IAS response to Government Licensing proposals

Local Authorities and Alcohol Concern unhappy with the plans – If the Government expected a chorus of praise for its White Paper on Licensing Reform (see Alert, no.2, 2000), then it must be very disappointed. Criticism has come from a wide variety of sources, not simply from expert organisations such as the Institute of Alcohol Studies (IAS) and Alcohol Concern, but from local authorities of all political persuasions, such as Camden, Islington, and Westminster. Perhaps rather more unexpectedly, the Government’s proposals have also been attacked by the body representing the nightclub industry.

What emerges is that the White Paper is ill-prepared and full of inconsistencies. This is made clear from the response given to the Home Office by the IAS. Whilst accepting that the present licensing laws are far too complex and in need of modernisation, the response says that “on a number of key issues, the White Paper is so confused and ambiguous that it is impossible to determine what the Government actually intends. It is disturbing that the Government has clearly not thought through a number of its own proposals.” The IAS is especially concerned “by proposals in the White Paper which go beyond the requirement of modernisation, and which are likely to undermine rather than protect the public welfare.” Similarly, in a joint letter to the Home Secretary the leaders of Camden, Westminster, Islington, and Hammersmith and Fulham Councils said: “The proposals grossly underestimate the complexity of the role that local authorities in London need to undertake in order to achieve a reasonable balance between the demand for increased flexibility by the entertainment industry and the protection of our residents from disturbance.”

According to the IAS the “principal benefit of the proposals for the public as distinct from the alcohol and hospitality industries, is claimed to be in regard to crime and disorder, in particular, a reduction in the street crime and disorder occurring around the closing times of pubs and clubs.” However, there is a problem here in that, important though they are, crime and disorder are not the only relevant considerations. “There is alsothe question of public health. It is not self-evident that these other considerations should necessarily be regarded as less important than street crime. This is especially so since the benefits of the White Paper’s proposals in regard to street crime are in fact extremely doubtful.” Alcohol Concern believes that “it is crucialthat the key principles of the Licensing White Paper should include improving public health as well as reducing crime and disorder.”

The IAS points out that for years there has been a vigorous lobby urging the abolition of closing time. “Those with a vested interested in selling alcohol, journalists and other self-appointed experts, have insisted that if only closing time were abolished, the English would become like the French and the Italians, the culture of drunken yobbishness that afflicts town and city centres at night and at weekends would disappear, and peace would reign on the streets.” It now appears, says the IAS, that the Government has now joined the ranks of those promoting this highly simplistic solution to a complex problem.

The response does not start from the position that the present licensing laws are written in stone, but “on the basis of the available evidence, we believe the Government’s proposals are a reckless gamble with the remnants of what was once justly celebrated as the English tradition of social peace and civility. We object particularly strongly to the way in which the Government promotes the case for the de-regulation of closing times by either ignoring or misrepresenting the available evidence.

“We regard it as highly regrettablethat the Government has scorned the opportunityto devise a licensing regime based on a wide-ranging social consensus and which, serving the interests of society as a whole, would be likely to last. Instead, the Government has preferred to propose a regime that will serve the interests of parts of the licensed trade and a minority of drinkers at the expense of the wider community.”

The IAS believes that the proposed reforms conflict “not only with public opinion but potentially also with the Government’s own policies on health and crime” and that some of them “will actually reduce the protection available to local communities”. The proposals, says the response, are likely to create more problems than they solve.

The Home Secretary’s passing reference to the national alcohol strategy in his Foreword to the White Paper serves only to emphasise how disconnected the Government’s licensing proposals are from these wider considerations. “There is no discussion in the White Paper of the possible long-term consequences of the proposals for the problem of alcohol misuse,” says the IAS and, after the Home Secretary’s reference, there is virtually no further mention of health in the document. “Nowhere in the White Paper is there any recognition that liquor licensing may have a role to play in protecting public health. Presumably, it is not without significance that the White Paper lacks an endorsement from the Secretary of State for Health,” the response’s author pointedly remarks.

“The Government is not able to justify its disregard of these issues on the grounds that its overriding responsibility is to meet the public demand for wholesale liberalisation of the licensing law, for the bulk of the population are opposed to it,” says the IAS, referring to the NOP poll which it commissioned earlier this year (see Alert, no.1, 2000).

The IAS response calls the Government’s attention to the social context of liquor licensing reform:

  • adult consumption in 1998/9 was probably higher than at any time since the First World War.
  • between 1990 and 1996, the average amount drunk by 11-15 year olds doubled.
  • more than a quarter of men (27%), and 14% of women exceed the old `sensible limits’ of 21 and 14 units of alcohol per week and among 16-24 year olds, 35% of men and 22% of women exceed these limits.
  • a notable feature of recent years has been a growth in young people of drinking to intoxication, with all its associated problems.

In the context of the last point IAS says that it is argued “by some, apparently seriously, that this trend too is yet another evil attributable to the present licensing system. This would be a remarkable feat indeed, as the trend is evident in those too young to drink in pubs and thus be constrained by the licensing law, and is also reported across most of Europe, including France and Spain – countries whose more relaxed licensing regimes are claimed to prevent these very problems.”

When discussing the Government’s actual proposals, the IAS expresses support for the intention to transfer responsibility for some licensing matters to local authorities, “although we think that the Government’s proposals go too far in excluding magistrates from the licensing processWe support the transfer of responsibility to local authorities on the grounds of public responsiveness and accountability. However, we are concerned that local authorities may well have a potential conflict of interest in regard to the granting and revocation of licences.

Local authorities will expect to obtain direct and indirect benefits from licensed premises in connection, for example, with the commercial development of town centres, and there is a clear danger that the interests of local residents will be sacrificed to these ends.”

On Personal and Premises Licences: “We do not object on principle to the concept of a split system of licensing but we question whether the Government’s proposals contain sufficient safeguards for the system to work satisfactorily in the public interestIt is difficult to tell from the White Paper where the responsibilities of the personal licence holder end and those of the premises licence holder begin, especially of course when they are different people.” If the holder of the premises licence is “a corporate bodyit will be necessaryto define the legal liabilities of [those] bodies

“The Government proposes making the award of a personal licence automatic in cases where the applicant has gained an accredited qualification and has no criminal convictions.”

The IAS argues that merely having a qualification and being free of criminal convictions are “not normally taken as an assurance of suitability for a job, especially in the absence of relevant experienceWe fully support the requirement of training for licensees. However, especially given the varied demands placed on them in the wide range of licensed outlets that now exists, the possession of an accredited qualification does not of itself indicate that a person’s suitability for a post can simply be taken for granted.”

The IAS believes that it will be necessary for an assessment to be made of the character and suitability of applicants for licences and of licensees and that experienced magistrates should perform this duty. Alcohol Concern opposes “a statutory presumption in favour of renewing a personal licence after ten years for a further ten years, and believe that licence holders should be required to undergo an additional period of training.”

The response points to the “vagueness of the White Paper in regard to the day to day management of licensed premises is also apparent in connection with the question of the skills and qualifications of staff other than the licence holderAs far as the premises licence is concerned, the operating plan is another area in which the White Paper’s lack of clarity is evident.”

The IAS believes “that what is actually called for here is that the new licensing authority seeks ways of entering into a constructive dialogue with licensees, facilitating the effective monitoring of premises and early warning of significant changes of trading policy.” Although the suggestion is obvious, it is not one made in the White Paper.

There is agreement between the Government and the IAS that a single unified on-licence, such as is envisaged in the White Paper, would have the great advantage of simplicity. There are, however, “dangers attached and we do not believe that the Government’s proposals maintain an adequate degree of social protection”.

