Australia’s hate-love relationship with alcohol

In the 2015 Foundation for Alcohol Research and Education (FARE) Annual Alcohol Poll, 34 per cent of Australians said that they drink to get drunk, 43 per cent said they had vomited as a result of drinking, and 75 per cent said Australia has a problem with excess drinking or alcohol abuse.

But in the same poll 92 per cent of Australians identified themselves as responsible drinkers.

As the young people might say, what the..?

A majority of Australians agree that we have a problem with alcohol. But almost all drinkers say it’s not a problem of theirs – it’s a problem other people have, that exists somewhere outside of their world.

There are both contradictions and abstractions in this discussion. But it makes perfect sense to me.

It’s simply easier to say that others are flawed, than admit that perhaps you might be the one who is flawed. Psychologists refer to it as the self-serving or positivity bias, and it’s the only way to protect our “fragile ego from the blows of reality” and to reconcile our often contradictory behaviour in a complex world.

To think our own behaviour is irresponsible requires us to actually admit that we might be a failure, or that we are out of control. And this would be a serious attack on our ego.

So we seek out evidence, in all its flimsy forms, that confirms how we would like to see ourselves and then interpret a question in the way that suits that approach.

Abstract language

But there are also problems in the way we use language to talk about the issue.

Terminology, such as “Drinking Responsibly”, “Wisely” or “Properly” is abstract at best, and diverting at worst.

What exactly is a responsible drinker? If I drink two or three glasses of wine at dinner during the week am I “Drinking Wise”? What about two beers after work on Friday, plus a cocktail at the Comedy Festival for a bit of treat?

And then the inevitable question: am I okay to admit that I might be an irresponsible drinker (whatever that means)? Irresponsible sounds pretty bad, doesn’t it?

And accusing someone else of being irresponsible because they were having “a couple of beers with their mates” or a few glasses of wine after a hard day at work would likely result in cries of being a wowser, “unAustralian”, “politically correct” or some other cliché that is rolled out whenever someone challenges the status quo.

The problem is that alcohol is such an integral part of most adult (and adolescent) life in Australia that it has become a social, and some would say structural, norm.  It requires significant psychological resources to challenge the status quo.

Think about it. When you refuse alcohol at social events, it is often followed by a “why?”, an assumption that you are pregnant or on some “health” regime, or participating in a fundraising abstinence month that the questioner wasn’t aware of.

The fact is that it is actually easier to be a drinker, than to not be a drinker.

And the messaging around drinking swings between broad and general to complex and overly detailed. There seems to be no middle-ground.

Diverting the problem

The use of imprecise language, rather than specific, measurable metrics, makes it difficult for anyone to judge their behaviour in comparison to others. By telling people to behave “responsibly”, we create a sense that something is being done. But at an individual level, it is up to us to decide what it actually means.

This “hands-off” approach to public health issues is common across a range of contexts. People are expected to assume total responsibility for managing their own well-being.

Industry and conservative legislators and commentators, as part of the structure, consistently highlight the role of the individual and personal responsibility in a range of public health contexts, including alcohol consumption. This particular approach also serves to implicitly absolve both policymakers and the industry from responsibility for the harms caused by these activities.

It’s a common technique in many sectors where a risk has been identified, but governments are uncomfortable about regulation, and vested interests believe that even if they admit that there might be a problem, it could jeopardise the status quo.

By emphasising threats to personal freedom and liberty, opponents to state-based interventions on public health grounds establish an argument that, at face value, sounds plausible.

Industry and conservative stakeholders use the term “nanny-state”, for example, to discredit any opposition and deride government public health interventions, despite the fact that traditionally nannies are people who are credited with being caring, considerate people, who have the best interests of their charges at heart.

So, they do something that looks like they are doing something. It’s a kind of “regulatory theatre”. It looks pretty good, with everyone playing their parts, but in reality at the end of it, we can all go back to our normal lives.

People not qualified to make judgments about human behaviour, work together to come up with simple interventions such as “Drink Responsibly” or “Drink Wise” labeling, along with industry codes of conduct. These campaigns work to some degree by gently modifying social norms, but their impact is minimal.

If the evidence tells us that Australians want change to our drinking culture, then I would argue that it’s time to use evidence to help us to make it.

That said, public health practitioners are often their own worst enemies. Because of their desire to be in a position to defend their approach and be seen to be responsible (there’s that word again), sometimes they over-complicate or provide too much advice, get caught up in statistics, or approach the message in an overly rational way.

