Daily Archives: 23/09/2014

Alcohol is by far the most dangerous ‘date rape drug’

This is taken from a really interesting blog article on The Guardian yesterday and you can read the full piece here.  The article was talking about some of the discussions surrounding products being developed to identify the presence of date rape drugs.  Because the liquid used to carry these drugs is invariably alcohol it then became a wider issue discussion:

Alcohol is such an integral part of our culture we frequently underestimate its potency. Among its toxic effects are memory impairment, which typically begins after just one or two drinks. Alcohol-induced blackouts are common among young, social drinkers. A study in 1999 found that 35% of trainees in a large paediatric residency programme in the US had experienced an alcohol-induced blackout. Another study in 1995 found a third of first–year medical students had experienced alcohol-induced amnesia. An investigation of 2,076 Finnish males found 35% had had at least one blackout in the previous 12 months.

Research suggests that alcohol-induced blackouts are even more common among university students. A 2002 study in the US surveyed 772 undergraduates asking them if they had ever awoken after a night of drinking unable to remember things that they did or places they had gone. Just over half of drinkers, 51%, reported blacking out and later learning that they had engaged in a range of activities they could not recall, including vandalism, unprotected sex and even driving.

Despite males in the survey drinking significantly more, men and women experienced an equal blackout rate, probably as a result of gender-specific differences in alcohol metabolism. Other investigations suggest that women may be more susceptible than men to milder forms of alcohol–induced memory impairments. In a subsequent study, 50 undergraduates who had experienced at least one blackout were interviewed. While the blackouts were deeply disconcerting to both men and women, women were far more likely (59%) to change their drinking habits after such an episode than men (25%).

While we may think we know our limits, alcohol metabolism is hugely variable and influenced by a range of factors, only some of which we control. Blood-alcohol content is strongly affected by the amount of food we have eaten prior to drinking, permeability of the gastric and intestinal tissues and body mass, among numerous other factors. Worse, alcohol reacts strongly with other drugs, particularly cannabis and benzodiazepines making blackouts far more likely. The latter is particularly problematic, as this drug type is the basis of many anti-anxiety and muscle-relaxant medication.

It is vital to remember that sexual activity with someone who cannot give informed consent is assault, regardless of the particular agent that rendered them incapacitated, and cannot be justified. Whether their becoming intoxicated is their own fault or someone else’s is irrelevant. The mentality that an inebriated victim is somehow “asking for it” should never be accepted.

While fears over exotic rape drugs might be unfounded, rape is all too common and alcohol frequently plays a role. Rather than fixating on unlikely scenarios of drink spiking, we might be better served by reexamining our collective relationship with alcohol and reinforcing the message that sex with someone incapable of giving consent is assault.

I wonder which one of the four key ‘benefits’ as identified within the Drinkaware drunken nights out report and described as  ‘escape’, ‘bonding and belonging’, ‘social adventures’ and ‘stories’ this would fit ……

Drunken Nights Out

Drinkaware have released a review on ‘Drunken nights out’, intending to inform possible future action the industry funded education charity could take.

I am going to share the email I received from Alcohol Policy UK which summarises this 290 report far better than I could so I am not going to re-invent the wheel.  However, what I will say is that this report makes me uncomfortable because of the language it uses.  Language is an important tool both to communicate a direct and indirect message and I find myself squirming at their indirect message.  What we need to remember first and foremost is that Drinkaware is the industries own mouth-piece and so we should approach their messages with caution as it is a double-edged sword.  Appearing to be helpful on the one hand but re-inforcing the message of it’s paymasters that alcohol is not only normal but also beneficial on the other hand.  This is divisive in my mind and does more harm than good.  What it does acknowledge though is the limited value of education as a tool to address behaviours and yet this is their chosen focus of activity.  Make of that what you will …….

The review attracted some headlines, largely relating to the finding that sexual harassment on nights out was common but often tolerated. Whilst much of the report describes what might be expected or previously identified in terms of attitudes and motivations towards what might more commonly be described as ‘binge drinking’, it offers a detailed exploration into these motives and other contributing factors.