Referring again to the NOP poll, the response says that “very large majorities are opposed to licensed restaurants becoming pubs in the way the Government proposes and of giving children unlimited access to barsAn even larger majority is opposed to the prospect of fast food restaurants like MacDonald’s becoming a kind of pub”

Objections to Licences and Conditions

The London council leaders in their letter to Jack Straw say: “We are concerned that the proposals undermine the current definition of nuisance and place the emphasis on the objector to ‘prove their case’ [sic]We feel that the presumption should be that the applicant must demonstrate that minimal nuisance will be caused, whether or not there are any formal objections.”

Similarly, the IAS believes that the proposals for objecting to licences place unreasonable burdens on local residents and will prove strong disincentives to their pursuing such a course. “Sometimes, local residents will have legitimate cause for complaint arising from the characteristics of specific, badly managed premises. In these cases, the proposed new police power to close disorderly premises will be helpful. However, we are concerned that the White Paper appears to deny local residents any means of appealing against a decision of the licensing authority to refuse to review a licence. We accept that it is necessary to discourage flippant or malicious objections, but to deny local residents any means of redress at all is surely going too far

“Where applications for a new licence or late trading are concerned, we consider it an unjustifiably onerous burden on local residents that they should be expected to prove in advance that their lives will be `unreasonably’ disrupted. Natural justice surely dictates that it should be incumbent on the party whose action might inflict damage on others to establish the acceptability of the proposals

“On the basis of the Government’s proposals, not only must the unfortunate local residents find a way of fighting and funding this unequal contest, they must do so in the knowledge that if they lose the case on appeal, they could have all the costs awarded against them

“As the defining criteria of ‘reasonable objections’ to new applications laid down in the White Paper are patently too restrictive, it follows that there should not be presumption in favour of granting a licence without a hearing in the absence of objections. In our view, the licensing authority should not be able to abdicate its responsibilities in this way: all applications should be examined to ensure that they are compatible with the public interest and the process of examination should always be conducted in public.”

Fair Procedures and Appeals

“The most conspicuous feature of the Government’s proposals regarding appeals,” says the IAS, “is their lack of clarity. The relevant paragraphsconsist of self-contradictory statements which assert both that the appeal courts will be able to re-consider the merits of the case and also that they will not be able to do so, as they will be restricted to legal and procedural matters.”

Children and young people

The IAS welcomes the conclusion “that the time is not right to lower the current age limit to 16 or 17. We are, however, concerned by the clear implication that the Government could yet be persuaded to change its mind, an impression reinforced by this being one of the few issues on which the White Paper explicitly seeks views.

There is minimal [public] support – less than 10 per cent – for any lowering of the legal age. Over three-quarters of the population favour retaining the present law.

There is more support for raising the legal age than for lowering it.

The response supports in principle all the proposals to tighten “the law on sales of alcohol to under 18’s. As usual, however, there are some aspects requiring clarification.” On the subject of access to licensed premises, the IAS says: “We accept that the necessity and applicability of children’s certificates is reduced by the blurring of the old distinctions between different kinds of outlet. We fear, however, that the vagueness of the White Paper in relation to the alternative safeguards proposed by the Government suggests that they are unlikely to be adequate.” In a jointly-signed submission to the Home Office, Chairman of Camden’s Environment Sub-Committee and the local police commander say that they too are concerned about the powers likely to be available to the licensing authorities to control children’s access to licensed premises. “This should not be left to the discretion of the licensee particularly in areas where there are many vulnerable young rough sleepers or where entertainment venues are aimed at young people.”

On this subject, the IAS continues: “In the first place, the White Paper gives no indication of what criteria will be employed by the licensing authorities to determine which premises are unsuitable for unaccompanied children, and whether licensing authorities will be free to select their own criteria or whether they will be nationally laid down.

“Secondly, in relation to premises deemed to be unsuitable for unaccompanied children, the White Paper refers to the children having to be “supervised by an accompanying adult”. Unfortunately, neither of these terms is defined. Presumably, “supervision” refers to something more than the mere fact of being “accompanied”, or the White Paper would have referred simply to children having to be accompanied by an adult, but what is that extra something? And what indeed is the meaning of “accompanied”? Presumably, the term implies at least being immediately available if needed, but would this require being in the same room, or merely arriving and departing from the building together?

“Thirdly, whatever criteria are chosen in regard to the (un)suitability of premises for unaccompanied children, these features are not necessarily permanent and unalterable. Licensed premises can change their clientele and hence their character quite markedly over time, even regularly during different times of the day and the week. The same pub can provide a very different environment at lunchtimes compared with late at night or at weekends. Is it the Government’s intention that even young children (normally unaccompanied) should have free access to licensed premises all the time they are open, irrespective of any changes in the environment they provide? Alternatively, if children’s unaccompanied access to licensed premises is to be restricted to times considered suitable, how is this to be managed?

“There is of course a significant and growing problem of under-age drinking, but there is no justification for implying, as the White Paper does, that the problem of alcohol misuse and the problem of underage drinking are one and the same. It is probable that more serious damage is done to young people as a result of adult drinking than their own, the very adult drinking that the Government’s proposals are likely to increase.

“We share the Government’s wish to improve public knowledge and understanding of underage drinking. We are, however, curious as to why the only organisation whose work in this area is recognised in the White Paper is the Portman Group. There are in fact a number of organisations which have been doing good work in this area for rather longer, and for less self-interested reasons than the Portman Group. Presumably, the Government has its reasons for ignoring them.”

Alcohol Concern, who might well see themselves as falling into the category adumbrated in the IAS’s response, echo the concerns of Camden Council and Police about under-age drinking and access to licensed premises.

The Criterion of Need

The IAS notes the failure of the White Paper to offer any justification for what has clearly become the Government’s view that the market alone, and not the licensing authorities, should decide how many licensed outlets there are in any locality:

“The White Paper states that decisions on whether to grant a new licence should be confined to considerations regarding impact on crime and disorder, public safety and ‘unreasonable public nuisance’. It accepts uncritically the current view of the Brewers and Licensed Retailers that the licensing authorities should not be able to take into account ‘commercial matters such as the economic demand for a new venue’.

“We agree that assessing the commercial viability of a new venture is not a proper function of the licensing authority, but protecting the public interest is. In our view, that requires having a adequate means of controlling the number of licensed outlets in a locality.

“There is good evidence that some alcohol related problems stem less from individually identifiable, badly managed premises than from the density of licensed outlets in a locality. These problems include drunkenness convictions, drink driving and admissions to hospital accident and emergency departments.

“Some may consider it strange, therefore, that a Government about to launch a strategy for tackling alcohol related problems should propose a new system preventing licensing authorities from taking into account these very considerations. At the very least, the research findings in regard to the density of outlets surely provide further reason for ensuring that the impact of the new licensing system is carefully monitored and assessed so that corrective actions can be taken if necessary.

“We are not convinced that the powers granted to local authorities under the planning procedures enable them to exercise sufficient control of the number of outlets

“Nor does the White Paper offer any justification for abolishing the `criterion of need’ in licensing law, or for rejecting the Scottish model which allows licensing authorities to reject applications for new licences on grounds of `over-provision’. These issues are not discussed at all in the White Paper.

“We believe it is in the public interest that such a power be retained in some form. Proposing to abolish it is one of the features of the White Paper that gives the lie to the Government’s claim that it seeks to empower local communities. There is overwhelming public support for residents to have the right to object if they think an excessive number of pubs and clubs are being opened in a locality. In our view, the criterion of need or over-provision is essential if that right is to be meaningfully exercised

“In the UK, a former Home Secretary (David Waddington) urged Magistrates to use the power that the present Government seeks to abolish in order to prevent what he called `alcohol flashpoints’ – an over-concentration of licensed outlets in a locality, in order to reduce public order problems. More recently, Superintendent Brian Wroe of Greater Manchester Police referred to the problem caused by the continuing explosion of new bars in the city centre, where in the last ten years the number of bars has doubled from 220 to 500, and where between 1998 and 1999, the number of recorded assaults outside bars and clubs rose by 30 per cent.

