Data from mid-July showed a total volume of 1.3bn litres of alcoholic drinks were bought in shops in the first 17 weeks of lockdown, compared to 2bn litres in the same period the previous year. This is a 35% fall in the total volumes of alcoholic drink bought compared to last year. But this may overstate the fall in alcohol retail purchasing, because we tend to consume more wine at home than beer, so getting twice or three times the amount of alcohol per litre. So, for the statistically inclined, here are some figures on sales volumes growth by drink type, which should allow the calculation of an estimate of alcohol volume purchased. This story will be updated with any resulting analysis. ■
It’s a well-known fact that drinking too much alcohol can have a serious impact on your health, including damaging your liver. But how much is too much? For conditions such as liver cirrhosis, that’s usually more than 21 units of alcohol a week – around two bottles of wine a week or one and a half pints of beer a day. The UK’s Chief Medical Officer recommends that adults don’t drink more than 14 units of alcohol a week to keep the risk of health problems low.
However, the liver isn’t the only organ that can be damaged by drinking – the brain can be damaged, too. Drinking over the current UK low-risk guidelines is associated with an increased risk of dementia. And a recent study, published in Scientific Reports, found that even moderate drinking is associated with decreased brain volume.
The researchers in this latest study looked at 300 people between the ages of 39 and 45 to understand the effects of drinking on the brain. Most people in the study reported that they drank at what was considered moderate or low-risk levels (an average of less than 14 units of alcohol a week). Even at this level, there was a reduction in the amount of total brain tissue seen on brain scans. This held true for men and women when other risk factors, such as smoking, were considered. Their brains were compared against a reference model of average brain volume.
Although the study didn’t look at the physiological impact of brain tissue loss, any significant loss of brain tissue will reduce the brain’s ability to function at an optimal level. Though the adult brain shrinks slowly with age, the earlier the loss starts, brain shrinkage is likely to be accelerated by other medical conditions, such as high blood pressure and diabetes, that may arise in late middle age and later life. This is important, as we now know that some of the early signs of brain damage from alcohol can be partially reversed after abstinence. Which has been seen as early at six weeks after total abstinence – more in the frontal lobes of the brain, which play an important role in regulating behaviour and our thinking.
These findings are similar to those of an earlier study which found that drinking between seven and 14 units of alcohol a week was associated with a smaller brain size. This level of drinking was also associated with poorer performance on skills that involved recalling memorised words on demand.
Frontal lobe damage
When we study the effects of alcohol on the brain, we naturally focus on dementia. This inevitably means looking for memory changes. After all, a diagnosis of dementia relies on memory loss. But we now know that the brain’s frontal lobes are actually damaged by alcohol at an earlier stage than those parts of the brain associated with memory. The frontal lobes control our personality, behaviour and ability to think flexibly. These skills are not assessed by tests commonly used to diagnose dementia.
But drinking in a way that the general population believe to be sensible and moderate might be slowly damaging our brains. Given this, we need to be better at detecting damage at an earlier stage. Luckily, a eight item test can now detect cognitive impairment early on, and is used routinely by specialists in mental health services to detect brain damage from alcohol in its early stages. Other tests of frontal lobe function can also be performed in hospitals or general practices.
The discovery that alcohol has the potential to damage our brains at levels at which we might find surprising and in ways that are not usually detected, has major implications for our society. For example, baby boomers (people now aged between 55 and 74) have shown the sharpest rise in harm from alcohol compared with other generations and previous generations of the same age. They are also at higher risk of dementia than younger age groups.
If we are to tackle the problem, we need to change both attitudes to drinking and in how we deliver healthcare. Changing drinking behaviour in older people needs to be accompanied by picking up the early signs of brain damage for all those who drink alcohol.
Progress has been made in asking older people about their alcohol use within both public health and mental health policy. But this not yet happened for the detection of brain damage in people who drink alcohol. Giving equal importance to both our brain and our liver can help us stay in better health. As a society, we have the potential to take care of both these vital organs.
Cutting down the amount we drink or giving it up altogether can reduce our risk of brain damage. But this can only happen if we also maintain a lifestyle that includes a healthy diet and exercise. ■
Recommendations for alcohol and other drugs from Professor David Best of Derby University based on evidence he outlined at yesterday’s NHS Addictions Provider Alliance conference:
- Get specialist help if you need it, including to deal with any trauma or long-term psychological health problems
- You can rely on peer support. It can be but it doesn’t have to be mutual aid groups like AA or NA [Narcotics Anonymous]
- Move away from using friends and find social groups that do not include alcohol
- Do things—sport, education, hobbies—they build your social networks and your self-esteem
- You can help yourself a lot by helping others
- Be optimistic—you will get there—most people do
It is not surprising people see overcoming their alcohol problems as a great liberation, because alcohol can undermine every form of freedom ever conceived.
My list of ways alcohol can do this to every idea of freedom developed over the last 350 years is “impressively comprehensive” says revered intellectual historian Professor Quentin Skinner (pictured), adding that the question is “very important”.
I would like to pretend this amounted to some major intellectual achievement, but I cannot. I simply overlaid my working knowledge of alcohol’s effects on to Skinner’s “genealogy of freedom”, an overview of the ideas of freedom in play over the last few centuries.
Politicians and commentators often talk with impressive certainty about what freedom is. But, in reality, there is no such certainty to be had. It is all rhetorical bluster, often with the goal of achieving selfish ends. Freedom is an elusive idea which nobody can dictate.
What freedom means is a matter of personal preference and discussion. There is no absolute right or wrong answer. We need to weigh up the options and choose the account we think best. Skinner’s genealogy lays out the enormous range of coherent alternatives open to us.
