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A FORK IN THE RIVER

Dear Quentin, There's an old adage in advertising that says, We know that 50% of it works; we just don't know which 50%'. There's no such problem when it comes to the pluses and minuses of drinking alcohol: we know pretty well when drinks will do the harm, and, unfortunately, the rot sets in long before we get to the traditional one over the eight'. It is the norm these days to preface any statement about harm with an acknowledgement along the lines that many people derive pleasure from drinking, and most do so without causing harm to themselves or to others. The first part of this is undoubtedly true, but the second is arguable, depending on your definition of harm. Faced with these two aspects of harm (that caused to ourselves and that caused to others), I suspect many would take the view that the former is purely a matter for the individual concerned; but, given the pressures on the NHS and the research that suggests up to 12% of all hospital costs are alcohol-related, I'm not sure that it is quite so straightforward. The third-party impact can, of course, range from the outrageous (drink-drive deaths, extreme violence) to the mildly irritating (pub bores, missed business appointments), but we would all be better off if we could restrict ourselves to the first couple of drinks that are a pleasure and give a miss to the subsequent rounds that lead toward the problems. I'm sure that you will share my concern that our young people now seem to be working on the premise that a drink is not a drink unless it's a binge and leads to a state of drunkenness. One of the biggest issues for our towns and cities - and their residents - is simply the rowdiness and intimidation (and frequently the vomit) that make many streets no-go areas for the latter part of the evening. Somewhere along the line young drinkers are getting the wrong message, and that message seems to be more is better (if not essential)'. Without necessarily wanting to put the obverse, it would make a real difference if we could shift the emphasis from quantity to quality. If we were, at a stroke, to cut our consumption of alcohol by 50%, we might focus on the pleasure and get less of the pain; and we might just find that the country really is a better place for it. Yours, Eric Appleby, Alcohol Concern

Dear Eric, I agree with some of the points in your letter. Our starting points are not that different, although we may disagree about what should be done. I agree that the primary problem is the harm alcohol misuse causes to others, and I share your concern that there seems to be a culture among some young people to get drunk deliberately and maybe get into a fight. However, the alcoholic drinks industry does not support such activity and would far prefer it not to happen. Any profit from excessive drinking is far outweighed by the damage to ordinary trade, not to mention possible interventions by police or new, more restrictive laws. Also, it must be said that most drinking is not of this sort. The fashion for drinking more at home, often with meals, has grown to represent 40% of the market, and for every rowdy bar, there are plenty where there is no disturbance of any kind. Where I take issue with you is your suggestion that we should all halve our consumption in order to combat the problem. The average alcohol consumption in the UK is not heavy - we are tenth in the EU league, well below the Sensible Drinking Message guidelines on average, and consuming nearly a quarter less than one hundred years ago. Our consumption per capita equates to that of Italy, a country where alcohol misuse is a rarity and where drinking too much is considered shameful. If we could move towards the Italian approach of drinking moderately with meals from a fairly young age, with the family, and without rigid licensing hours, we would be a long way towards the sensible drinking ideal. On the other hand, Government intervention to reduce overall consumption would affect sensible drinkers more than those who drink to excess, leaving us nearer the position of Norway and Sweden, where low average consumption (half that of the UK) is matched by enormous cross-border smuggling and illegal production of drink at home that is inherently dangerous, and can even lead to death. This is what happens when it is drink itself that is projected as harmful, rather than the mistreatment of it. The aim must be to target our actions to hit misuse without interfering with sensible drinking. The actions of the minority who misuse alcohol need a separate approach from the sensible behaviour of the majority. Drinking and driving has been cut remarkably without disturbing sensible drinking and we should act similarly against alcoholic loutishness. Education and social change must be the main key - to get over the Sensible Drinking Message that drink can be life-enhancing, but being drunk is bad. That is why we support The Portman Group and have been calling for a National Alcohol Misuse Strategy in England, as they have in Scotland. Yours truly, Quentin Rappoport

