Alcohol Guidelines - Science and Technology Committee Contents


Written evidence submitted by Dr William Haydock (AG 14)

CONTEXT AND SUMMARY

1.  Government guidelines regarding alcohol consumption are primarily designed to inform people's alcohol consumption. Although they must be based on scientific analysis, they should not be set without reference to their aim in shaping drinking behaviour—and indeed the numerical figures have never been precise in terms of how they relate to harms resulting from alcohol use (Nicholls 2009, p.212). The guidelines and associated communication strategies must be chosen with an awareness of how people may respond to them. This submission therefore discusses potential responses of current drinkers to various Government social marketing campaigns.

2.  It is not clear that recent strategies for communicating guidelines for consumption, exemplified by the Units and Would You? campaigns, have been effective in altering young people's drinking behaviour. Some young people actively seek out the unusual, and apparently undesirable—and yet not criminal—behaviour depicted in the Would You? advertisements, while others defend their drinking against quantitative consumption guidelines as communicated by the Units campaign by reference to the understanding lying behind Would You?: that behaviour while and after drinking is the measure by which problematic drinking should be defined, rather than quantity consumed.

3.  Therefore, learning from previously successful campaigns to change norms and behaviour, I recommend that the setting and communication of alcohol guidelines be shaped by a focus on demonstrable crimes and harms to the individual drinker concerned and, perhaps more powerfully, to others around them.

CREDENTIALS

4.  I will shortly be taking up a post as Information and Research Officer for Dorset County Council's Drug Action & Community Safety Team. However, I write here in a personal capacity and this submission is based on research and analysis conducted for my PhD, "Gender, Class and "Binge" Drinking", awarded by Bournemouth University, available from http://eprints.bournemouth.ac.uk/16236/. This included analysis of existing Government policy relating to alcohol, and interviews, observations and focus groups involving a range of relevant stakeholders: young drinkers themselves as well as various related professionals from youth workers to bar staff and managers, as well as local council staff. The names have been changed of all participants and venues referred to herein.

DECLARATION OF INTERESTS

5.  I am not aware of any relevant interests. The research for my PhD was funded directly by Bournemouth University.

RECENT GOVERNMENT SOCIAL MARKETING CAMPAIGNS

6.  The key attempt to communicate specific Government guidelines on drinking in recent years was the Units campaign of 2008. This showed the number of units in various drinks, such as glasses and bottles of wine, pints of beer, and glasses of gin and tonic, followed by the phrase: "Units. They all add up." The targeted individual was considered to be 25 or over (see Home Office and NHS 2008).

7.  In tandem with the Units campaign, the Government ran the Would You? campaign, which aimed to highlight the possible negative consequences of drinking "excessively", asking drinkers whether they would undertake a number of actions if they were sober. These actions ranged from the criminal through the dangerous to the antisocial or, arguably, simply immoral. The campaign was organised around the overarching theme "You wouldn't do this sober". Various posters, for example, advised drinkers not to smash up a shop, jump in rivers, or urinate in the street while another, implicitly aimed at young women, asked whether they would get into a car with a man they had just met if they were sober.

8.  In some cases, the consequences of drinking that were portrayed as being undesirable in these two campaigns clearly relate to personal health and safety or committing crimes against other people. For example, to smash a glass in someone's face, as one of the Would You? posters envisages, is unquestionably a crime. Equally, there are undoubtedly alcohol-related health issues underlying the Units campaign, even if their precise relationship with the specific recommended consumption limits may be debatable.

9.  However, not all the apparently negative consequences of drinking envisaged by the Would You? campaign are so clear cut, and can be seen as resembling something of a moral panic.[22] A number of actions depicted might be considered "anti-social", but it is difficult to see who is the direct "victim" of the transgression—apart from the perpetrator, who might have their pride or self-respect damaged. This is well illustrated by the television advertisements for the Would You? campaign. One shows a young man preparing to go out(NHS and Home Office 2008a), another shows a young woman(NHS and Home Office 2008b); as they get ready, the man urinates on his shoes, spills food on his t-shirt and rips his jacket, the woman gets her skirt wet, smudges her eye make-up and smears vomit in her hair. The adverts then ask: "You wouldn't start a night like this so why end it that way?"

