Binge drinking as an issue of concern

Responsible drinking’ messages are to be placed on bottles and cans of beer and spirits, though not immediately on wine, ‘to tackle binge drinking.’ The move, agreed between the Department of Health and alcohol manufacturers, and which will also extend the practice of ‘unit labelling,’ is intended by the industry to head off legislation to force it to introduce health warnings.

The Government is also planning a publicity campaign against binge drinking, probably including TV and radio advertsing.

Here, Andrew McNeill comments on the importance of binge drinking as an issue of concern, and on the Government’s approach to tackling it.

Binge Drinking

Hypocrisy is a major element in the distinctive British attitude to alcohol. No southern European government would, in the perverse way chosen by the British, encourage the bars to stay open longer and longer -if possible, permanently - in order to encourage the population to drink less.

The drinking that the government says it wants reduced is heavy sessional intake. The media label this ‘binge drinking’ and Tony Blair calls it the new British disease. In reality, bingeing is neither new, nor a disease. It’s a choice. As the term has come to be understood, it is actually a culturally prescribed style of consumption practised by most young people at least occasionally, and often regularly. Of course, while bingeing is not a disease in itself it can certainly cause some severe health problems. Death rates due to acute alcohol intoxication resulting from binge drinking have doubled in the last 20 years in both men and women.

As this suggests, while bingeing has been a feature of British drinking culture for generations- there is a difference in the scale of it, and in particular in the mass public bingeing that is the economic basis of the commercialised night-time economy. This means that as well as being a culturally prescribed, if regrettable, choice, binge drinking is also a product on sale in every town centre. Other differences with the past are the fact that bingeing is now common even among the ‘underage’, and that it has ceased to be solely a male prerogative.

Binge drinking is more prevalent in Britain than almost all other countries of Western Europe except Ireland. In 18-24 year olds, only one in four women and one in six men say they never binge drink, so the great majority do so at least sometimes. In the 20 to 29 age group, 60 per cent of the alcohol consumed by women is taken in bouts of heavy drinking – defined as more than six units a day. For men of this age, half the drinking is done in heavy bouts, amounting to more than eight units a day. Bingeing is thus an integral part of the social life of most young adults.

Not only this, but overall alcohol consumption in Britain is still increasing sharply while in most other European countries it is stable or declining. In Britain, increased consumption is particularly noticeable in young women. It is true that compared to men the rise in women’s consumption started from a low baseline but that does not mean it can be dismissed as of no consequence. A recent Datamonitor report found that British women under 25 already drink more than their counterparts in other European countries and it estimated that over the next five years they will increase their intake by an additional 31 per cent, with the result that by 2009 they will be drinking more than three times as much as young women in France and Italy.

In neither men nor women does heavy drinking suddenly start from nothing at the age of 18. It begins in the teenage years, and indeed, British girls are now even more likely than boys to be bingers – a pattern that so far as we know is without precedent anywhere. Teenage binge drinkers are more likely than others also to be binge drinkers in their twenties, so the comforting idea that bingeing is merely a phase, a rite of passage, may be wishful thinking.

How much does it matter? Some suggest that public and political concern about drinking in general, and women’s consumption in particular, is unwarranted, often little more than a ‘moral panic’, a thinly disguised expression of an interfering Puritanism and, in the case of women, an attempt to deny them their newfound freedom to behave as they choose.

Unfortunately, the motives of those who warn of the dangers can be dismissed rather more easily than can the dangers themselves. It is simply a statement of fact that binge drinking is causing rising levels of alcoholic gastritis, pancreatitis and liver damage especially in women, diseases that were until comparatively recently found only in men of middle age and older.

In recent years, there has been a huge amount of research into the medical and social consequences of alcohol, and one of the main findings is that the pattern of consumption matters as much, or more, than the overall amount consumed. Bingeing is a choice, and arguably it is the most unhealthy pattern of consumption it is possible to choose. For one thing, none of the supposed health benefits of alcohol is obtainable from a bingeing pattern of consumption: binge drinking does not reduce the risk of heart disease, it actually increases it. Repeated heavy drinking can lead to high blood pressure, heart muscle damage, irregular heart beat and stroke.

