Sunday, 15 July 2012

Alcohol Addiction and Education: Some random thoughts

Over the past weekend I was involved in a twitter conversation and I happen to make the observation that alcohol consumption was linked to price.  The reply which came from people I know to be health professionals left me a little surprised.  The link between alcohol and price was doubted and then a comment was made how will this help the addict?  Further conversation stressed the need for more education.   Clearly there are evidential blind spots in operation here.  Lets deal with price first.  As the alcohol industry will not tire of tell you there is no proof of a causal relationship between alcohol consumption and price.  In this they are correct, but what they won’t say is when looking at wider population effects this is almost impossible to show.  What we have is the very next best thing, a plethora of cross-cultural/international evidence that shows there is a strong relationship with greater levels of alcohol-related harms and low priced alcohol.  Paying a realistic price helps the addict because it means that alcohol is not so ingrained into our culture. 

Secondly the panacea of education that is often beloved of health professionals and certainly the alcohol industry largely because it makes barely a dent in their profits.  I support alcohol education so long as it is delivered in an evidence based way-which unfortunately is rare.  But even when delivered according to the evidence, behavioural change is minimal.  The alcohol industry loves it because it gives the impression of doing something but in reality has a minimal effect.  The result of education is to increase knowledge but the evidence for behaviour change is very weak, indeed sometimes it has shown that it encourages rather discourages experimentation.  So please let us have evidence driven education programmes but accompanied by measures that really will have an impact;-increase in price and reduction of availability.

Especially whenever representatives of the alcohol industry are asked to comment on consumption the spectre of the predominance of the responsible drinker or consumer is raised-ergo people who are not responsible are "spoiling the fun of the majority.”  Alcohol is fun I am a drinker and most of time I consume responsibly but there will be occasions when I don’t but I think elements of “fun for the majority” need to be unpacked.  It may be a bit po-faced but I despair of some of the attitudes that surround drinking.  I have lost count of the number of times I have heard comments along the lines of when I get home “there will be a nice glass of something cold waiting for me.”  Notwithstanding the inherent dangers of using alcohol as a reward (see my last blog-Home drinking: because I am worth it) if the words “glass of something cold” was replaced with “a joint” “ a valium”, “line of coke” “syringe of heroin” it does not quite have the same ring.

This week I read something that threw into sharp relief the dysfunctional culture that surrounds drink.  Devon and Cornwall police returned 27 sixteen year old youths staying as a group without their parents in Newquay who were “running riot” having  smashed up their rented accommodation whilst on drunken sprees with alcohol brought down from Bristol, Birmingham and Guildford respectively.   For some on twitter apparently this was caused by a “lack of alcohol education.”  If ever there is a case of the horse having bolted this is it.  I am less critical of the young people than their parents.  Nice to give someone a rite of passage provided other people pick up the tab.  No doubt most of the parents would regard themselves as responsible I beg to differ, I shudder to think what messages they have been given albeit not consciously concerning how alcohol is fun.  Education has no chance when it is undermined in such a manner by our wider culture.  

Now for some final thoughts about addiction, I welcome more treatment services but I also feel that wider society can help the addict by realising that an addiction is just the extension of an unhealthy habit and “there but for the grace of God go I.”  I have worked with individuals who were addicted to alcohol for many years and understand from talking to many of them that the main challenge they face is relapsing on leaving treatment services.  They will describe putting themselves in situations where eventually they are overwhelmed by cues. (although they are unlikely to use such a word) usually in response to a stressful situation or wishing to test themselves.  A cue is something that they associate with drinking, such as a pub, going back to areas where they drank, the smell of alcohol.  I spoke to someone recently who had been drinking for many years and could provide a thirty year perspective.  The main challenge he now faces is that alcohol is far easier to obtain and cheaper- he stressed the role of supermarkets in making alcohol easily available. 

The addict plays a vital role in helping to persuade ourselves that we are not like him or her for we use alcohol “responsibly”.  I may be making a utopian suggestion here, but if we paid a realistic price for alcohol, accepted some restrictions on its’ availability and examined some of our own beliefs and attitudes to alcohol we might be creating a creating a healthy culture for us all and at the same time making recovery for those who have become addicted to alcohol just a little bit easier.

Dr John Foster is Principal Research Fellow at the University of Greenwich-School of Health and Social Care.   This blog represents my personal opinions and do not represent those of the University of Greenwich.