10.  The actions are symbolic of being excessive and irresponsible. They are not normal everyday (or daytime) behaviour. However, it is not immediately clear why the Government should be concerned with all the actions in the advertisements from a crime and health perspective. Even urinating on one's shoes or having a wet skirt are unlikely to cause a health problem, although the fact that one has vomited suggests that one has drunk more alcohol than one's body can cope with. This approach sprang from the conviction that alcohol-related problems originate in a wider culture surrounding drinking in the UK—a conviction that has been central to both the Labour and the Coalition Governments' approaches to drinking.

11.  Therefore, it appears that there are two key assumptions behind this approach. First, if the activities shown are being engaged in, then there is a significant risk of genuine offences or mistakes occurring—also as a result of alcohol consumption. Second, a focus on these activities is a way to shape drinkers' behaviour, as they will be ashamed of them.

12.  This rationale also lay behind Diageo's similar 2007 Choices campaign. However, Diageo understood that this tactic and campaign was only suitable for targeting those who do feel ashamed of their drunken behaviour—which is a particular group of young drinkers, referred to as "irresponsible shamefuls".[23] In my research I did not find quite the same groupings as Diageo, but the point remains that not all drinkers in the night-time economy have a sense of shame that can easily be mobilised to change their behaviour, as I discuss in the following section.

YOUNG PEOPLE'S ATTITUDES TO DRINKING

13.  Many young people drink to get drunk, which according to recent Government definitions would classify them as "binge" drinkers (see, for example, Szmigin et al. 2008). I refer to this approach as a "carnivalesque" drinking style, which one participant, Ollie, explained in very clear terms, telling me that in order for a night out to be considered "legendary" something "unusual" must happen, and this is only really possible if people drink and get drunk.

14.  The most striking example of such a "legendary" story was told to me by Hannah, a first-year university student reminiscing about a day she had spent drinking when she was 17. She had gone to the toilet in the pub where she and her friend had spent the afternoon drinking shots, and was walking back to her table when her friend came over to her in the middle of the pub and stopped her. Hannah had walked out of the toilet with both her trousers and underwear still around her ankles because she was so drunk. She explained that initially such incidents can be embarrassing but they can soon become amusing: "You think "Oh God", and a few, maybe a few months later on you think "Oh that's really funny", you tell it to all your friends and they laugh and you laugh." She then laughed herself, remembering the incident, and, thinking about it, declared: "It was brilliant though". Importantly, the day was considered "brilliant" despite the fact that later in the evening she was sick and fell over a small wall—and still bears the scar from the fall.

15.  These are precisely the sorts of actions that were condemned in the Would You? campaign, yet in Hannah's case are, if not celebrated at the time, considered perfect fodder for a funny, legendary story later. The incident is not shied away from or entirely veiled in shame, though the re-telling of the story may involve negotiating shameful associations. Such drinkers are deliberately trying to end the night in a different way from how they started it, in contrast with the Would You? slogans. Any instruction to avoid certain situations where the problem or harm is not evident to the drinker is therefore likely, I suggest, to be met with indifference or frustration.

16.  As in the Diageo Choices campaign, however, such social marketing campaigns are not necessarily targeted at "carnivalesque" drinkers. In my research I found that some drinkers reject such celebrations of out-of-the-ordinary behaviour, and stress instead their difference from those they see as being mainstream "binge" drinkers. I understand their approach to drinking using the term "everyday".[24]

17.  In terms of alcohol consumption directly, this everyday approach rejects the idea of drinking to get drunk. Simon expressed this neatly when he told me "I enjoy a drink, rather than drink to enjoy myself", and "I drink and have a laugh" contrasting this with those who drink in order to have a laugh. He explained that, for him, drink is involved, but for most other "people today" drink has to be part of their night out.