There are also adverse psychological effects. Bingeing, resulting in rapidly rising blood alcohol concentrations, causes a higher level of psychological morbidity, particularly in the case of anxiety and neurosis, than even the same amount of alcohol consumed more steadily over a longer period. Again, these effects are more pronounced in women.

As might be expected, the adverse effects of bingeing are particularly evident in the young. Repeated high blood alcohol concentrations are particularly bad for teenage brains, with obvious implications for learning capacity and memory. Teenage bingeing has been linked to impaired mental and social development, reduced school performance and attainment, and increased likelihood of school exclusion. It is not surprising that the subtitle of a recent publication aimed at youth, sponsored by the American Medical Association, was ‘Drinking makes you stupid’. Early introduction to alcohol, particularly binge drinking, increases the likelihood of heavy drinking and alcohol problems later in life.

Then there are all the other social problems linked to bingeing, such as consumption of illegal drugs, crime and antisocial behaviour. There is, for example, a close relationship between bingeing and undesirable or undesired sexual behaviour. Alcohol is quite certainly the biggest date rape drug, and high proportions of first sex and unprotected sex take place while the participants are drunk. In this connection, given what is known about the effects of alcohol on the reproductive system and on the foetus, there are some obvious and disturbing implications of the popularity of binge drinking in young women of childbearing age. Here, as elsewhere, it is not just that there are problems in the here and now, it is that they are also being created for the future.

What to do?

Government initiatives fall under three main headings: a new Alcohol Licensing system; an Alcohol Harm Reduction Strategy, and the Public Health White Paper. These encompass a large number of measures, some of which are sensible, but there is also a great deal of naivety and, more cynically, a good deal of playing fast and loose with the evidence. The idea, central to the new Licensing Act, that the principal means of countering binge drinking is the abolition of the system of permitted hours was promulgated in spite of the evidence rather than because of it. The idea, favoured by the Alcohol Strategy, that alcohol education in schools is the answer to the problem similarly lacks any convincing evidential base.

The Government is now planning an anti-binge drinking advertising campaign. The issue here is the same. – evidence, or, rather, the lack of it. There is no known example of a publicity campaign of this kind bringing about any measurable reduction in the incidence of binge drinking. Such campaigns may be of benefit in the sense that they draw attention to the issue, and they may even affect people’s attitudes towards it, but it is simply naïve to expect them to bring about any sustained change in what people actually do.

In contast, the evidence on the value of controls on the fiscal and legal availability of alcohol was discounted in the Alcohol Strategy. For example, there is good evidence that one of the most effective ways of reducing bingeing and violence – the main cause of public and political concern – is to increase the price of alcohol. A one percent rise in the real price of alcohol could be expected to result in up to 5,000 fewer assaults in England and Wales. Unfortunately, the Government rejected this as an approach.

Similarly, in relation to young people, the evidence is clear that what we need is a concerted policy of delaying the onset of regular drinking in childhood and adolescence, not naïve attempts to teach them to drink ‘sensibly’.

But, of course, measures such as delaying onset and tax increases are politically more difficult, and certainly deeply disliked by the alcohol industry.

In regard to national policy, therefore, the root of the difficulty lies in the Government’s heavy reliance on forming a partnership with the alcohol industry, a policy likely to be a very mixed blessing indeed. As evidence of the benefits of this approach the Government will point to the recently announced initiative of the British Beer and Pub Association purportedly to put an end to ‘binge drink as much as you like for £10’–type promotions among its member companies. Unfortunately, what is proposed falls a long way short of the billing and it does not begin to tackle the features of the market that give rise to these promotions in the first place.

The larger picture suggests that it is very unwise to place the alcohol industry in such a privileged position that it has almost a power of veto over national policy. Binge drinking, after all, is dangerous and destructive to both individuals and society, but it is also extremely profitable.