“This view is shared by some in the licensed trade. In Scotland, the then president of the Licensed Trade Association identified over-provision of outlets as one of the main problems facing the industry and as a significant cause of alcohol abuse. He said that too many outlets were chasing insufficient trade by means of sales promotion and corner cutting, accepting lower profits so that there was less money available for reinvestment and staff training.”

Licensing Hours

The IAS makes it clear that it does “not object on principle to any extension of licensing hours. In our view, the priority should be to make the licensing system democratic, more accessible and responsive to local communities. It follows that those who wish to extend licensing hours should have the right to do so. Equally, longer hours should not be imposed on localities that do not want them. The evidence suggests that most will not. We assume that there is greater demand for extended hours in town and city centres than in residential areas.

“None of tis, however, implies agreement with the Government’s proposal for complete de-regulation of closing times, a proposal to which the great majority of the public, especially women, are opposed and which, if implemented, is likely to impose considerable burdens on local communities and, ultimately, the wider society.

“We are particularly concerned that the effect of the Government’s proposals will be to prevent the licensing authority from operating a coherent policy on licensing hours for its districtThis proposal in particular reveals the Government’s claim that it seeks to empower local communities as mere pretence.”

The Argument

“The principal claim,” says the IAS, “is the ludicrous one that the sole reason for drunken disorder on our streets is the restrictions introduced during the First World War ‘to keep the munitions workers sober’. The clear implication of this story is that both licensing controls and drunkenness are inventions of the early C20th, an eccentric reading of British history but one to which both the White Paper and the Home Secretary in his statement to the House of Commons appear to subscribe.

“According to the mythology that has been so assiduously constructed, these restrictions are the cause of all the problems. Only get rid of them, we are assured, and there will be no bingeing and drunkenness: we shall become like the French and the Spanish, who, apparently, are entirely free of alcohol problems.”

The response highlights the absurdity of the chart, published in the White Paper and drawn to the attention of Members by the Home Secretary in the House of Commons. Alert (Issue no.2, 2000) has already pointed out that, so far from indicating that public disorder is caused by “the eleven o’clock swill”, the chart shows clearly that pub closing time is irrelevant: the same number of incidents of public disorder occur at four and five o’clock in the afternoon as at eleven o’clock at night.

If the Home Secretary seriously believes the 11pm pub closing to be the cause of so much public disorder, “it is worth noting the irony that the effects of this restriction must now be exactly the opposite of what they were when first introduced.

‘A transformation of the night scenes of London has followed the closing of the public house at 11 o’clock .. The police instead of having to move on numbers of people who have been dislodged from bars at 12.30 at night, found very little intoxication to deal with, the last hour and a half being responsible for much of the excess of which complaint is made.’

“This comment was not made by any individual or organisation with ‘anti-alcohol’ views: it was contained in an editorial in the Brewers’ Gazette. Testimony to the beneficial effects of 11pm closing was also given by Sir Edgar Saunders, then director of the Brewers’ Society, in evidence to the Royal Commission on Liquor Licensing in 1931.”

Who will make use of the extra hours?

The White Paper implies that present closing times are a considerable inconvenience to the bulk of the population, who are very keen to have the opportunity of drinking late through the night. “None of this,” says the IAS, “is true.

“Only a relatively small minority – around 20 per cent – say that they will make use of extended drinking hours at all frequently. This minority is made up disproportionately of people who, presumably, the Government and the alcohol industry would describe as ‘alcohol abusers’. Those who exceed the recommended ‘sensible limits’ promoted by the Government and the industry are twice as likely as those who do not to say that will make use of the extra hours. This is the same pattern that has already been found in relation to previous extensions of drinking hours in the UK and elsewhere. Evaluation of the 1988 Licensing Act showed that the more heavily people drank, the more likely they were to make use of the later drinking hours: 60%-88% of men exceeding the ‘sensible limits’ reported later drinking in pubs, compared with just 22% of ‘sensible drinkers’. In one Australian study, two thirds of those drinking in bars late at night were found to show signs of alcohol dependence.

“A conspicuous irony of the Government’s proposals, therefore, is that the economic viability of extended drinking hours is clearly going to depend to a large extent on the custom of the very groups of people whose drinking the national alcohol strategy will presumably seek to reduce.

“The White Paper contains a list of improvements that ‘research shows’ de-regulation will bring about. Unfortunately, the source of this ‘research’ is not an authentic academic publication, but a book published eight years ago on behalf of the Portman Group, an association comprised of some of the very brewing companies which have campaigned most vigorously for extended drinking hours.

When this book first appeared, it was condemned by a reviewer as being of such poor quality that, had it been submitted for peer review, it would have been rejected for publication.

“The White Paper ignores completely the authentic scientific literature on the subject. Generally, this finds that while increased hours of trading may not increase the overall level of alcohol consumption (at least where alcohol is already widely available), they do increase the problems associated with consumption. A recent publication summarised the international research evidence as follows:

  • Increases in hours of sale are consistently related to increases in alcohol-related harm, including traffic injury, street disorder and violence.
  • Later and longer hours for alcohol sales contribute disproportionately to heavier drinking and drunken behaviour.

These findings, of course, confound the whole premise of the White Paper.”

The response then turns to the evidence for Scotland being a model of peace and sobriety as a result of de-regulated closing: “Even the Portman Group report concludes that the Scottish evidence is too ambiguous to draw definite conclusions in regard to the effects of changes in permitted hours.

“However, the only other source cited in the White Paper, the Home Office report Alcohol and Crime: Taking Stock, states: ‘The Scottish experience of more liberal drinking hours appears to have worked well, changing the masculine binge drinking culture to a slower drinking, female-friendly environment.’

“No evidence in support of these claims is given.” Indeed, the response quotes telling evidence to the contrary, including the views of the Chief Constable of Aberdeen who “blamed the late-night opening policy for a growing problem of disorder on the streetsA year after the chief constable’s comments, the Scottish Office sent a circular to all the licensing boards which stated:

‘From recent representations to the Secretary of State, it is clear that, in a number of licensing board areas, the proliferation of regular late night extensions is causing difficulty and distress to local residents, and to police in the maintenance of order in the early hours of the morning, out of all proportion to any benefit the community may derive from the grant of such extensions.’

“In Edinburgh, the Safer Edinburgh project team concluded that the liberalisation of the licensing law had gone too far, “meeting the interests of the licensed trade and a small section of the drinking public at the expense of the wider community”. Part of the problem was that lack of a uniform closing time resulted in considerable numbers of people wandering homewards through the city centre throughout the night. The random incidents that occurred in consequence led to police resources being over-stretched.

“A reduction in late night drink-related violence and disorder emerged as one of the main priorities of the Safer Edinburgh Project. Statistics provided by Lothian Police show that substantial improvements resulted from the re-imposition of restrictions on late night opening and the reintroduction of zone closing, ie set closing times in a specified geographical district.

“It is particularly disturbing that the policy that proved beneficial in Edinburgh is precisely the option that the Government has rejected for England and Wales.”

The IAS’s response goes on to provide evidence from the Netherlands, New Zealand, and Australia that late night opening has the opposite effect from that envisaged by the Government.


“On one particular issue,” the response says, pulling no punches, “the Government threatens not so much to ignore public opinion as to treat it with utter contempt. The majority of the public are opposed to greatly extended drinking hours on any day of the week but especially on Sundays. The Government rejects the possibility of any special arrangements for Sundays on the grounds that we live ‘in a multi-cultural and diverse society in which a great range of days are held by certain groups to be sacred or special’. The ‘only sensible approach’, therefore, is to treat each day equally in respect to licensing law.