18.  However, this approach does not imply drinking within Government unit guidelines. Another participant, Sam, defended his consumption by suggesting that unit-based definitions of "binge" drinking are "stupid". He explained that he and his friends had been drinking in the Rose and Crown since 12.30pm and it was now about 7.30pm, yet they were not about to "kick off" despite having "binged" according to, as he saw it, the Government definition. As far as he was concerned, quantity of alcohol consumed was irrelevant; what was important was people's behaviour, and he stated in his defence that he and his friends were probably the "sanest" people there, certainly more so than some "18-year-olds" who had had "a couple of pints of Stella".

19.  This is not to say that such drinkers did not in fact engage in activities that Government might consider undesirable, quite apart from any potential health damage of drinking significant quantities of alcohol. Two young men were particularly vocal in stressing their "difference" from other mainstream, "binge" drinkers. Nevertheless, one explained with a laugh how the other had once set fire to public bins in a park on his way home from a night out. This was told as a funny story, and was not seen to compromise their position as different from "binge" drinkers.

20.  It is therefore not clear that campaigns of either approach—Units or Would You?—will be effective in targeting those with a carnivalesque or an "everyday" approach to drinking, disregarding the possible group of "irresponsible shamefuls" who might be identified and relied upon to respond in the desired way. Those with a carnivalesque approach will tend to see many of the criticisms of the Would You? campaign as unhelpful, and will reject its model of ideal drinking behaviour. Conversely, those taking an "everyday" approach would be unlikely to recognise themselves in such campaigns focusing on apparently out-of-control drinking behaviour as this does not fit their conceptions of their own behaviour or motivations. At the same time, the Units campaign seems unlikely to resonate with these "everyday" drinkers as they choose to define their behaviour as responsible in terms of behaviour relative to other drinkers.

IMPLICATIONS FOR COMMUNICATION OF ALCOHOL GUIDELINES AND SOCIAL MARKETING POLICY

21.  These criticisms serve to make the point that where Government has used multiple definitions of concepts, such as "binge" or "responsible", it is not always the case that drinkers will take these and use them to understand and change their own behaviour in the desired way. The idea of drinking responsibly when considered in terms of behaviour or motivation is completely at odds with the carnivalesque drinking style, and cannot be employed to regulate people's behaviour within it. On the other hand, the definition in terms of behaviour and motivation allows those within the "everyday" drinking style to see "binge" drinking as the primary problematic form of consumption, and their practices as "responsible".

22.  One possible response to these problems is therefore that the concepts should be more clearly fixed and defined. It could be argued that the Government already has very clear unit definitions and daily and weekly limits, which have been communicated through the Units social marketing campaign, and yet drinkers like Sam still duck the issue. However, Sam was able to sidestep the Government's unit-based definition of "sensible" or "responsible" drinking by virtue of invoking another: the behaviour-based one. Although he had drunk more than the recommended number of units, he was still drinking "responsibly" because he was not behaving like a binge drinker, and therefore he could feel he was referencing legitimate authority to support his claim.

23.  To some extent, it is difficult to avoid tensions and alternative definitions of "binge" or irresponsible drinking, because there are different ways in which alcohol-related problems can be conceptualised. There are potential long-term health issues but also immediate harms more associated with "binge" drinking, as well as other policy issues in the areas of crime and economics, for example. Nevertheless, I would suggest that tighter and more consistent definitions and campaigns can serve to resolve some of these issues.

24.  My criticisms so far might be seen as somewhat counterintuitive or back-to-front. To some extent they suggest that a campaign to address "binge" drinking should be shaped by precisely the attitudes that it is trying to change. However, this approach can be better understood if it is considered that there are two ways to approach the aims of alcohol-related social marketing: first, to work within existing norms to make people manage their desires and behaviour better; second, to change those overarching norms themselves. The evidence presented here suggests that recent Government campaigns are unlikely to have been successful in the first of these aims; I would also suggest that these campaigns are also unlikely to succeed in the second.

25.  When considering previous attempts to change social norms from a public health perspective, the—successful—examples of drink driving or, more recently, the ban on smoking in workplaces, are sometimes cited(eg Stead et al. 2009). Although the cases differ, with Government in both cases prepared to criminalise the activities in themselves, the comparison does provide useful lessons for alcohol policy given that the campaigns, separate from criminal justice proceedings, have served to make the targeted practices socially unacceptable—an aspiration of Government with respect to "binge" drinking.

