There are maybe 770,000 part-time and full-time jobs connected with alcohol business in the UK, according to an IAS estimate. And there are about 638.000 people who are alcohol dependent, meaning they experience side effects when not inebriated. ■
alcohol
Enhance anything by never pushing
Western culture makes a fetish of strenuous effort. Put in lots of effort, we are told, and we can reliably expect cracking results. I, like a lot of people, was brought up to believe it. Media reinforce the idea. But it is not true.
Many of us often work extremely hard and get very limited results in return. What we invariably get, however, is fatigue. Over the long term we often get chronic fatigue. We also increase our chances of injury and becoming jaded.
We also boost the chances we crave relief from the pain and strain we have induced. Enthusiastic efforts to improve our health can lead us to look for relief using alcohol or in other counterproductive ways.
I was brought up to be a firm believer in the try hard ethos. Whether it was memorising irregular foreign verbs or running round a playing field until we puked. It was all quite unpleasant, but rest assured the pain would have a pay off.
There is something to be said for seeing where our limits are and experiencing what happens when we reach them. It is instructive, but constantly pushing our gauges into the red is a flawed long-term strategy.
Real achievements typically emerge from steady, sustainable and enjoyable effort. Bodies strengthen, but they take time. Books, academic papers and brick walls take shape, but not thanks to an afternoon of frantic exertion.
Willing ourselves to regularly hit our pain thresholds can induce endorphins that soothe strain and stress. But over the long term this can backfire when we no longer want to endure discomfort simply for a painkilling payoff.
My own experience was that I became tired of the satisfaction and reward of enduring things as an end in itself. Eventually I found what Chinese philosophy calls wu wei, a slippery idea one might say means “never pushing”.
The idea is to never strain oneself. One should look at ways to sail rather than row to a destination. Rather than giving oneself a pat on the back for labouring, one should focus on technique, reducing effort and enhancing enjoyment.
It is an approach that can be well embodied in some tai chi classes. If you feel any pain or strain you are told to stop moving quite so much. The lesson for an inveterate try-harder is stop trying so hard, progress will come anyway.
I did no more than the tai chi basics, but “never pushing” works with anything. I swam this way for three years. I was never injured, tired or stressed and was able to enjoy every minute. I emerged far stronger and with technique improved.
The ultra low intensity meant there was no pain or discomfort during or after. This meant there was not the slightest temptation to self-medicate with alcohol or anything else. Swimming itself became a longed-for stress relief.
Making never pushing and enjoyment the key parameters of success make activities themselves the rewarding relaxation it should be. Well-being not effort is the most reliable basis for progress. ■
Trying to cut back on alcohol? Here’s what works
by Nicole Lee, Curtin University
With everything going on over the past couple of years, many people have changed their drinking habits.
We’ve seen an increased demand for support, suggesting more people are trying to cut back or quit.
There are so many options for cutting back or quitting alcohol it’s hard to know what will be most effective.
What works depends on how much you drink
Most people successfully quit or cut back their alcohol consumption on their own.
People who drink more frequently are much more likely to have symptoms of dependence and might find it more difficult.
You might be dependent if:
- you can’t easily go a day without drinking alcohol, or find it hard to cut back
- a lot of your social activities include or are based around drinking
- you find yourself thinking about or wanting alcohol a lot
- you find it difficult to control the amount you drink once you start
- you need to drink a lot to feel the effects
- you experience withdrawal symptoms, even mild ones, such as feeling unwell or a slight shaking in your hands when you go a day or two without alcohol.
The more of these signs you have and the more severe they are, the more dependent you’re likely to be. You can check your risk of dependence here.
If you have a mild dependence on alcohol, you may be able to cut back on your own. But if you are moderately dependent, you may need to get some kind of support.
If you are severely dependent, you should seek medical advice before you make any change to your drinking because stopping suddenly can cause severe health problems, including seizures and even death in some people.
For people who are severely dependent, the usual recommendation is to take a permanent or temporary break from alcohol. It may take six months to a year or more before you are able to start drinking again. Some people find it’s better for them not to drink again at all. With severe dependence, there’s a high risk of quickly going back to heavy drinking if you just try to cut back.
If you experience any symptoms of dependence, once you stop or cut back your drinking, you might need specialist treatment or ongoing support to prevent going back to heavy drinking.
‘Cold turkey’ or reduction?
If you’re not dependent, you should be able to either reduce the quantity or frequency of drinking or quit altogether. You may do this on your own or choose to get some support. If one method doesn’t work, try a different way.
If you experience mild to moderate dependence, every time you have a drink it can become a trigger to drink more. So it’s sometimes easier to increase drink-free days, rather than reducing the quantity on drinking days, or to quit altogether for a period of time.
People who are severely dependent usually require some kind of withdrawal support to stop drinking. It is usually better to stop altogether (“cold turkey”) as long as you have medical support. You can undertake withdrawal treatment in a hospital, at home with the help of a GP or nurse, or via telehealth. Alcohol withdrawal typically lasts about five to seven days.