“There is no justification for assuming that religion provides the only reasons anyone could have for objecting to extended drinking hours on Sundays. On the contrary, unless there were good secular reasons involved, it is very unlikely that the majority against extended drinking hours on Sundays would be as large as in fact it is.

“We are, however, dismayed by the arrogance of the Government in dismissing as unworthy of consideration or respect the cultural heritage shared by the vast majority of the population it is supposed to represent. This attitude is particularly objectionable in a Government that claims, obviously hypocritically, ‘to love British history, Britain’s cultural heritage (and) the British way of life’.

“As well as arrogance, there is dishonesty involved here. The Government recently sought to amend the Sunday Observance law on the basis of an assurance that, in order to protect local residents, before deciding whether to allow the sale of alcohol late at night, the licensing authorities would be required to consider ‘the special nature of Sundays’.

Economic Considerations

The White Paper goes on to detail the cost savings to the alcohol industry as a result of the Government’s proposals. The IAS makes the point, however, that it does not “address the question of what savings or, alternatively, additional costs will be experienced by the taxpayer. The implication of the White Paper is, of course, that the decreased levels of crime and disorder it promises will save taxpayers’ money by reducing the costs of policing.

“Experience from abroad suggests, however, that the opposite is more likely to be case”.

“In our view, there is no acceptable case for forcing the ordinary taxpayer to subsidise late night opening. We believe that the obvious sources of the money are the licensed premises themselves: there shoud be a special charge for late trading licenses, large enough to cover additonal costs”.

Where is the alcohol strategy?

Kelvin Hopkins MP, the Chairman of the All Party Group on Alcohol Misuse, sees the present high levels of consumption, especially among young people, as a major problem. Outlining his views at a meeting of the Medical Council on Alcoholism, he drew attention to the fashion for binge drinking and our excess compared to other countries. Mr Hopkins made it clear that he looked to see these things addressed “when the national strategy appears”.

It was clear that he was unaware of when this would be but felt that the reason for the long delay in its appearance was the result of a desire “to get it right”. The Department of Health itself has offered different excuses, originally pointing to staff shortages – perhaps one reason for employing the man from Bass Breweries to draft the plan – and then to the re-organisation of the National Health Service. Some have commented that the delay may also be in part a result of the government realising that, in setting out to establish a national alcohol strategy, they were likely to end up in the politically unacceptable situation of pleasing no-one and alienating many of the interested parties: health professionals, the drinking public, the industry. A complicating factor has no doubt been the less than enthusiastic response in many quarters, including local government, to the proposed reform of the licensing laws.

Many of those at the MCA meeting in the Royal College of Physicians, including clinicians and representatives from organisations such as Alcohol Concern, Al-Anon, the Foetal Birth Syndrome Association, and the Institute of Alcohol Studies, had hoped that Mr Hopkins would be able to let us know when to expect the strategy to appear. Although this was not to be, he did express views to which, given his position as the voice of backbenchers on the alcohol problem, the government ought to pay attention. Mr Hopkins believes in a continuing high level of taxation as a means of limiting consumption and in curtailing promotions such as “happy hours”. Questioned afterwards, he said that he believed that the government ought to move towards a per capita reduction in alcohol consumption. The Department of Health, as reported previously in Alert, has stated that the Labour Government, presumably at the behest of those lobbying on behalf of the drinks industry, has set its face against the consumption model.

Mr Hopkins’ views also contrasted with those of the government on other matters. Discussing how to get the message over to young people that alcohol has the potential to ruin lives, he advocated a ban on alcohol advertising in public places and on television. In addition he was strongly in favour of lowering the drink-drive limit, a move which the government has rejected after apparently being in favour.

One of the dangerous results of the delay in producing the alcohol strategy was highlighted at the Medical Council on Alcoholism meeting by a representative of Alcohol Concern. At the moment treatment and rehabilitation services are starved of funding as all the money currently allocated to substance abuse problems is poured into the high profile campaign against illicit drugs use. Given that far more people are suffering from problems related to alcohol abuse, the consequences of this are not simply tragic for individuals but also place a further burden on the overstretched National Health Service. Local public health teams respond to the “must dos” received from government and, at the moment, alcohol treatment is not among them. Mr Hopkins said that this and other problems would at least be partially addressed were the Department of Health to issue an interim strategy, perhaps consisting of a number of major bullet points which would indicate the policy it intends to pursue.

The most recent information from well-informed sources indicates that the strategy itself will not be much more substantial than the interim measure adumbrated by the Chairman of the All Party Group on Alcohol Misuse. According to these sources, it has been decided that the strategy will not appear before Christmas so as not to be confused with the seasonal drink-driving message.

Crime, disorder and nuisance

The Home Office has published its action plan, Tackling alcohol related crime, disorder and nuisance. In the style the government has come to adopt in its desire to accommodate the industry, the document begins by making the point that “almost 90 per cent of the UK population enjoys alcohol, in the most part without causing difficulties for themselves or others”. It goes on to say, however, “alcohol misuse is a major cause of both ill health and social distress”. The stress on “misuse” is the Home Office’s.

Although reference is made to the long-awaited national alcohol strategy from the Department of Health which is now due to be published “later this year”, the Home Office clearly recognises that it has to make progress now in tackling the crime and disorder problems associated with alcohol. The new plan outlines a range of initiatives and “a context for developing new ideas and innovative approaches.”

The document states that something in the region of 40 per cent of violent crime; 78 per cent of assaults and 88 per cent of criminal damage cases are committed while the offender is under the influence of alcohol. Alcohol is often used by offenders and victims before an offence is committed, and it is inextricably linked to disorder around licensed premises. It is acknowledged that fear of alcohol-related violence or intimidation may well mean that large numbers of people avoid city centres on weekend evenings.

The plan aims “to encourage local action to reduce levels of alcohol-related crime, disorder and nuisance”. The reduction of under-age consumption of alcohol is the first of three specific objectives set out. Although it is important that the myth that alcohol problems are essentially associated with the young is not strengthened, it is absolutely true to say that underage drinking “must be addressed because it increases substantially the risks of young people becoming involved in criminal and disorderly behaviour, as well as leading to under-achievement at school, poor health and poor employment prospects which may lead on to additional problems in later life”. As reported in Alert at the time of its publication, the 1998/99 Youth Lifestyles Survey reported that 84 per cent of 12 year olds had drunk alcohol at some time in their lives, with drinking increasing as they get older. It has been shown that the earlier the onset of drinking, the more likely dependence is to occur later in life.

The plan suggests, whilst pointing to measures proposed in the white paper on licensing reform, that “the existing legislative provisions – set out in the Licensing Acts of 1964 and 1988 – should be rigorously enforced to prevent the sale of alcohol to under 18s”, that the provisions of the Confiscation of Alcohol (Young Persons) Act 1997 should be widely used, and that there should be more widespread use of “Proof of Age” schemes to enable those 18 and above to establish their age in premises where alcohol is on sale. The statement that “more widespread use of these schemes, which are voluntary, will make it less likely that those under 18 will attempt to purchase alcohol themselves because they will be unable to prove that they are 18 years of age” should be read in conjunction with recent research reported on page 15 of this magazine.