The review drew on qualitative research including interviews and workshops with 80 drinkers aged 18 to 29, a review of literature, and interviews with key informants. By ‘drunken nights out’, the report refers to a package of behaviours, rejecting ‘binge drinking’ due to its inconsistent and often stereotyped use.

The full report and 20 page executive summary can be found here, press release here, and below we look at some of the key findings and implications.

Attitudes and motivations for ‘drunken nights out’

In the review, ‘drunken nights out’ were found to deliver clear recognised benefits to participants, something previously highlighted by research criticising over-simplified attempts to address such behaviours via messaging about risks. The report explores four key ‘benefits’ identified with drunken nights out under headings of ‘escape’, ‘bonding and belonging’, ‘social adventures’ and ‘stories’. It states there are few alternatives “which provide the same mix of benefits” and drinkers found hard to think of other things they could do.

Alcohol itself plays a crucial though not universal role in ‘drunken nights out’:

‘Alcoholic drinks are treated as ethanol-delivery mechanisms, with calculations of ‘units per pence’ and appropriate concentrations guiding choice of drink. People value the effects of alcohol, which they see as giving them the confidence and reduced self-consciousness needed to do things they would not normally do; take on their drunken night out identity; and access the benefits of a drunken night out.’

It states that “drunkenness is therefore prized, not only for its direct effects, but also because it is an entry ticket to the social permissions afforded by the drunken night out.” Furthermore, experiences of being sober in the night-time economy were experienced as “abnormal and uncomfortable”, and so “drunkenness is a required condition of participation in the drunken night out.”

Limits and attitudes to health

Such drinkers do express personal “limits” but not as a health consideration, rather than a point at which they do not intend to pass in terms of ability to control their behaviour. Reasons for doing so may include avoiding shame (beyond just embarrassment), but particularly for women, protecting themselves against vulnerability was valued. Groups played an important function in terms of perceived safety. However “as people become more drunk, they are less likely to regulate their consumption consciously, and more likely to respond to situational prompts to drink and conform to social norms.”

Longer-term risks “were discounted altogether”, in part as drinkers saw health problems associated with “alcoholics” or daily drinkers who overall were thought to drink more. Even where health harms were accepted, their young age and cutting back in the future were seen as reasons not to consider health risks.

Pre-drinking

In the review “pre-drinking” (or pre-loading) is considered “part of the overall package” of behaviours, and drinking games were common. Although the review, and Drinkaware in general, are not involved in pricing debates, it recognises “the opportunity to get drunk for less money does play a role”. However it also suggests there is evidence that pre-drinkers may drink as much when out as those who have not pre-drunk.

Risks and Risk Management

Two key serious risk were identified in the review:

  • There is a significant problem of violence associated with drunken nights out, skewed towards more serious incidents such as wounding. Many of our participants had witnessed or been victims of violence on a drunken night out.
  • There is an association between alcohol consumption and sexual assault. Responses from our participants suggested that molestation and groping are common experiences as part of a drunken night out.

A strategic framework for Drinkaware

The review was conducted to inform potential activities Drinkaware could take, but acknowledges the limited impact of educational approaches, as many public health roles are keen to highlight:

‘There is a substantial body of evidence that education and communications are best deployed as part of a wider package of behaviour change interventions – and that, by themselves, they are unlikely to achieve changes in behaviour. Education and communication interventions by Drinkaware need to be developed alongside efforts by other partners using other approaches. In particular, efforts to change the norms that shape drunken nights out will require co-ordination of multiple agents, covering both the delivery of messages to support new norms, and the elimination of messages which, intentionally or unintentionally, sustain and strengthen existing norms associated with increased harm.’

The review identifies four ‘strategic territories’ for possible education and communications interventions: ‘boundaries’; ‘conscience’; ‘consequences’ and ‘vulnerabilty’. Within each of these, it suggests potential avenues for activities to help address some of the motivations and attitudes that may lead to ‘drunken nights out’ and its associated problems.

As explored previously, Drinkaware has some way to go to convince many in the public health community it has a valuable role to play in reducing alcohol harms. To what extent this work may help with that will remain to be seen. Regardless, Drinkaware remain the key player when it comes to ability to deliver messages to drinkers – whatever the effect may be.