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If Alcohol Were Discovered Today, Would it be Legal?

Booze has created a public health crisis of immense proportions.

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The industry claims its advertising is aimed at providing information and choice, but there is a powerful symbolism to the sheer volume of advertising that people are exposed to on a daily basis. To quote the BMA: “the fact that promotion is allowed, ubiquitous and heavily linked to mainstream cultural phenomena, communicates a legitimacy and status to alcohol that belies the harms associated with its use. It also severely limits the effectiveness of any public health message.” There’s a lot of evidence that the more common and acceptable consuming alcohol is seen to be, the more people will drink, and this cultural context is especially influential on young people. All this further entrenches the false division between alcohol and illegal drugs, persuades people that consuming alcohol is safe, and makes realistic discussions of the harm alcohol causes very difficult.

7. Education about responsible use is the best method to protect society from alcohol problems

It is useful for the drinks industry to emphasise the value of education, because it takes the focus off regulation: if how much a person drinks is just their individual choice, then there’s no need to control how much alcohol they have access to. As well as being implausible with a drug like alcohol that dissolves one’s self-control, there is also extensive evidence gathered by the WHO from around the world, showing that merely providing information and education without bringing in other policy measures doesn’t change people’s drinking behavior. At best, they are a waste of money – though in the UK the sums involved (a few million pounds a year) are pitifully small anyway. At worst, especially when these education programs are funded by the industry, they can reinforce heavy drinking by improving people’s opinions of the industry. This is especially worrying in the UK, as from 1989 to 2006 the drinks industry-run Portman Group was funding and delivering many of the alcohol-awareness campaigns in this country.

Of course I believe that informing people about the harms done by drugs has an important role to play in reducing those harms – that’s why I’ve written this book – but it’s not enough on its own. When it comes to an addictive substance that impairs our judgement, we can’t rely on people cutting down the amount they use, just because they have a rational understanding of its harms. If the product is freely available, being aggressively marketed all around them, and changes their brain to make self-control nearly impossible, they need other sorts of interventions too. 

Case Study 1

I was called out on a home visit to see a man in his late 40s with severe agoraphobia (the fear of going out). He had been drinking heavily all his life, and was now dying from cirrhosis and the damage alcohol had done to his nerves. He had been diagnosed as an alcoholic, but the reason he drank was to control his extreme anxiety: he told me he had to drink four cans of lager to be able to get to his Alcoholics Anonymous meetings, and one can of lager just to be able to brave going outside to cut the grass. His anxiety disorder pre-dated the drinking, and, having been given no other help, he felt forced to self-medicate with alcohol. But as soon as he started drinking regularly, all the health practitioners he saw identified his primary problem as alcoholism, and no one would treat the underlying anxiety while he kept drinking. I treated him with SSRI antidepressants which help with anxiety disorders. 

Case Study 2

I was taken to see a man in his late 30s who had been admitted to hospital to dry out. He’d been through problematic withdrawal several times, and had had seizures in the past when trying to dry out. I asked him when his drinking began. He said he was given his first can of beer at age seven when he was out fishing with his dad, and he immediately felt that the person he became when under the influence of alcohol was his real self: “For the first time in my life, I felt normal.” He probably belongs to a minority of people who are biologically programmed to have very strong liking for alcohol, and are highly likely to become alcoholics. Hopefully in the future we will be able to identify these people before they start drinking, so they know to avoid the drug, and we may develop medications to help them feel normal without alcohol.