It’s a practice founded in an epidemiological model, rather than a human behaviour model.

Marketing the message

In any marketing campaign, whether you are trying to get people to “buy” your product (and in this context, the product would be to reduce drinking) or maintain loyalty (continue to drink less or not at all), programs need to communicate to the target market in a way that is, direct, accessible, personal and incremental.

So, instead of generic, unclear language such as “responsible”, “wise” or “proper”, we should be helping the different markets and vulnerable segments understand what actually is wise, proper or responsible. How many drinks are safe? What actually constitutes a standard drink, in comparison to what we are actually served?

But, we also need to be careful not to get into the complexity of weight, height, alcohol content, sex, and so on, which will simply confuse the campaign. Marketers of commercial products recognise that they have to gently, incrementally, move their customers towards a place where the only sensible option is to buy the product: in this case, a reduction in the consumption of alcohol.

Simply running an advertisement telling people to stop doing something because it’s bad for them, or because their friends will reject them, is not the way to change behaviour.

Don’t get me wrong, awareness campaigns are a start. However, behavioural change requires significant resources, repetition, modelling, and support from range of individuals, institutions, leaders, and infrastructure for them to be successful.

You also need to build a support network around the target market, that makes it easy for them to adopt the new behaviour, and more difficult for them to “defect” or return to their old habits.

The only way forward is to recognise that there are a range of parties who must be involved in addressing the problem. I refer to it as the four pillars of responsibility:  the individual, family and friends, government and institutions, and the alcohol industry.

Of course the individual has to have responsibility for their behaviour.

But we need to have a realistic understanding of how choice is undertaken, how implicit attitudes and the effect of other people and institutions influence our choices, support from a range of stakeholders, and clear information to help guide our own behaviour.

Beyond the individual

Family, friends, authority figures and leaders, governments and the alcohol industry all have a role to play in changing behaviour around alcohol. It’s not one individual, it is a shift in the way we recognise our responsibilities.

Family and friends play a significant role in determining the types of behaviours seen as norms. They model both positive and negative behaviours, and provide support – whether psychological, social, financial or structural – for the behaviours of those in their networks. Pretty much from birth children look to parents to see what is an appropriate way to behave, and as they grow older they look to friends and aspirational groups to make their way in the world.

Government and institutions have a role to play through legislation, policy, processes, and symbolism. The fact that former NSW Premier, Barry O’Farrell, introduced and implemented a range of laws in Sydney, including a lockout to new customers from 1:30am and a cessation of alcohol trading by 3am, along with minimum sentences for drug and alcohol fuelled offences, sent a message that this behaviour was no longer a remote problem and that the state would no longer tolerate it. It was a combination of the enactment of laws that served as a deterrent, but also the symbolism of the leader of the state pushing so hard to change behaviour in what he said, and what he did.

Government also has a role in using other means, such as taxes, to make it easier for people to not choose alcohol. This requires significant effort to understand what motivates people to buy alcohol, and find ways to replace what they are seeking. This can’t be addressed solely with a single taxation change to just one product, such as alcopops.

Government can provide support to institutions who work with people who want to reduce alcohol intake and support those who don’t wish to drink alcohol.

Institutions, including workplaces, educational providers and non-profit organisations, and their leaders play a significant role in developing and maintaining policies and processes that support appropriate behaviour.

And, finally, the alcohol industry has to take the problem seriously, and recognise that the product they manufacture and sell is part of the problem. The industry and its lobby groups should recognise that they are beneficiaries of a society that allows consumption of their product and therefore have a role to play in addressing associated problems.

The alcohol industry also needs to follow the lead of other industries, such as essential services, that have recognised that they have a responsibility toward vulnerable consumers, and seek to play a constructive and mature role in addressing the complexity of the problem. Sadly, some in the alcohol industry continue to deny the evidence and engage in ad hominem arguments against the work of the public health sector, which is embarrassing for those willing to be part of the solution and behind public opinion in so many ways.

Despite some positive evidence from the ABS that, on average, all Australians (including those who do and do not drink) appear to be consuming less alcohol now that any time in the last fifty years, alcohol continues to kill 15 Australians every day and is estimated to be involved in up to half of partner violence in Australia.

The evidence is clear. While the issue is gaining traction, we have to keep raising the issue in the public arena, debating it, and using evidence across a range of fields from public health to psychology to systems theory and even political theory to develop ways to make our country a safer and healthier place for everyone.

An edited extract of this post appeared in The Conversation as “My problem with your drinking: Australia’s hate-love relationship with alcohol”.