26.  One key feature of both smoking in public places and drink driving is that although both practices place individuals' own health at risk, this is not the basis on which either initiative was justified. Rather, the central point was that drink driving or smoking in someone's workplace can harm other people, and therefore the state does not consider that individual drivers or smokers should be allowed to impose this risk on others. There is no doubt that this argument can be applied to alcohol-related crime—for some people at least, their drinking-related behaviour places others at risk. Identifying such a hard-hitting impact could be a successful way to defuse the implicit criticism of the Would You? campaign inherent in the carnivalesque drinking style.

27.  Therefore, when communicating the downsides of certain forms of drinking, I suggest that Government should focus on those where either the individual themselves or, perhaps more powerfully, another person is demonstrably harmed—rather than concerning itself with the broader moral health of British young people, in terms eerily reminiscent of previous "moral panics". This will also ensure greater consistency across different definitions and campaigns, as none of the harms could be easily dismissed. I argue that by condemning a particular drinking culture the important messages regarding health and individual safety may become diluted and therefore ignored. If these implications for social marketing can be summarised in one sentence, it is that one must be very clear about what the problem is, and who the message regarding this is being targeted at.

REFERENCES

Borsay, P, 2007. Binge drinking and moral panics: historical parallels. History & Policy, September. Available from: http://www.historyandpolicy.org/papers/policy-paper-62.html [Accessed: 2 October 2008].

Cohen, S, 2002. Folk Devils and Moral Panics: The Creation of the Mods and Rockers. 3rd ed. London: Routledge.

Haydock, W, 2009. Gender, Class and "Binge" Drinking: An ethnography of drinkers in Bournemouth's night-time economy. Thesis (PhD). Bournemouth University, Poole.

Hobbs, D, 2005. "Binge drinking" and the binge economy. In: Stewart, I., and Vaitlingam, R. eds. Seven Deadly Sins: A new look at society through an old lens. Swindon: ESRC, 24-27.

Home Office, and NHS. 2008. Alcohol Know Your Limits: Stakeholder Update, 9 (May). Available from: http://www.alcoholstakeholders.nhs.uk/pdf/Newsletter.pdf [Accessed: 16 January 2009].

NHS, and Home Office. 2008a. Would You? Male TV Advert. Available from: http://www.alcoholstakeholders.nhs.uk/media/Alcohol_Harm_Reduction_Boy.mpg [Accessed: 19 January 2009].

NHS, and Home Office. 2008b. Would You? Female TV Advert. Available from: http://www.alcoholstakeholders.nhs.uk/media/Alcohol_Harm_Reduction_Girl.mpg [Accessed: 19 January 2009].

Nicholls, J, 2009. The Politics of Alcohol: a History of the Drink Question in England. Manchester: Manchester University Press.

Stead, M, Gordon, R, Holme, I, Moodie, C, Hastings, G, and Angus, K, 2009. Tackling alcohol harm: lessons from other fields. Joseph Rowntree Foundation. Available from: http://www.jrf.org.uk/sites/files/jrf/alcohol-attitudes-behaviour-full.pdf.

Szmigin, I, Griffin, C, Mistral, W, Bengry-Howell, A, Weale, L, and Hackley, C, 2008. Re-framing "binge drinking" as calculated hedonism: Empirical evidence from the UK. International Journal of Drug Policy, 19 (5), 359-366.

September 2011


22   This is perhaps an overused term but is helpful in this context. See Cohen (2002) originally, and Borsay (2007) and Hobbs (2005) on drinking specifically. Back

23   For an introduction to this campaign, see the "Brief for Meeting 3" of Responsibility Deal: Working with businesses to improve Public Health, pp.9-10. Available from http://www.publichealthcommission.co.uk/pdfs/PHCMeetings/NA-Pre-reading.pdf Back

24   I have discussed the everyday and carnivalesque drinking styles in more detail elsewhere (Haydock 2009). Back


 
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Prepared 9 January 2012