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. ■

Brexit need not be a yes/no question


Having just banged my head on the underside of the kitchen cabinet I was also struck by a brilliant idea: “omni-Brexit”. This is a Brexit which both happens and does not happen at the same time, so keeping everyone happy.

The current model for Brexit, used by both sides of the debate, is based on the premise that leaving the EU is incompatible with staying. This sudden blow to the back of the head made me realise the debate is centred on a false dichotomy: The UK can both leave the EU and remain at the same time.

The key to this realisation is to recognise we are a nation, or rather nations, of individuals who can and should be able do whatever we want. Some of us wish to leave the EU and some remain. All of this is fine. The government should not be there to interfere or prescribe but, instead, provide mechanisms to enable all of our individual choices, all at the same time.

My suggestion for doing so is this: Those of us wanting blue travel documents would simply need to provide evidence of a commitment to minimise their social and economic interaction with continental Europe. More important, perhaps, since we live in the real world, would be to show we genuinely begrudge whatever European dealings we do have.

Once over this hurdle we would have the right to claim a modern new blue Brexit travel document entitling us to be ineligible for a whole range of work, residence, benefits, healthcare, trade in all the remaining 27 EU countries, not including the UK.

Both the private and public sector would be encouraged to provide a range of blue-passport-only-products, like special prices for overseas goods, trade impediments, a new 50p coin and a full country of travel options. Technology, particularly apps, could be relied on to provide new levels of Brexit personalisation further down the line.

Meanwhile, those content to plod on with their one-size-fits-all burgundy travel document could continue to do so. But, before continuing, they would be sent an information pack outlining the consequences of not being ineligible for EU offerings in quite the same way as blue passport holders.

Omni-Brexit, as set out here, offers an open, flexible system with an opt-in, opt-out approach, able to respond to Brexit demand over time. Only those who campaigned for Brexit need be taken as lifelong blue passport holders to ensure a dependable core user-base.

Some details need to be fleshed out, of course, but it is largely a matter of implementation. Far from being an impending national disaster omni-Brexit offers everyonewhether they want to be in, out, or to have a bit of botha real win-win-win solution.

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. ■

We can avoid alcohol’s mental health icebergs

A brain-centred approach will enable millions of us to avoid the alcohol icebergs we know are out there. 

The latest smudge on the radar screen in was made in February by 10,000 extra cases of early-onset dementia lurking in French medical data. Alcohol factored in 57% of them, tripling the risk of all dementias. This mass suffering must be mourned, as is the fact that the risks are not widely known, as I discovered investigating my book Alcohol Companion.

Other investigations are poised to confirm the dementia statistic, which is almost certainly an underestimate. “No surprise,” say many in the psychiatric and mental health professions on reading this week’s dementia statistic. For them alcohol damage is is a commonplace of working knowledge. 

There are more statistical icebergs are out there too, simply waiting to be given wider recognition. There is already an undisputed correlation between drinking more than a little alcohol and depression and anxiety. So too post-traumatic stress, problems with decision-making abilities, cognition, memory and impulse control.

Some of us may know this on paper or have found out from experience, but how many of us really act on what we know? It is already known that drinking no more than 14 UK units (140ml) of alcohol a week will minimise our chances of problems. If we take our mental health seriously, as surely we should, we need to follow this guidance.

Our brains are not just the fall-guy in our relationship with alcohol either, they also initiate it. We drink alcohol because we like how our brains make us feel after, feelings informed by our beliefs. We often imagine it boosts our confidence, our mood and or helps us relax, all understandable ideas, but also inaccurate enough to backfire.

The brain-centricity of this week’s news make it a turning point, but real change will not happen overnight. As if to illustrate, a story ran alongside it peddling the “good news” that alcohol may prolong our lives. No matter, it seems, these reports were slammed by experts in alcohol and longevity as misleading speculation.

But these lapses of collective reason do not spoil the real good news about the path of our relationship with alcohol. The ice has been broken about mental health which has gone from taboo to borderline trendy, with young people drinking less. The internet, for all its problems, has put us in touch with our psychological quirks, both good and bad. And we can inform, organise and support each other better than ever.