Zero-alcohol drinks
Zero-alcohol drinks are alcoholic drinks with the alcohol removed but which retain a taste similar to the alcoholic version. There is now a huge variety of options for spirits, beer and wine.
If you are not dependent but are trying to reduce your alcohol intake for health or other reasons, these can be a good option. By replacing some or all of your usual alcoholic drinks with zero-alcohol drinks, you can still enjoy the social aspects of drinking without the health risks of alcohol.
If you are dependent on alcohol, the smell and taste of zero-alcohol drinks can act as a trigger for drinking alcohol. They might make it more difficult to make permanent changes to your drinking.
Treatment apps and online support
A range of computerised, web-based, and mobile apps have been developed to support people cutting back or quitting alcohol. They have shown promising results in early trials. The benefit of these apps is accessibility, but the outcomes are modest and they seem to work best in conjunction with professional support.
Hello Sunday Morning’s Daybreak program is a large online alcohol support community, accessed through a mobile and desktop app. It’s designed for moderate drinkers who want to cut back or quit. Early research suggests it’s effective in reducing drinking, as well as improving psychological well-being and quality of life.
Some previously face-to-face support groups like SMART Recovery and Alcoholics Anonymous have moved online, which has increased accessibility. These are typically more suited to people who are dependent on alcohol.
Psychological interventions
Brief interventions: As little as five minutes of advice from a GP can reduce alcohol consumption by 30%, especially for people who are in the mild to moderate dependence category. So it’s worth chatting to your doctor if you need a little help getting started.
Counselling and psychological therapy: The main treatment type to help with alcohol issues is counselling. Sessions are usually once a week with a qualified professional, such as a psychologist. Sometimes they are delivered in group settings. Counselling is suitable for any level of drinker who is trying to make changes.
Some of the main evidence-based counselling treatments in Australia are behavioural and cognitive therapies, such as cognitive behavioural therapy and mindfulness-based relapse prevention. These types of treatments have been shown to be at least as effective as medication
Intensive group programs
A number of more intensive group programs are suited to people who are dependent on alcohol or who are having significant problems, including:
- residential rehabilitation, which is usually for people who have tried other treatments unsuccessfully or who may be unsuitable for non-residential treatment because their home life is not supportive of making changes. It has been shown to be effective in increasing abstinence in dependent drinkers
- day programs, which are similar to residential rehabilitation programs but participants live at home and go in each day. These are a relatively new treatment type and there is limited good quality research on their outcomes.
Medication
A number of medications can help people who are moderately to severely dependent on alcohol. They tend to work best in conjunction with counselling.
- disulfiram is an older medication that works on the alcohol metabolism system and induces nausea and vomiting if alcohol is taken at the same time
- acamprosate can help prevent relapse in people who have already been through withdrawal
- naltrexone reduces cravings in heavy drinkers.
Self-help groups
Alcoholics Anonymous’s 12-step movement has a long history dating back to the 1930s, when there was very little available in the way of real alcohol treatment. There is relatively little research on AA and much of that has been conducted from within the organisation. The known outcomes are modest – the success rate is estimated to be around 10% and the dropout rate appears high.
AA can be helpful for some people and also provides a very well-established peer support network if you need support. It seems to be more effective in conjunction with professional treatment.
There are many options if you are trying to reduce your drinking and no single strategy works for everyone. The best approach is to start with something that looks appealing and feasible to get the outcomes you are looking for. If that’s not effective, try something else or seek professional help. ■
Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
Parliamentary influence worries touch alcohol harm
The discussion over parliamentary groups is important to tackling alcohol harm, with some promoting alcohol interests while another looks to curb alcohol harm. They are not mutually exclusive.
The chair of a group of UK parliamentarians focused on reducing alcohol harm is also co-chair of another recently revealed to have taken money from an alcohol-industry-linked group.
Christian Wakeford, who switched from the Conservatives to Labour in January, is chair of the Alcohol Harm All-Party Parliamentary Group (APPG), supported by charity Alcohol Change for a figure of £3,000.
But Wakeford is also co-chair of the alcohol-industry supported group on the Night Time Economy, which has the mission, “To recognise the cultural and economic importance of nightlife to the UK.”
Records show this APPG received £7,500 or more from the Night Time Industries Association (NTIA), which campaigns to #SaveNightlife for pubs, clubs and alcohol companies including Pernod Ricard and Jägermeister.
Wakefield and Alcohol Change were both contacted for comment on the issues raised by this story, but had yet to respond at the time of publication. Any replies will be added accordingly.
Just over half the £25m put into all-parliamentary bodies since 2018 was from the private sector, says research from the Guardian newspaper, a sum which critics say gives them undue sway in politics.
Journalists and members of the public are, arguably, encouraged to confuse reports written and published by commercial interests with one which has had politically balanced parliamentary oversight.
The smallprint of a 46-page NTIA report on the impact of covid-19 last year was billed, “An inquiry by the All-Party Parliamentary Group for the Night Time Economy,” and bears the parliamentary portcullis logo.