The second objective of the plan is to reduce public drunkenness which “can give rise to serious problems of disorderly conduct, nuisance, criminal damage and alcohol-related assaults, particularly in the proximity of licensed premises at closing time”. The unsupported assertion that the white paper’s proposal for flexible opening hours, with the potential for up to 24 hour opening, will ease this situation is again repeated. In respect of public drunkenness, the plan puts forward nothing which is not already in the white paper

The prevention of alcohol related violence is the plan’s third objective. The document says that research into alcohol and violent crime has consistently shown that a high proportion of violent crime (between 50 and 80 per cent), including assault, rape, and murder, is committed by people who have been drinking. In addition, “studies of violent offenders have found them much more likely to be heavy drinkers”. Among the solutions suggested are that:

  • hotspots associated with alcohol-related crime and disorder should be targeted;
  • greater use too should be made of information sharing schemes to keep troublemakers from pubs and clubs;
  • the role of both bar staff and door supervisors in helping to reduce incidents of disorder be properly recognised;
  • there should be more widespread use of toughened drinking glasses in pubs and bars and a refusal to sell beer in bottles in pubs and clubs, to help reduce the possibility their being used as weapons.

The Home Office hopes that all of its action plan will be adopted into local integrated strategies for tackling alcohol related crime and associated disorder and nuisance. It will be launching a good practice “tool kit” later in the year to assist local partnerships in delivering their strategies for tackling alcohol-related crime, disorder, and nuisance.

Alcohol and tobacco ‘worse than cannabis’

Medix UK, a website operated for the medical profession, has conducted a survey over nearly 1,000 doctors which shows that the vast majority believe that cannabis is far less addictive and considerably less of a health problem than either alcohol or tobacco. Although there remain serious reservations about the safety of cannabis, and a great deal has been said in recent years about its potential to induce psychosis, the majority of doctors would be in favour of relaxing the present laws on cannabis and would prescribe it were it legal to do so.

The doctors surveyed were asked, given their experience with patients of tobacco, alcohol, prescribed drugs, illegal drugs other than cannabis, and cannabis itself, which substance they believed to be the most addictive:

  • 58% view tobacco as the most addictive
  • 28% view cannabis as the least addictive
  • 72% view tobacco as the worst health problem
  • 44% view cannabis as the least serious health problem

The survey showed that doctors see far more patients with alcohol and tobacco dependency or related health problems than with cannabis. Their answers showed that:

  • 64% see at least 10 patients per month with tobacco-related problems
  • 24% see at least 10 patients per month with alcohol-related problems
  • 2% see at least 10 patients per month with cannabis-related problems

54% of doctors believed that current cannabis laws were too strict. 32% responded that they believe that cannabis should be legalised.

As far as the long-term safety of cannabis is concerned, one doctor commented, “to say that cannabis is safer than alcohol or tobacco is no great boast”. Although 88% of doctors said that they would prescribe cannabis for a grave illness such as terminal illnesses if it became legal, only 20% would prescribe it for pain relief of minor problems. The survey indicates that the majority of doctors have professional experience that cannabis use can lead to dependency on other drugs. Half of the doctors questioned said that they had had patients to whom this had happened, while only 30% had not.

A significant number of doctors volunteered their experiences of cannabis triggering serious mental health problems in patients. The other concerns mentioned were:

  • Driving and cannabis
  • Extension of available means of drug dependency or abuse
  • Lack of reliable scientific studies about the medicinal benefits and long term effects of cannabis
  • Links between tobacco smoking and cannabis
  • Long active life of cannabis in the body (one week half life)
  • Memory and intellectual loss associated with cannabis use
  • Possible link between cannabis smoking, cancer and lung disease
  • Pregnancy and cannabis

Many will see the Medix survey as an important contribution to the debate about cannabis legalisation. Cannabis appears to be less of a health problem and less addictive than alcohol or tobacco in the experience of the vast majority of doctors. Most of them seem to see cannabis as a potentially valuable drug for treating serious illnesses and are in favour of some change in the present state of the law. There are, however, serious concerns voiced about the safety of long-term cannabis use and its potential for contributing to serious mental illness.

Public want time called on alcohol related crime

The majority of the British people believe that the level of alcohol-related violence continues to rise. This is one of the findings of an opinion poll commissioned by the drink industry-funded Portman Group.

The MORI survey found that 61 per cent of the public thought that this violence was increasing on the street and 52 per cent thought the same thing was happening in pubs. Whilst people living in London, the south-east, and Scotland are the most likely to be victims of street violence, the Scots run the greatest risk in pubs. Women are almost twice as likely as men to suffer alcohol-related violence in the home (9 per cent as against 5 per cent).

Unsurprisingly, a majority of the public (57 per cent) see teenagers as the major offenders when it comes to street drinking. 28 per cent see young adults as the problem on the streets, 24 per cent weekend drinkers, and 23 per cent “down and outs”: anyone other than themselves, presumably.

The survey – the third part of an exercise that began some months ago – shows that 70 per cent of the population still see drink-driving as a major problem. The Portman Group says: “Heavier penalties for persistent offenders, better enforcement of existing laws, more public education campaigns and random breath testing all attracted more public support than reducing the drink-drive limit.” This statement must be viewed in the light of authoritative surveys which show that between 70 and 80 per cent of people want to see the limit lowered from 80 to 50 mgs per litre.

A few years ago the Portman Group was more anxious to show that there was no general link between alcohol and crime – and, by implication, with violence. When it published a report called “Low in Alcohol” in 1995, Professor Robert Solomon dismissed it as “beside the point” in this magazine (Alert, January 1996). The report, said Professor Solomon, “appears to be structured to achieve preordained outcomes”. In the case of the present survey, there is no disguising the association in the public’s mind between alcohol and violence, although the Portman Group’s Director, Jean Coussins, wonders whether those who took part in the poll were right in their opinions – which rather suggests that there was little point in bothering with the survey in the first place. “This survey,” says Miss Coussins, ” tells us a great deal about what the public believes, although there is a dearth of reliable evidence to help us assess the accuracy of public perceptions when it comes to alcohol and crime.” Given the volume which exists, how much more evidence does she require?

The industry campaign to influence the Government, in many respects already conspicuously successful, was reflected in the two other surveys which the Portman Group commissioned earlier in the year. In one, health warnings were the target: “The survey reveals that nearly twice as many people (39 per cent: 21 per cent) think shock tactics are more effective than long term health warnings.” It is important to the industry, and presumably to the Portman Group, to convey the impression that alcohol problems are confined to a minority of misusers: “(63 per cent) see binge-drinking as a major problem. Yet when questioned about their own behaviour, only 5 per cent said they regularly get drunk.” What these figures are intended to show is unclear. The are certainly compatible with the experience of therapists that truth and misuse of alcohol are usually strangers.

“The vast majority of respondents (77 per cent) understand the Government’s advice that sensible drinking does not damage your heath.” Some may think that this is a misleading statement since the question asked made no reference to Government advice and it is by no means certain that the 23 per cent – who, by implication, did not understand a perfectly simple statement – were not merely disagreeing with the premise on which it was based. Of course, the use of the word “sensible” weights the question. If one accepts that something is sensible, in the common meaning of the word, then how can it damage health?

In the second survey it is revealed that a “massive 91 per cent of the British public believe that a wider use of ID cards could help slash the scale of our underage drinking problem.” The problem here is that too many young people are not being challenged when they attempt to buy alcohol, as recent research shows (see page 15). Compulsory ID is said to be wanted by 83 per cent of those questioned, although the question did not define what was meant by this term.

The Portman Group’s assertion that there is a “dearth of evidence” linking alcohol to crime may well come as a surprise to the Government which has just launched its initiative against that very combination of cause and effect. The considerable body of evidence that exists indicates that, quite naturally, the public perception is sometimes inaccurate, as Miss Coussins implies. On the other hand, the underlying trend of the answers shows that the good common sense of the public tells them that there are considerable problems associated with alcohol use, as well as the pleasures on which the Portman Group prefers to dwell. It would be tragic if this kind of survey added to any false impression people had that the alcohol problem was confined to discreet groups: persistent drink-drivers, dependent drinkers, and especially the young.

