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. ■
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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.
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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.
Ultimately, 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.
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. ■
UPDATE: Ireland: WTO alcohol labelling trade obligations met
Ireland’s health department says it has met all its obligations under World Trade Organisation rules over the health labelling requirements of its alcohol bill.
The US government’s trade agency recently said it had asked Ireland to notify the World Trade Organisation about its health labelling plans so as to comply with the organisation’s Technical Barriers to Trade Agreement.
“We can confirm that all obligations under WTO in relation to the Public Health (Alcohol) Bill have been met by the Department of Health,” the department told Alcohol Companion.
“Ireland intends to notify WTO Members of all amendments made to the Bill at the earliest opportunity, ie once all amendments have been made.” ■
Minimal alcohol drinking linked to longer life
Our life expectancy is lower if we drink more than 125ml of alcohol a week, according to new research.
“Drinking alcohol at levels which were believed to be safe is actually linked with lower life expectancy and several adverse health outcomes,” says Dr Dan Blazer from Duke University, a co-author of the Lancet study.
The decline in life expectancy was found to start slightly below the UK’s guideline maximum amount of 140ml, or 14 UK units, a week. Guideline maximums in Italy, Portugal and Spain are almost 50% higher, while the US one for men is nearly double.
The lives of those who drank 125-250ml a week were shorter by around six months over the age of 40. Those who drank 250-438ml lived between one and two years less, while drinking beyond the top end of the range typically cut lifetimes by between four and five years.
It strengthens evidence, the authors say, that “total cardiovascular disease risk is actually comprised of several distinct and opposite dose–response curves rather than a single J-shaped association”.
Higher alcohol consumption was associated with a higher risk of stroke, heart failure, fatal hypertensive disease, and fatal aortic aneurysm, with no thresholds below which lower alcohol consumption stopped reducing risk (see chart).
But higher consumption was also associated with a lower risk of non-fatal heart attacks, or “myocardial infarctions”. The authors say, however, that the increased risk of having fatal heart problems means we are likely to lose years of life if we were to drink alcohol to ward off non-fatal problems.
“The key message of this research for public health is that, if you already drink alcohol, drinking less may help you live longer and lower your risk of several cardiovascular conditions,” said Dr Angela Wood, lead author of the study from Cambridge University.
Non-drinkers were excluded from the study, because we often stop drinking when we develop health problems, so skewing the numbers. The study also excluded people with pre-existing heart conditions. ■
Alcohol: Go easy on the amygdala🗼
Fear is often our friend, but alcohol makes it more difficult to quash unhelpful worries and so prolongs the ill-effects of our misfortunes.
Our sophisticated brains learn to make us wary of many things: speeding cars, public speeches, deadlines, double-dip recessions, emails from the HR department and letters delivered in brown window envelopes.
These connections are sometimes born of painful first-hand experience, but our intelligence also allows us to skip personal demonstrations and pick up our fears second-hand, from stories and images.
This pairing seems to happen in the amygdala, two almond-shaped structures buried deep in our brains (pictured). They specialise in linking emotions to memories, so informing our impressions and decisions.
Combining feelings with rational thoughts allows us to navigate the world better. Nervousness will tend to make us shy away from things which might harm us, while good vibes will attract us to positive things.
This interplay allows us to adapt to the demands of our surroundings. In the Australian outback it makes sense to fear spiders more than brown envelopes. In others places it makes more sense the other way round.
Activating our alarm bells helps us heed good advice, find objects and social connections which might benefit us, or give appropriate weight to warnings or more complex arguments.
But sometimes it goes wrong and we can be fearful of things which we needn’t be, like European spiders or clowns. A mixed up amygdala may underlie many of our most common mental discomforts.
Sometimes these are merely an inconvenience, but they can also undermine our lives by making us feel generally anxious about things, feel the after-effects of a troubling experience long after, limit our range of choices or underlie poor decisions.
Managing our fears productively is not a sign of “character”, as we have often been brought up think, based on traditional ways of looking at ourselves. It has more to do with the way our amygdala are working.
Taking care of our amygdala rather than our characters is a better way to benefit from the emotional aspect of our thinking. Doing so is a choice which benefits us and others besides.
Looking out for amygdala
We might look at ways to look after our amygdala. We can recognise the burden they take and allow them to adapt and recover, like emotional limbs, with their strengths and limits.
Alcohol drinking is no help to them, though long used to allay anxieties, from snarling pitch battles, to interview rooms and first dates. We have often used it to get over the aftereffects of stresses too, a hard week at work, defeat or nasty shock.
But, while drinking alcohol provides almost immediate relief from feelings of tension, it prolongs the nagging emotions we might feel after. It seems to hinder our amygdala in attaching the right feelings to stressful experiences.
Nevertheless, perhaps three quarters of Brits over 30 use alcohol to relieve stress with those of us who do being more likely to drink every day. If we keep it up for long enough we will develop a dependency, which shows itself in a range of ill-effects when we are not drinking, a long list which ironically includes anxiety.
Alcohol is no better when we encounter big problems than routine ones either, although we are often tempted to drink more than normal after a job loss, accident, breakup or some other unusual trauma.
But heavy alcohol use has been linked to post-traumatic stress disorder (PTSD), where our fear response does not turn off after a fearful event. Rats plied with alcohol continue to flinch longer after a threat is gone.
Rats made alcohol dependent in the lab tend to be more timid than ones which have not, preferring to stay in less-expose parts of their environment. This anxiety might also give former dependents a motive to go back to drinking.
As with rats some of us seem to be more prone to drinking in response to stress than others. We might look at our relatives for a hint on this, but it is not uncommon. A more easily identifiable high-risk genetic group for drinking to alleviate stress is men.
Enduring stress, particularly the intense discomforts of trauma is difficult, even agonising, but it seems our amygdala have evolved to recover better if we do so without looking for temporary relief from alcohol.
Laying off alcohol can leave our amygdala working better. For those of us who have developed a dependency it might take between three months and a year, although there are benefits along the way and after. In the end there is less to be afraid of. ■