But, in a small footnote, it adds, “This is not an official publication of the House of Commons or the House of Lords. It has not been approved by either House or its committees.”
The disproportionate role of commercial interests in establishing and being the real power behind All-Party Parliamentary Groups has wider implications for alcohol harm too.
There APPGs for beer, recipient of £30,000 from beer business; scotch, set up by the Scotch Whisky Association; and wine and spirits, the brainchild of the Wine and Spirits Trade Association.
The wine and spirits APPG produced a report last week on the “unworkability” of the government’s tax proposals. Some of its contentions were inaccurate but still gained uncritical media attention. ■
Temperance, unfinished history
This week BBC Radio 4’s In Our Time told the story of the Temperance movement in Britain which is said to have really got going in 1832 in Preston. It provides fascinating insight into where we find ourselves now, where we have moved forward and where the debate has become frozen in time. You can listen yourself here.
What struck me was that we are not so much reliving this history, but that the knotty issues raised by retailing addictive psychoactives were never resolved. While we might scoff at our ancestors, we have not come much further. What we see now on the internet are, perhaps, are echoes of the arguments made in temperance halls and colourful lantern slides.
One notable quote from the programme came from Bishop of Peterborough in 1872. Looking it up verbatim in Hansard it was, “…it would be better that England should be free than that England should be compulsorily sober.” He went on, however, “I would distinctly prefer freedom to sobriety, because with freedom we might in the end attain sobriety.”
The bill he was opposing with this speech to the House of Lords was one to allow local parishes to stop the issue of alcohol licences. This might well have been a blunt and ineffective instrument. I don’t know. But what is clear is that the bishop’s argument brushed aside positive freedoms we typically value on a par with the freedom to do business.
This is a fateful oversimplification of the conception of freedom, which has the dire consequence of polarising the discussion from there on. I outline this more fully in the opening chapter of Alcohol for Nerds, drawing on the work of intellectual historian Professor Quentin Skinner who created a detailed genealogy of freedoms, plural.
But, in essence, 150-years on it is still not accurate to portray those who seek to regulate alcohol sales more as being “against freedom” and those in favour of fewer regulations as being “for freedom”. It ignores the fact that restrictions help curb the freedom-reducing effects of things like inebriation, violence, dependence, illness and disability.
As the BBC programme makes clear the Temperance movement was largely led by and for the benefit of working people looking to improve their lives, by avoiding the many perils of Victorian life. It was also part of a wider struggle to find a political voice. This is a struggle for freedom, not against it, although it can impinge on some commercial freedoms.
The UK has not found a satisfactory democratic solution to this day. Elected representatives have long abdicated responsibility for regulating alcohol marketing and advertising, handing it to the alcohol industry itself, despite the direct conflict of interest. The results are predictably poor, with government ministers unable to introduce something simple as guideline labelling.
We have changed enormously since the days of the Temperance movement, as has the knowledge-base from which we work. But the balancing of different conceptions of freedom goes on. This is society struggling to decide what freedom is and how to deliver it. Long may it continue. ■
Deadly lockdown drinking polarisation quantified
The heaviest drinking households bought 17 times more alcohol than the lightest drinking ones at the start of the covid pandemic, a study says, helping to explain record high levels of alcohol-induced death.
The polarisation of alcohol consumption found between the top and bottom fifth of households in the UK is likely one reason why there was a 19% rise in alcohol-specific deaths in 2020, reaching the highest level for 20 years.
The US saw an even bigger alcohol-induced death surge in 2020 Alcohol Review revealed last month (see chart). The CDC has since confirmed the 26% rise that year and now also estimates a similarly high level for last year.
The increase in US deaths has so far attracted scant public attention or research. But it is likely the lifestyle changes and stress of the covid crisis saw heavier drinkers in both sides of the Atlantic increase their intake to deadly levels, just as this research suggests they did in the opening phase of the covid crisis in the UK.
Late last year around 30% more people in England said they drank more than the official low risk guidelines of 14 units (140ml) a week compared to before the covid crisis, said a Office for Health Improvement and Disparities survey.
“It is also likely that reduced access to care and treatment during covid contributed to an increase in alcohol-related deaths,” said lead author Professor Peter Anderson of Newcastle University when asked if other factors played a part in the UK.
Households in the more socially disadvantaged locations of northern England bought more alcohol. The pattern in Scotland and Wales was “less pronounced”, possibly because they have minimum alcohol pricing policies, the study says.
“This suggests that a focus on policies to reduce high levels of drinking are even more important in extraordinary times, such as those we’ve seen since March 2020,” said Professor Anderson from Newcastle University.
“By failing to implement minimum unit pricing as part of its plans for public health, England is now falling further behind the rest of the UK in the race to tackle alcohol harm,” said Professor Sir Ian Gilmore of the Alcohol Health Alliance.
The research is a joint project between Newcastle University and the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) North East and North Cumbria.
The study used retail data from Kantar WorldPanel for 30,000 UK homes for six years to 2020. ■