Like a drink, sonny?

Buying alcohol is no great problem for underage drinkers and the threat of legal action does not seem to deter rogue vendors. Research published in the respected journal Addiction(1) further indicates that “Prove-It” identification cards are rarely asked for, most requests from underage purchasers being met unchallenged.

The study, carried out by psychologists from the universities of Wales Swansea, Leeds, and Reading, and with the assistance of the Thames Valley Police, had three aims: to find out how easily adolescents could buy alcohol; gather information of how vendors regarded sales to those who are legally underage; and to evaluate police intervention intended to reduce those sales. Thirteen and sixteen year-old boys and girls were recruited to try to buy different types of alcohol – alcopops, beer, cider, wine, and spirits – in a variety of retail outlets, such as off-licences, pubs, supermarkets, and corner shops. The children, who operated in pairs, were under the supervision of a researcher and usually a parent. The assessment took place in two phases, separated by a telephone survey of a sample of those vendors who had unwittingly been part of the experiment.

In the first phase, the vast majority of sixteen year-olds (88.1 per cent of girls and 77 per cent of boys) were successful in purchasing alcohol. The difference between the sexes was much more marked at thirteen years old. Here 41.6 per cent of girls managed to buy alcohol whilst only 4.1 per cent of the boys were successful. An interesting feature of the survey was that the figures were much the same irrespective of the nature of the outlet, location, and type of alcohol. A refusal to sell more often happened when another vendor was present.

Significantly, 80 per cent of purchases by sixteen year-olds and 65 per cent of sales to thirteen year-olds were made without any form of challenge. In addition, identity cards were demanded during fewer than 12 per cent of the purchase attempts by both age groups. In the telephone survey vendors claimed that they rarely encountered underage customers and that when they did they refused to sell. Ninety per cent of vendors said that if they became suspicious they asked for ID. Only two of the vendors surveyed envisaged any adverse consequences for themselves from selling alcohol to underage customers.

At one point in the survey there was a police intervention resulting in warning letters, visits to vendors, and the issuing of a small number of police cautions. In the words of the researchers: “The fact that the police intervention failed to decrease sales suggests that vendors do not change their behaviour in response to the threat of legal action.”

Clearly what most people have strongly suspected is in fact the case: sales of alcohol to children presents few problems. If you are sixteen, then the strong probability is that you will be served without any questions being asked. Even a substantial proportion of thirteen year-old girls are easily able to buy alcohol whether this is in a corner shop, an off-licence, or in a supermarket. It is important that the police take note that a low-key approach to vendors is virtually useless. If there is a serious intention to prevent underage children purchasing alcohol then more severe measures appear to be necessary.

(1) Alcohol Sales to underage adolescents: an unobtrusive field study and evaluation of police intervention, Paul Willner et al., Addiction, Volume 95, Number 9, September, 2000.

Griffith Edwards interviewed

Griffith Edwards is a world expert in alcohol and drug addiction. The founder of the National Addiction Centre, and adviser to governments throughout the world, from Bolivia to Russia by way of the White House, he is a medical scientist who has studied the problem for forty years. To mark the publication of his major new book, Alcohol: the ambiguous molecule, he is interviewed for Alert by the Institute of Alcohol Studies’s Andrew McNeill.

AM: May I ask you about the primary purpose of your new book? Who did you have in mind when you were writing it?

GE: I won’t say that it is for “the educated layman” because that is such a patronising phrase. I dislike segregating people into the intelligent elite and the rest. I suppose I wanted to see people on trains reading the book. But I have no ideas of revolutionising the world – an easy madness when you write a book. I wanted it to contribute to public debate and to encourage people to think about alcohol, not just about addiction. So it was a book to address and engage the public.

AM: At the end of the book you describe two possible futures for this country: the first is a ‘let it rip’, twenty-four hour a day drinking binge in which we all drink ourselves to death; the second is alcohol going somewhat out of fashion. You seem to think the second is more likely. Why?

GE: I think you need to look at historical processes and the ways in which certain reactions occur. There have been times, such as the present, when society’s use of alcohol has become damaging. For example, I tried to do some calculations on what it would have been like at the beginning of the 19th century at the time of the birth of the Temperance Movement and I am not surprised the Movement came into being. It is quite clear that in the 1700s and 1800’s the scenes of public drunkenness on the streets of this country were unimaginable. It was the appalling upswing in cancer deaths, sudden and tragic, which brought about the change in attitude towards tobacco. It took a long time for the reaction against tobacco, but it came. Today you can find mothers rising against heroin abuse on their council estates. Eventually the people may say enough. Of course, one can see that in certain Latin countries like France, drinking has declined. It is no longer cool to drink a lot of wine at lunchtime if you are a young French person. You will find that nowadays many French professional families have wine no more than once or twice a week.

We swim in the sea of public attitudes and I think that people have become more conscious of health. With that in mind, it is possible that our drinking behaviour will move towards a different pattern from the one we have seen in post war years. In some ways, these were years with a ‘let it rip’ attitude, although we never got back to the Georgian dining table where a gentleman slipped under the table towards the end of the evening. That sort of behaviour would not do one’s professional reputation any good today but it once was alright. Once it was perfectly acceptable for a judge or a doctor pass out drunk. So there are profound changes in fashion and I believe that fashions are to some extent affected by the slow infiltration of science. My book might make a microscopic contribution to that process. But changes in attitude must be supported by wise legislation. Legislation is educative. From the research angle, I think having 24 hour drinking is an interesting experiment. But, of course, it is also a very negative message educationally.

AM: Do you feel that there is a difficulty in getting the alcohol message across to the public in a positive rather than a negative way?

GE: Yes. It is easy to be accused of being a health fascist. I expect to take such statements with good will and a little laughter. I think I am trying to provide scientific information rather than reacting emotionally. But, of course, I am not merely a calculating machine. I have my own ethical values and I rejoice in our society, in its culture, and its civilisation. To me health is something to do with the health of all the people. I am not a doctor treating individuals only. Compassion for individuals is very important but not enough. You cannot individualise the whole thing. You can’t deal with smoking just by helping the next person in an anti-smoking clinic. You have got to be concerned with the entirety and that is as real to me as the health of the individual.

AM: We are at the moment awaiting the national Alcohol Strategy. There may be a call for more research. Can I put the point to you that we actually know enough already in order to put into place a strategy for reducing alcohol-related harm? Do you agree with that?

GE: Yes, I think I do. We have very good science in this arena and it has been revolutionised over the last thirty years. On the other hand, consider what happened with tobacco. Sir Richard Doll showed us the connection between cigarette smoking and cancer in the early 50’s. Some people said that it was unnecessary to do any further research: that the answer was simply to stop people smoking by raising the tax. But during the last fifty years there have been huge research advances in cigarette issues and I think it’s a good thing we didn’t shut down our research base when Sir Richard published his work. In our own field, we have enough research to get an Alcohol Strategy underway but I think there is far more needed to make it as effective and strong as possible.

AM: In relation to that, do you believe that there is a satisfactory mechanism in existence for feeding the findings of scientific research into the alcohol policy making process?

GE: In relation to alcohol, having looked at the situation in other countries, I think it is difficult to make a relationship between science and policy and scientists ought to be modest in their claims: politicians, after all, are there on the vote of the people. Alcohol policy has to be formed against a background of many political decisions and multiple considerations – including, of course, getting re-elected. I have never expected to do more than inform the government of my concerns. I won’t get angry if they don’t take my advice but I will come back to them and inform them, inform them and inform them again. At present I don’t think that there is a good mechanism for the voice of those working with alcohol issues to reach government. There is such a mechanism in relation to drugs. The Advisory Council on the Misuse of Drugs (ACMD) has extraordinarily independent responsibility. It isn’t a poodle of the government and it can set up working groups which examine all the evidence, prepare a scientifically thought out case, and report to ministers. What is more, there is a statutory responsibility of ministers to respond point by point to that report. They don’t have to swallow it whole but they do have to come back and say whether they like it or don’t like it and what they are going then to do.