There are still formidable alcohol icebergs out there which will come to wider recognition in due course. We can be sure of that. But we also have the knowledge and tools to minimise risk. It can only get better, even if it is sometimes a bumpy ride.

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””

Guest post: Why we should call time on airport drinking

by Simon C Moore, Cardiff University

As the alcohol industry continues to make healthy profits, Britain is left counting the increasing cost of its unhealthy relationship with booze. From overstretched accident and emergency departments to a steady incidence of alcohol-related disease, the cost is massive. The most recent figures reveal that alcohol-related harms cost the NHS around £3.5 billion annually.

And the problems don’t end there. Often the erratic and antisocial behaviour of intoxicated people will have an impact on others. This becomes apparent when walking down any UK high street on a Saturday night, as you dodge obstacles from aggressive drinkers to broken glass.

Alcohol issues aren’t limited to towns and cities, either. Recently, budget airline Ryanair once again called for airports to introduce “preventative measures to curb excessive drinking”, following a flight that had to land unexpectedly when three passengers became disruptive. Airports are places where high security and order are paramount to safety so, really, no alcohol should be allowed whatsoever.

Drunk on board

In recent years, there have been several high profile incidents involving drunk passengers on planes – as well as countless other unreported events. In fact, figures show 387 people were arrested for being drunk at airports between February 2016 and February 2017 – up from 255 the previous year. And a BBC Panorama investigation has found that more than half of cabin crew have seen disruptive drunken passenger behaviour at UK airports.

Problems linked to alcohol consumption in airports and on planes include passengers being too drunk to board, or being out of control on planes. Those who do not board have their bags removed, causing delays for other passengers, while those who board drunk can cause disorder and endanger passenger safety – especially pertinent in the confines of an aeroplane where other passengers can become scared.

Cheers? [cunaplus/Shutterstock]

Drunk behaviour is not just disruptive to other passengers, however. Air travel involves a tightly integrated, complex set of processes and the effects of drunk passengers can impact this infrastructure. The number of professionals required for the safe management of drunks can divert resources away from normal service, potentially affecting security and the safety of other travellers.

Drunk people have reportedly tried to open plane doors and smash windows while in flight. The extent of drunkenness has caused planes in flight to divert so that the intoxicated and disorderly can be offloaded, again affecting all other passengers’ safety and convenience.

Licensing rules

The government is examining how alcohol is sold in airports, but they stop short of banning it altogether. Instead, restrictions have been proposed to end rules which allow airport bars and pubs to operate outside UK licensing laws. Limiting the number of drinks a passenger can have, both before and during flights, would almost certainly bring this number of alcohol-related incidents down, and result in fewer delays and a more secure and pleasant trip for passengers and staff.

It’s not about being puritanical. Choice is important and many choose to make alcohol an important part of many activities, including their holidays. At the same time, choices have been made to ensure the safety of air passengers and to keep flights running on time. Airport and aeroplane staff, given the choice, would probably prefer not to mop up vomit from those who have drunk too much – or worse, potentially put themselves in harm’s way to protect other passengers.

During air travel, travellers are contained in secure areas, with no choice over their fellow passengers. Removing the irrationality of intoxication from such an activity is not the tyranny of the majority, it is simply asking people to temporarily abstain until they reach their chosen destination. Many passengers choose not to drink and, given the choice, families would likely prefer that their children are not exposed to disorderly drunks.

No one has the right to cause harm to others and it is trivial to expect abstinence while passengers make their way to their destination, whether it is an alcohol-fuelled excursion, a family holiday or a business trip. For those who use alcohol to cope with anxiety, there are more effective and safer alternatives. For those who cannot go without alcohol there are many services available to help with dependence.

The ConversationUltimately, the needs of the many must outweigh the desires of a minority who want to “start their holiday early”. ■

Simon C Moore, Professor of Public Health Research, Co-Director of Crime and Security Research Institute and Director of Alcohol & Violence Research Group, Cardiff University This article was originally published on The Conversation. Read the original article.