“These are all just vocabularies,” says Skinner, who favours a pragmatist approach to choosing between them. “The question we should be asking ourselves is: Which one is going to go deeply into our society and do the most for us.”
Despite the huge range of coherent, sophisticated accounts, incoherent and potentially harmful accounts still abound. The freedom to tote guns, not wear a face mask in a pandemic or to purchase alcohol unhindered are unlikely to serve us well.
Beware self-serving dogmas
Alcohol sellers, as one might expect, simply champion a version of freedom which suits them, damning anything which impedes sales and implying that alcohol is inherently liberating to boost sales.
It is unwise to take this self-serving account seriously. We need to be able to think clearly to benefit from every form of freedom ever devised, with regulations there to help more of us do so.
Logic goes out of the window in likening lower US guidelines to “stealth prohibition”. It is an absurd exaggeration to suggest medical guidance even amounts to coercion, let alone a bygone legal bar.
Following the same approach we might portray the posting of a sign saying “mind the step” as first stages in a banning free movement. It uses the rhetorical power of an idea of freedom to protect a commercial interest.
The goal is not a meaningful discussion but a distraction from it. Thankfully there remain many genuine and coherent ideas of freedom to choose from intended to serve human goals rather than commercial targets.
Real accounts of freedom
Over the past three-and-a-half centuries formulations of freedom have fallen into three main types, according to Skinner’s genealogy (below): not having outside interference; not being answerable to arbitrary power; and in self-fulfilment.
Thinkers and countries shift from one school of thought to another, as did JS Mill to defend women’s rights and the US since its foundation. We need not be any more wedded to a single vocabulary. Some ideas of freedom might work better in some areas of life than others.
To figure out which view suits us, it may be useful to look at the consequences for different areas of life, say family, education or health, for instance. And we could also be usefully be aware of what threatens them, since the price of freedom is eternal vigilance.
My rough shortlist of ways alcohol threatens every formulation of freedom so far invented includes:
- Alcohol dependence can put us under the arbitrary power of alcohol suppliers, so making us unfree in the “republican” tradition.
- In the “no-interference” liberal tradition, our freedom is undermined by coercion in the form social pressure, advertising and withdrawal.
- In the same tradition alcohol also acts on our selves to arguably induce innauthenticity, impaired judgement or false consciousness.
- In the traditions of self-realisation alcohol inebriation, dependence and withdrawal may undermine our chances of realising our spiritual or political natures.
We do not need to exclude alcohol from our lives or societies to be free. But we would benefit from awareness that the commercial exploitation of an addictive psychoactive poses a threat to freedoms we may cherish.
Positive alcohol experiences could also be included in the picture too. Alcohol’s sedative effect may aid forms of self-realisation, allowing us to see the upside of being less uptight, perhaps finding it also without alcohol.
A debate we need
What adds and detracts from our freedoms is something we have to decide for ourselves. It has been discussed for centuries and the debate has never seemed more important. Science, society, technology, nature and our fellow humans are creating new threats and new opportunities.
New forms of demagoguery, authoritarianism, geopolitical rifts, pandemic, social division, deception, coercion and censorship threaten freedoms we value. We should be as clear as we can be about what these freedoms are and what they are not so we can defend them effectively.
Alcohol offers a warning that we can lose our freedom without realising it, perhaps partly because we seldom stop to think what it is. It also reminds us that, while freedom can be easily lost, it can also be rediscovered. ■
With the US celebrating its political independence and the UK the reopening of pubs tomorrow, July 4th, it is worth remembering that it is our capacity for clear thinking which underpins our personal freedom.
Alcohol reduces our ability to make good decisions, while our decision to consume this mind-numbing substance is often made on the basis of coercion or misguided expectations.
In many situations we may expect immediate penalties for not drinking, which can seem like a mandatory entry-ticket for full social participation.
And, once across our blood-brain barrier, alcohol influences our decisions in ways we can only be partially aware of while experiencing our own alcohol-influenced thoughts and feelings.
Inebriation slows our brain activity, so reducing our brain’s role in informing our actions. From the inside, however, things seem to speed up. Our fate is left more to luck.
The gamble can sometimes pay off, sometimes not. About two in every five prisoners says they were drunk when they committed the offence which led to their abrupt loss of freedom.
Alcohol also often triggers brain responses which make inebriation seem to have great significance, making us more inclined to repeat it. We cannot be relied on to realise.
Alcohol also increases anxiety, mood and interferes with sleep, while we commonly feel the opposite. So we can easily find ourselves spending undue resources on consuming alcohol.
Heavy drinking can make our brains misfire sober, meaning we feel tense, forgetful and gloomy between sessions. Dementia and mental health problems are far more likely.
The discomfort of sobriety when alcohol dependent makes escape an ever-more attractive option. This is why we might spend our last few pennies on barely-drinkable budget brands.
Freedom is about more than the freedom to buy things. To be free we need an environment in which we are spared from harm, including damage to our mental capacity.
Commercial restrictions and timely and accurate information can help us avoid alcohol harm and in turn reducing our chance of other harmful errors.
Clarity before commerce
Our freedom to shop should not outweigh our freedom to think clearly. We would not champion our freedom to lock ourselves out of our own house, though it is among our freedoms.
A notice reminding us, say, to remember our keys before going out, or warning us of a blind bend are not oppressive. Similarly alcohol warnings are no infringement of our freedom.
Nor is it oppressive to withhold instruments used almost exclusively for self-harm. Minimum alcohol unit pricing, on trial in Scotland, may to be found to do exactly this.
Alcohol drinking can be pleasurable, but it also underlies many mistakes, small and big. Preventing these does not diminish our freedom to be spontaneous or take risks.
Measures to curtail heavy alcohol use can help share freedom’s benefits more widely. They are keys to greater freedom. ■