AM: Would you like to see the same arrangement for alcohol?

GE: The temptation is to say that we should have exactly the same set-up for alcohol. I think the ACMD is a good model but I am not sure that it should be imitated in every detail. The ACMD puts the viewpoints of experts and practitioners in the field together with those of different government departments’: for instance, the Department of Trade and Industry, the Department for Education and Science, the Home Office; the Departments of Health and Social Security. There is no tension because we are all on one side serving our country as best we can. The difficulty on the alcohol front arises with the drinks industry. This is because a government with an Alcohol Policy may say that an important part of it must be considerations of profit or the protection of the Scotch whisky industry. They will say that there must be a balance between health issues and employment issues, or advertising revenue, or whatever. So the drinks industry has to be given a voice. I think that it would be difficult to get good policy advice in those circumstances. It would be better to say that alcohol policy advice was related to health and social welfare where I think that the drinks industry is not a legitimate actor. The industry has a legitimate role as a producer but I think that the issue becomes too broad if you put those interests in with the total package of policy concerns. I am not against the drinks industry but out of courtesy to them I would not want to put them into a forum where their presence is inappropriate.

AM: What sort of things would you like to be in a National Strategy? What do you think it should be aiming to do? Do you think it should be concentrating on controlling consumption or on changing the culture?

GE: Partly on dealing with individual problems as they come: the questions of public order, lager louts; the issue of drinking and the young; drunk driving. There is a very big issue of alcohol and crime. These need to be dealt with separately from the drinks industry which is necessarily compromised by a fundamental conflict of interests. The industry has produced a report saying that there is no relationship between drinking and crime. Of course, that is simply not true but commercial interests force them to say it. I would say to anyone advising the government that many individual issues need to be taken on the hoof. There is always then the question of putting individual issues within a larger frame so that you have a sense of background issues and foreground issues.

You ask whether one should control the drink supply and hope the rest will look after itself? Controlling the drink supply is important but there are plenty of other small things which are important too. I think it is easier to deal with problems which are of immediate social and political concern. When you get into very abstract debate you usually get lost and ministers don’t want to hear. I hope an alcohol policy forum will approach large and difficult questions such as the acceptable national level of drinking as well as the smaller ones but I think the important thing is to get it up and running and you make sure you have got around the table civil servants from every department. I think you then need some people who are front line actors such as probation officers, magistrates, and teachers. You don’t need it crowded with heavy scientists. You do need some people with academic research background. We need quick action. We would certainly need to tap expertise from other countries. I don’t believe that these issues can be dealt with by little England alone.

AM: In the last few years you have been very much involved in the relationships between science and policy making. Do you feel there is a tension between the role of scientist and the role of advocate? Or do you think the two things need each other?

GE: I don’t think there needs to be a strong line taken that scientists should keep clear of advocacy. Richard Doll never bothered about it but Charles Fletcher, another leading researcher, helped set up an activist organisation in ASH. I am willing to tell the truth as I see it but I am not willing to exaggerate or distort the truth, however good the cause. An honest activist doesn’t do that either but there are activist skills, which I don’t have. I want to keep my scientific credentials. On a good day I think I am a scientist, on another day I think I am a jobbing researcher. I don’t want to be swept into any sort of partisan position. I live in a world where other people are going out and doing things like defacing billboards. I would probably fall off the ladder. So I think that when advocacy uses science well and honestly you have very strong movements. For example, the relationship between health advocates and science is very strong in tobacco, it is quite strong in food. It is quite strong in poverty issues. Honesty in both scientists and advocates is vital. There is no need for trumpeting the latest exaggerated horror story or to claim to have all the answers when only one tenth of them are available. I want science to be used for the public good and I am happy sometimes to be a player in that endeavour provided that none of us accidentally compromises the integrity of science.

Alcohol – the ambiguous molecule

Griffith Edwards, Penguin. Reviewed by Chris Cook

Alcohol is a drug with a long social and cultural history. Too often, its properties as a drug are considered in isolation from this history – or else the history is studied without reference to pharmacology and biochemistry.

There are, of course, few experts who can claim to understand both the medical science, in its biological and social strands, and the social history of this fascinating molecule. Yet, the problems that we face in the UK and internationally, in respect of the use and misuse of beverage alcohol, cannot be understood properly unless we take into account both an historical and a scientific perspective on their causes and their consequences. Only an inclusive and multidisciplinary overview of this kind can do justice to the full complexity of our collective relationship with this “ambiguous molecule”. This book provides such an overview.

Griffith Edwards shows an unique familiarity with his subject across diverse areas of interest – including epidemiology, mythology, pathology, medical history, pharmacology, and psychology. He looks at heavy drinking and drunkenness, as well as the choices facing the social drinker. He considers social policy, and treatment of the individual. He does not over emphasise his own significant contributions to this field, but readers will find that they are succinctly and clearly outlined. For example, the alcohol dependence syndrome is described in such a way as to convey a vivid understanding of the day to day experiences of the dependent drinker. Here, as elsewhere, the use of brief case histories helps to bring to life the theoretical material.

The treatment of people with drinking problems is reviewed in such a way as to convey clinical wisdom and human insight, but also so as to inform the reader about important research findings. Especially interesting are the insights in respect of the history of research on the possibility of controlled drinking as a treatment goal for the dependent patient. The role of abstinence, the 12 step philosophy of Alcoholics Anonymous, and the place of the disease concept of alcoholism, are also sympathetically but critically reviewed. In a field where controversies continue to rage, we are warned of the need to steer a course between extreme and opposing views. But this is done without compromise, and it is not a naïve or superficial overview.

It is easy to take a polarised view of alcohol in more respects than merely that of treatment. Griffith Edwards avoids the pitfalls of either viewing alcohol as unmitigated evil, or being seduced by its benefits. This is therefore a very balanced book, and one which necessarily portrays clearly the ambiguities to which the title alludes. It is thus difficult not to be polarised in ones view of the book itself. There will be those who will be infuriated by its author’s failure to speak out in favour of the need for temperance and those who will be angry at its criticism of their actions in support of their product. There will be therapists who will disdain the failure to advocate only abstinence as a treatment goal, and those who will see it as insufficiently critical of the 12 step approach. Equally, this reviewer finds it hard not to be uncritically delighted with such a balanced and thoughtful book as this, which eschews simple answers or extreme positions. Doubtless it has its weaknesses, but I failed miserably in my attempt to find anything of note to say against it.

This book manages to convey information in such a way as to be accessible to the lay person, but also informative to the expert. It is highly interesting to read – even for someone who is already familiar with the field. It conveys a fundamental grasp of the issues and problems, and this is its greatest strength, but it also conveys a lot of factual information in the process and has an excellent bibliography. It is an important book for the individual who is concerned with their own drinking, or the drinking of a relative or friend, but it is also an important book for those concerned with the health, economy and security of communities.

Those who know Griffith Edwards personally will be aware that he searches and asks questions in a way which is both infectious and addictive. He does this supremely in his own field, which is the subject of this book, but he has not lost interest in exploring other fields as he encounters them along the way. Do not read this book unless you want to be infected with interest in this ambiguous molecule. Do read it if you want to be stimulated and drawn on in an addictive process of inquiry into one of the major public health issues of our time.

Chris Cook is Professor of the Psychiatry of Alcohol Misuse at the Kent Institute of Medicine & Health Science, University of Kent at Canterbury.