Dear Quentin, I'm glad that we agree on so much, and in particular that we need a change in our drinking culture. A National Harm Reduction Strategy, as currently being developed by the Government, will be an important start in co-ordinating our efforts. But it will work only if we all play our part, because there are not, unfortunately, two separate populations - of those who drink sensibly and those who misuse alcohol. Although there are some people who will remain firmly entrenched at either end of the drinking spectrum, large numbers of us move in and out of sensible drinking at different times and as the circumstances of our life change. Even wine drinkers will recognise that the patterns of their (or their friends') drinking shift over time. Many of those whose consumption increases will move back out of the danger zone before any real damage is done, but they are not helped by our tendency to show approval of quantity, rather than quality, when it comes to drink. There are some warning signs to heed when it comes to wine consumption. Wine tends not to be popularly associated with great excess, or with incitement to riot. And yet the recent trend of wine bars to serve 250ml glasses (a third of a bottle) to often unsuspecting customers looks suspiciously like a move away from the appreciation of quality towards the encouragement of high-volume consumption. More than one drink like this and you are already moving out of the sensible zone! A 50% cut back to the traditional measure would be an excellent start in addressing our shared concerns. The point about cutting consumption is to get at the 50% that do the harm. This does not mean targeting the sensible drinkers, but it does mean encouraging them to stay within these bounds, and it does mean targeting others who may see themselves as heavier social drinkers (but still prone to hangovers, missed appointments and family tensions) to reduce their intake to within sensible levels. If we could achieve this it would save the country far more than simply targeting the relatively small number of the heaviest drinkers, and would contribute massively to the much-needed change in the culture that always presses us to have another one'. Eric

Dear Eric, We need priorities. Alcohol misuse in the UK concerns particularly people who treat drunkenness as something to be proud of, sometimes accompanied by violence. Binge drinking and its attendant bad behaviour are a longstanding British problem, which is exacerbated by many young people, including women, joining the ranks of misusers. If we can get them to accept that it is not cool' to be drunk, and actually dissuade them from excessive drinking, we shall have done a great deal to improve society. The key to this is education in its widest sense, i.e. promoting the Government's Sensible Drinking Message. The Portman Group has launched its If You Do Do Drink, Don't Do Drunk' campaign with considerable success. In addition, it has promoted unit awareness through its Cardboard Wheel', which is available in alcohol advice agencies, health promotion units, doctors' surgeries, etc, and many other initiatives that we support. The National Strategy should deliver a co-ordinated message to schools and other institutions, targeted at all who binge - and not just the young. With help from Government and other public bodies, we can start to change attitudes. We also support consistent application of the law to forbid sales to people who are drunk and to underage drinkers (with a national proof-of-age card). As well as the quantity of drink consumed, there is the closing time' problem, when many people come onto the streets all together, often without adequate public services. I am impressed with the success of Manchester police in reducing rowdiness by simple improvements in policing and transport. With variable closing times, the new Licensing Bill promises to reduce an obvious problem. Binge drinking and public drunkenness are not the end of the problem, but the same educational message and campaign against binge drinking will also promote unit awareness and discourage excess in other contexts. For instance, understanding the unit content of one of the extra large' wine glasses is the way to prevent misuse, rather than trying to ban them. The industry has the duty to promote the Sensible Drinking Message to consumers, and good practice among those who serve alcohol. Self-regulation is the key. The Portman Group Code of Practice sets standards of packaging and promotion and is a great success. Few products come on the market nowadays without The Portman Group first checking their conformity with the Code. Getting the balance between responsible promotion and excessive prudery is always difficult, but I believe they have got it right. Similarly, drink advertising is controlled by the ASA and ITC, and here there are legal sanctions for anyone who defies their codes. The industry is actively encouraging stricter standards and better enforcement of alcohol advertising codes across Europe. Meanwhile, let us not forget the benefit of sensible drinking. Alcohol in moderation is a part of our national life, giving pleasure to our eating, helping social interaction, and for the majority of drinkers it can bring benefits to health. Let us not lose one of life's great pleasures just because some people overdo it. Quentin

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