Alcohol Research in History

A Presentation by Professor Virginia Berridge given at the launch of Alcohol Research UK

In many areas of health policy, it’s now axiomatic to refer to ‘the evidence’ and to try to base practice and policy positions on the results of research.

Research funding organisations such as the Alcohol Education and Research Council (AERC) and the new Alcohol Research UK, whose launch we are celebrating today, are playing a crucial role in those developments.

But this connection between evidence and policy and practice is relatively recent – a connection which has risen with some force since the 1970s.

The history of research goes back further than that and today I want to sketch in very briefly some key stages to set the context of the rest of the day.

It’s a whistle stop tour of the period since the first half of the nineteenth century looking at where alcohol research has come from. What I’m going to look at includes:

1. temperance investigation and how it became science
2. interest in the action of alcohol on the body
3. the particular impact of the First World War
4. drink driving and science
5. new influences coming from the US and WHO
6. new directions in Britain after the Second World War
7. the rise of ‘evidence’
8. international networks
9. the AERC and where it came from and is going to.

Temperance investigation

As with many issues historically, it all began with temperance.

In the nineteenth century, drink was the natural accompaniment of many work related activities and it was also in widespread use in medical practice. There was also a belief that it was a food and strengthening.

The temperance movement in the nineteenth century was keen to disprove all of these common beliefs and practices.

So we find temperance literature from the 1840s investigating the impact of alcohol on the body,looking at whether moderate use was a good thing(they thought it was not and abstinence was best) and whether its use in medicine could be approved.

There was a particular focus on the impact of alcohol on hard work. W.B.Carpenter for example, a lecturer in physiology at the London Hospital, cited in an essay he wrote in 1849, a type of natural experiment where the output of brickmakers who drank was compared with those who didn’t. You can guess whose results came out best. The same was true of teams of farm labourers who had been deprived of drink at harvest time.

At the same time, temperance advocates also developed economic arguments. Expenditure on drink was wasteful for the individual and for the economy-so every year temperance reformers drew up a ‘National Drink Bill’ showing the annual national expenditure on drink. This was published in the Times and also in poster form as here. It represented the direct loss sustained by the nation as the result of its drinking habits.

Here are some other posters, from the collection of the Society of Friends, also conveying economic and other arguments:

Temperance becomes science

Much of this had a strong moral dimension and by the end of the nineteenth century research started to separate out as a distinct practice.

It took 2 forms:

• what we might see as early social science investigation with investigations of social conditions and statistical surveys (for example Seebohm Rowntree and Arthur Sherwell’s Poverty)
• but also the physiological and pharmacological tradition, the interest in the action of alcohol on the individual cell. All of this was set within a very strong emphasis on heredity.

There was the belief in the inheritance of acquired characteristics – if I drank to excess then my children would do the same.

There was a lot of European influence on this thinking. And the context was also the national debate about degeneration and deterioration in the wake of Britain’s poor showing in the Boer War.

A key text was Horsley and Sturge, Alcohol and the Human Body first published in 1907, full of experimental work some of which is illustrated here – on cress, kittens (who lost their ability to purr) and what was termed ’the race’:

Many of these medical scientists clustered round the newly formed Society for the Study of Inebriety.

We can see in this slide how some long standing debates in the alcohol area, for example whether abstinence or moderate drinking was best, had their origin at this time.

World War 1 and new styles of research

The First World War had a major impact on the style and focus of research.

Many of you will know that during the war a Central Control Board was set up which instituted major change in the way in which drink was managed in the interests of the war effort-control on opening hours (the afternoon gap); treating; control of the trade; and even possible state purchase with a specific focus on certain areas such as Gretna and Enfield Lock in London.The Board had government, temperance and industry interests on it. Its work had a major impact on drinking patterns, their health effects and on criminal justice effects, as you can see here:

What is less known is that all of this effort was to be founded on research and evidence. But this was evidence of a different sort to the temperance focus.

The Board set up a research committee of eight experts chaired by Lord D’Abernon himself, the head of the Board.

Its view was

“In dealing with the various problems connected with the Liquor Traffic a sound administrative policy must be based on a full knowledge of the relevant physiological and other scientific evidence, and that,in the numerous cases in which the available scientific information was defective, investigations ought to be promoted with a view to filling the gaps in exact knowledge.”1

During the rest of the war it promoted research with a wide remit-alcohol and typists’ speeds for example; the ‘effectiveness of prohibition in Russia’ or the value of drunkenness statistics.

Unlike the temperance era, it was prepared to conclude that moderation in consumption was not always bad. The focus was on what was called’ national efficiency’. Its conclusions were published in 1918 as Alcohol; Its Action on the Human organism and were widely cited and often reprinted.

Drink driving

In the interwar years this new style of work took on more of an economic dimension and work on differential taxation and social conditions was part of the work which was presented to the Royal Commission on Liquor Licensing which reported in 1931.

But the height of interest in research which had marked the war time period died away and alcohol was no longer a central issue in a time of depression, unemployment, and falling consumption.

