alcohol industry-run information platforms.

Inaccurate beliefs are therefore common, just as they are in stock market bubbles and politics. Grassroots education is the only way to put a lid on the spread of misconceived ideas.

Underpinning change
Financial education does not provide a safeguard from financial mistakes, but it does make us justifiably wary and recognise the benefit of robust regulation.

And, should we fall prey to financial misfortune, we can find the financial knowledge we need to understand what went wrong and how to avoid it in future.

Reliable alcohol knowledge can fulfil a similar role, helping to improve the lives of those who embrace it, for next to nothing, and enabling us to make the best of mistakes.

Alcohol education does not offer immediate, measurable payoffs, but a lack of understanding rarely has positive outcomes in any other area. Alcohol should not be shrouded in mystery.

Education ranks low on the policymakers’ alcohol to-do list, but it still remains vital to achieving a less harmful relationship with alcohol long term.

Learning about alcohol, a topic with enormous social, psychological, economic, health and political reach, can help us engage more fully as citizens as well as students. ■