Last week I spoke at an event on parental alcohol misuse, a hugely important issue given the significance of parent’s influence on their children. A teenager that has seen their parent drunk is twice as likely to regularly do so themselves; important because the adolescent brain is particularly vulnerable to alcohol misuse. Early on-set drinking and childhood stress are also key predictors of later life alcohol problems. But it is always important to emphasise the importance of a whole system (or ‘multi-component’) approach if longer terms alcohol harm reduction is to be achieved. Addressing parental alcohol misuse is crucial, but not at the expense of recognising wider issues around pricing, availability and marketing.
In emphasising the need for broader action as well as parenting specific approaches, a potent panel debate followed. In particular, after I had called for greater understanding of the guidelines and further delivery of brief interventions, a counterpart speaker’s response was to say they ‘didn’t believe in nannying’. Somewhat to my surprise, this sentiment was shared by some of the audience members, no doubt contributing to the enthusiasm of the debate. But is it really nannying to support a further awareness of the guidelines and for those drinking above them to be targeted with brief interventions? I believe it is absolutely not – so long as people have the right to choose whether to take any notice of information they may be offered or decline a brief intervention.
“People should make their own informed choices” was another response, and no-one disagrees. But the fact is that most adults are not able to correctly identify how many units are in most drinks, or cite the recommended guidelines. A Drinkaware survey recently found that only two in five people could identify the units in common drinks, and in my experience of regularly delivering training, most people are genuinely shocked that a glass of wine can contain over 3 units. But I do recognise there is often a general sense of disdain towards the guidelines, and that many heavier drinkers dismiss them as unrealistic when contrasting them to their own consumption. I know, I’ve been there.
The problem itself stems from the common assumption of alcohol as an ordinary commodity, rather than as a potentially harmful drug. Since many of us like to experience various degrees of intoxication, work on social norming seems to suggest it might suit us to take comfort in the knowledge that many of our friends and peers drink the same as or more than we do. Highlighting the fact that the consumption levels of a risky drinker’s peer group is generally lower than they think can be an effective piece of feedback to a an individual willing – but not coerced – to reflect on their alcohol use.
My sense is that a lack of recognition of the importance of dose effect is a key issue – that is the greater the amount of a drug consumed, the greater the risks. Of course setting a cut-off point is flawed because of the inappropriateness of a ‘one-size fits all’ approach. But we wouldn’t do away with speed limits because some cars are safer or some people are better drivers. But unlike the speed limit, the alcohol guidelines are not about saying ‘you must stick to this limit’ – they are about recognising what is more or less a ‘low risk’ dose, and considering all the risks of going above them. People know the more they drink the worse their hangover might be, but are often surprised to learn how easily it can also affect sleep, mood, or wide range of common health problems.
Personally I feel the guidelines are important, but equally so is how the Government and health groups use them. There may be a fine line between providing information and patronising or pushing people if they choose not to use it. If people don’t want to reflect on their drinking they won’t, in which case there’s no point forcing it. But I don’t accept that by simply promoting a guideline on ‘safer’ consumption or offering people advice is in any way ‘nannying’ in itself.
Whatever the current review says about what the guidelines should be, there will be critics who reject the principle of them as interfering with personal choice. But when asked, those people will rarely disagree with the importance of making properly ‘informed decisions’.
Where does that leave us with this year’s alcohol awareness week, running from 14th to 20th November 2011? I believe it is a good opportunity to raise the profile of the need to address alcohol misuse and its damaging impacts, and also as a platform for initiatives to raise individuals’ understanding of whether their drinking could be harmful to their health. Once they have been offered that information, how they use it is completely their choice. Anything beyond that is arguably ‘nannying’, ‘lecturing’, and worst of all, ineffective.
But whilst alcohol awareness week may help, what we do in the other 51 weeks of the year must also receive further focus from public health approaches. To progress in supporting drinkers to make properly informed decisions, sustainable strategies to deliver routine brief interventions and ensure appropriate resources and information materials are needed throughout the year. This does not mean that those who choose to continue drinking above the guidelines – where it is not harming anyone else – should receive any stronger intervention. It means those who want to make healthier choices are enabled to do so. That’s not nannying, its good public health.