The Ambiguous Molecule is available from IAS at £7.99 not including p&p.

Amis père and Amis fils

In the second of two articles Andrew Varley looks at issues raised by Kingsley Amis’ letters and by his son, Martin’s, autobiography.

Kingsley Amis’ playing the part of old buffer in his club, damning the eyes of lefties, may have been less wholehearted and sustained than Evelyn Waugh’s furious squire, but it raises the question as to why people play rôles. It is reasonable to assume that they are looking for protection, possibly from the dangers of intimacy or emotional hurt. Waugh had been badly affected by the collapse of his first marriage after his wife ran off with another man. Although Amis’ part as boozy curmudgeon was already well-rehearsed by the time that Elizabeth Jane Howard left him, the experience was more painful than he had anticipated and led to new excesses of misogyny as in Stanley and the Women and Jake’s Thing. “Work’s the thing, of course. Yes, but that’s just what I can’t settle to,” he wrote. “Now whisky” Her first condition for returning to him was that he give up drink. It was unimaginable, as was the thought of any of his friends’ climbing on the wagon. Behind the chaff, his concern that Philip Larkin might not drink alcohol again is plain: “Are you still not drinking? What’s the matter with you?Why did you give it up? Come on, you can tell me. Come on.” Again and again, the alcoholic mocks anyone who gives up or moderates his drinking. This is, after all, a reproach. Just, as schoolchildren, we found it much more of an ordeal to stand in front of the Headmaster’s desk alone, so the drunk finds the downward slide eased by the knowledge that he is in similarly afflicted company. The fact that Larkin was a more moderate drinker than him1 was neither here nor there. The alcoholic believes what he wants to and quite often this includes delusions that those around him are putting away the stuff as quickly as he is.

Writers have their own theories about how fiction is, or should be, created. If they are any good, these are practical ideas arising from experience of what works and what does not. Despite the fact that he taught literature at a university, it is to Kingsley Amis’ credit that he did not believe in innovation for innovation’s sake. New ways of doing things are best developed to solve particular problems – and, after so long, the scope for effective, lucid innovation is strictly limited. Just as many architects, especially those we hear most about, have abandoned this sane approach to the development of their art, so novelists no longer believe that they are functioning properly if they are not inventing new ways of telling a story. The result is usually obscurity and pretentiousness.

Which brings us to Martin Amis. He approaches the subject of his father’s drinking entirely from the angle of its effect on Kingsley not on himself. The account is disjointed because that is the way Martin Amis has chosen to write this book, under the impression that memory is more honestly served by presenting it in imitation of the fragmented way it comes to mind. This is clearly nonsense. Each fragment of memory has undergone the literary process of transformation from its form when it first popped up in his consciousness into what eventually appeared on the page. And is memory so fragmented? If something comes to mind unbidden, it is not unusual to pursue it, rerun the events from the storeroom of unconscious and in the process create in the mind a coherent narrative, accurate or not as the case may be. With Martin Amis the result is that the style he has chosen is mannered and intensely irritating. He is interesting on the subject of Kingsley, however.

“Getting drunk: there was no doubt that that was always the quest. Being drunk had its points, but getting drunk was the good bit,” he writes about his father in Experience. “Kingsley has written often and poignantly about the moment when getting drunk suddenly turns into being drunk.” Again the anticipation and, of course, the ritual. Martin Amis, recalling his father’s elaborate cocktail making, describes his attitude to alcohol as “hobbyistic”. Many drunks like to surround what they do with a kind of religious mystery. With them it is in some ways like a dionysic rite, as though the process of getting drunk leads to enlightenment. Martin connives at this deception when he quotes the perceptive words of Anthony Powell2, who befriended Kingsley at the beginning of his career. “In vino veritas – I don’t know,” says Powell, “but in scribendo veritas – a certainty.”3 Martin Amis adds, “In vino and in scribendo alike, the conscious mind steps back and the unconscious mind steps forward.” Now this is to misunderstand what getting drunk is about, at least for the addict. It is not a liberation of the unconscious but an imprisonment of the conscious. Putting it another way, it is the conscious robbed of its context, a hopeless situation for a creative artist. It is a common piece of self-deception that intoxication in some ways aids the artistic process and it is understandable that Amis fils, a keen smoker of dope as a youth, goes along with it.

This kind of drunk – the mytholgiser, the ritualist, or whatever you choose to call him – seeks to elevate drinking to an art form. However hopeless his case may be, however obvious that the whole point is to get drunk, he will discuss vineyards and chateaux in mindnumbing (if inaccurate) detail or compare one single malt to another, Islay versus Speyside4. Kingsley Amis was not above honouring his favourite tipple by using it as an image to illumine a critical point. For example, in reviewing Larkin’s last book, High Windows, he says, “When everyone else has gone to bed, how many poets compete successfully with a new recording of the Tchaikovsky B flat minor5 as accompaniment to the final Scotch?” Naming a number of the poets he most admired, he continues, “The quality they share is immediacy, density, strength in a sense analogous to that in which the Scotch is strong.” Martin felt this comparison to be indecorous when it was written but later, he says, he came to accept it. He does not say why this was. Whatever his reason, the image comparing the strength of poetry to the strength of Scotch is telling but false. More than that, in using it Kingsley Amis inadvertently – or sub-consciously, if you prefer – draws attention to the tragedy of his own situation. He sees and recognises the strength of poetry which enriches and empowers but he chooses another sort of strength which diminishes and imprisons. It is the difference between the strength of a friend and the strength of any enemy.

At the end of the section he devotes to his father’s drinking, Martin Amis tells a sad story of accompanying him home after dinner. At the beginning of the meal he noticed the look on his father’s face which told him that he was about to pass on to the state of complete intoxication. Many of those who live with a drunk know the moment and the feeling of hopelessness which accompanies it. Martin sees that he must escort Kingsley home. On their way, they stand on a traffic island in the middle of the Edgware Road and Kingsley falls over. Not a trip, not a sudden tumble, but a comprehensive collapse which Martin Amis experiences as though it were happening in slow motion. It is an image of the total disintegration of an individual as much as a particular incident.

Alcoholics in treatment are often shown a film on the Alcoholic Family. This is one of those rough and ready concepts with which the recovery industry abounds. They may not mean much scientifically but they accord with many people’s experience. The star of the film – an American Catholic priest famous for the treatment centre he ran – suggests that the most common behaviour of the eldest son of an alcoholic is to strive to please his father or to outstrip him. He will be looking over his shoulder for approval and confirmation of his status. Martin Amis, in the days of his first success, appeared on some television book programme. One of the works under discussion was the actor David Niven’s memoirs, The Moon’s a Balloon. The author was present and, in his amiable and self-deprecating way, talked about the book. Amis said that he thought it was not a bad effort for someone who was not a professional author. At the time, the absurd condescension of the remark grated; now, it seems more like an attempt to establish his own position on the literary ladder.

Martin Amis suggests that Kingsley never gave him any encouragement to be a novelist – and quite right too, you might think – but that is not to say that he did not pick up the message during his childhood that professional writing was an admirable intellectual and artistic exercise. There is evident hurt when he records that his father rarely showed appreciation of his work and, from Kingsley’s comments, it is apparent that he had ambivalent feelings about it. In his turn Martin is clearly in two minds about his father’s drinking. It appears to the son to be such a part of the father than any separation seems impossible. This is to make the sub-conscious acceptance that alcohol made Kingsley Amis what he was. Perhaps that is going too far. It may be better to say that, by the time Martin came to perceive his father as an individual, something which all sons must eventually do, drink had so far exerted its power over Kingsley that it was difficult to know when he was talking and when it was. Literature might have been richer if he had done more and it less.