Two things did mark these years however;

1. one was the rise of research on drink driving, which in the post Second World War years helped secure policy changes
2. the other was research influence from overseas and in particular new trends from the United States.

Perhaps unfortunately drink driving research in the interwar years was associated with the person of the Rev Dr Courtenay Weeks, a scientific populariser and temperance advocate who felt that prevention was the main course of action. Those who were abstinent before driving would not have a problem. But internationally a community concerned with the effects of alcohol on performance and competence became established in the 1930s. Analysis of blood, urine and later breath, developed.

Influences from the US and WHO

Also internationally a further significant development came with the new scientific understanding of alcohol developing in the post prohibitionist US.

E.M.Jellinek, who later transferred to the newly established WHO in the 1950’s, became head of a multi disciplinary research programme on the invitation of Howard W.Haggard, head of the Laboratory of Applied Physiology at Yale University. The influence of Jellinek, Yale, the Quarterly Journal of Studies on Alcohol which they founded, and Yale summer schools, filtered into the UK.

Here they came as a breath of fresh air- the influence of social scientists such as Seldon Bacon and David Pittman led the way in the development of new ideas on alcohol and the rediscovered concept of alcoholism.

This carried over into WHO which became a key focus of new thinking in the post war years,  Jellinek’s book, The Disease Concept of Alcoholism was a major influence on a new direction after the war.

Optimism after the war and research

The period after the war was a time of optimism and a feeling of rebirth in particular in psychiatry.

One of those strongly influenced by those international developments was Griffith Edwards, a psychiatrist at the Maudsley.  The work he initiated was also focussed on the location of the hospital in the inner London borough of Camberwell.

Edwards’ Alcoholism Impact project initially funded by the DHSS (Department of Health and Social Security), became the Addiction Research Unit in 1967 (later the National Addiction Centre), funded in addition to research the rapid rise in heroin addiction. Here there was ground breaking UK research on patterns of drinking in the local community and the needs of the homeless alcoholic. Later on the focus became one which was on drugs rather than on alcohol.

But there is no doubt of the importance of the social sciences – commentators have pointed to the optimism in this decade and the 1970s that science and social science could provide the understanding and the remedy for complex social problems. In particular psychology began to play a key role in understanding the nature of the condition, new theories of dependence and later what was termed ‘ problem’ alcohol and drug use emerged.

The rise of evidence

This was the period of a more general interest and focus on evidence in medicine, health and health policy which began in the 1970s.

Key figures included Thomas McKeown, and Archie Cochrane.

This was an international movement too with advocates in the US, Canada, the UK and the Netherlands. It had its origin in wider issues, such as the rise in health care costs and the economic difficulties caused by oil price rises in the 1970s.

International networks and population approaches

The evidence based approach and international collaboration – as well as post war optimism-came to the alcohol field with the publication of the path breaking 1975 work Alcohol Control Policies in Public Health Perspective – a team led by the Finnish social scientist Kettil Bruun, pictured here, and also spearheaded by WHO Euro, by Edwards and by the Addiction Research Foundation in Toronto, and influenced by the Canadian Lalonde Report’s focus on lifestyle issues. One can see this as part of further developments round health promotion and primary health care in the 1970s. WHO developed its Health for All initiative which was so influential in the 1980s.

The 1975 report adopted the Ledermann hypothesis, which had been around since the 1950s, of population consumption and harm rather than the older alcoholism paradigm.

The list of authors but also the content was important. This was the revival and renewal of the belief that research and policy were closely interconnected. The book had just 10 pages of research references, some of them going back to the 1860s, but the emphasis was definitely on evidence. This belief has continued to animate further productions by that team and their successors in Alcohol and the Public Good in the 1990s and Alcohol No ordinary Commodity in the early 21st century.

This population based line of argument was not popular with the incoming Conservative government in the 1980s and many of you will know about the fate of the Think Tank report which proposed the consumption harm thesis as the basis for government policy.

The Alcohol Education and Research Council (AERC)

But the 1980s is also where the AERC comes in and I want to end this very brief overview by saying a little about its origins and role.

The AERC in fact owed its origins to some of the issues I talked about at the start – in particular the impact of the temperance movement. For its origin was in 1981 as part of the winding up of the Licensing Compensation Scheme which had been established in the early twentieth century as part of the reduction of the concentration of public houses in certain areas. The scheme had provided compensation for publicans whose pubs were closed in areas considered to have too great a concentration- reduction of over provision is another echo of the past in the present.

There is no time to review the AERC’s recent history in depth but simply to note, as Ray Hodgson, its research director (and a psychologist), did in a recent interview with me, how the Council’s focus on research, evidence and impact has grown over the years. Its funding is diverse and in recent years, it has developed priorities rather than just seeing what comes in.

The Council has funded innovative work on family interventions; community action programmes; and screening as well as brief interventions. Its chairs have increasingly come from a research background – as epitomised by Robin Davidson currently.

The Council has relocated departmentally from the original Home Office responsibility; to DCMS (Department of Culture, Media and Sport); and then finally to the Department of Health.

Now it operates as a free standing charity and that brings new challenges.